急诊科患者入院的危险因素:从分诊到入院。

IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE
Jemima Koh, Oh Hong Choon, Seah Zeyen, Steven Lim
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引用次数: 0

摘要

简介:医疗保健系统通常提供多种渠道获得急性住院治疗,急诊科(ED)是主要的访问途径。急诊科面临多方面的需求和供应挑战,涉及资源分配和病人流动。在这项研究中,我们的目的是确定与新加坡三级医院急诊科患者入院相关的因素。方法:对2019年1月1日至12月31日期间新加坡急诊科所有符合条件的就诊进行回顾性队列研究,采用多变量、混合效应logistic回归模型研究与住院相关的因素。该模型考虑了患者的人口统计学特征;分类类别;到达模式;推荐来源;急诊科探访时间;出院诊断;和ED的入住率。结果:2019年,急诊科有141719次就诊,其中42238次(29.8%)住院。与住院率增加相关的因素包括年龄增加、男性、种族(马来人与华人)、患者敏度度更高、非自我转诊患者(与自我转诊患者)、患者由救护车运送(与上门)和疾病类别。我们的模型显示,住院患者入院的最高几率归因于患者的视力(最高与最低视力:比值比[OR] 326, 95%可信区间[CI] 292-363),其次是患者的年龄(70岁及以上vs 30岁及以下:OR 13.8, 95% CI 12.8-14.8)。所有其他显著增加录取几率的因素的or值都不大,在1.12-4.18之间。尽管在病人处置决定的时间、就诊时间和就诊月份的急诊科占用率与住院率显著相关,但在这些因素的可能值范围内,住院率的变化是微乎其微的。结论:我们的研究揭示了与住院率显著相关的几个因素,其中患者的视力和年龄是最重要的因素。此外,急诊医生接纳病人的决定在临床上是一致的,只受ED拥挤程度的轻微影响。这些发现为后续研究提供了宝贵的见解,对于制定新的政策或设计新的干预措施,以加强当前的预防性健康或医疗保健提供系统,以减少急诊科患者住院床位需求的增长,将是至关重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk Factors for Hospital Admissions Among Emergency Department Patients: From Triage to Admission.

Introduction: Healthcare systems typically provide multiple channels to access acute inpatient care, with the emergency department (ED) as the main route of access. The ED faces multifaceted demand and supply challenges, which implicate resource allocation and patient flow. In this study we aimed to identify factors associated with hospital admissions among ED patients in a Singapore tertiary-care hospital.

Methods: Using a retrospective cohort study of all eligible visits to a Singapore ED between January 1-December 31, 2019, we conducted a multivariable, mixed-effect logistic regression model to study the factors associated with hospital admissions. The model accounted for patients' demographics; triage category; arrival mode; referral source; time of ED visit; discharge diagnosis; and ED occupancy levels.

Results: In 2019, there were 141,719 visits to the ED, with 42,238 (29.8%) of these visits resulting in hospital admissions. Factors associated with increased odds of hospital admissions included increasing age, being male, ethnicity (Malay vs Chinese), higher patient acuity, non-self-referred patients (vs self-referred), patient being conveyed by ambulances (vs walk-in), and category of disease. Our model demonstrated that the highest odds of inpatient admissions were attributed to the patient's acuity (highest vs lowest acuity: odds ratio [OR] 326, 95% confidence interval [CI] 292-363), followed by patients' age (70 and above vs 30 and below: OR 13.8, 95% CI 12.8-14.8). The ORs for all other factors with significantly increased odds of admissions were modest, ranging from 1.12-4.18. Although the ED occupancy levels at the hour of the patient's disposition decision, the hour of the ED visit, and the month of the ED visit were significantly associated with hospital admissions, changes in the probabilities of hospital admissions across the possible range of values of these factors were marginal.

Conclusion: Our study revealed several factors significantly associated with hospital admissions, with patient acuity and age as the most important factors. Moreover, emergency physicians' decisions to admit patients were clinically consistent and only marginally influenced by the degree of ED crowding. These findings offer invaluable insights into follow-up studies that will be crucial in shaping new policies or designing new interventions to enhance current preventive health or healthcare delivery systems to curtail the growth in inpatient-bed demand among ED patients over time.

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来源期刊
Western Journal of Emergency Medicine
Western Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
5.30
自引率
3.20%
发文量
125
审稿时长
16 weeks
期刊介绍: WestJEM focuses on how the systems and delivery of emergency care affects health, health disparities, and health outcomes in communities and populations worldwide, including the impact of social conditions on the composition of patients seeking care in emergency departments.
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