摘要
目的探讨急诊科拥挤对预检分诊的影响.方法回顾性分析该院急诊科2017年1月~2017年6月就诊的126078例患者相关资料,根据急诊床位占有率分为拥挤组和非拥挤组,比较两组患者流行病学资料、等待分诊患者人数、等待分诊时间、急诊停留时间(LOS)、分诊延迟率、漏检率、危重患者漏检率及危重患者过检率、病情级别、护士分诊工作年限和分诊流向等,通过线性回归和Logstic回归分析患者等待分诊时间、LOS及患者分流至门诊的影响因素.结果拥挤组分诊延迟率、漏检率、危重患者漏检率均明显高于非拥挤组,差异均有统计学意义(均P<0.01),分诊准确率、危重患者过检率差异无统计学意义;等候分诊时间与等候分诊人数、分诊护士工作年限显著相正关(P<0.01),LOS与等候分诊人数显著正相关(P<0.001),与分诊护士分诊工作年限量负相关(P<0.001),两者与患者年龄、病情级别及性别无关;分诊护士工作年限及低年龄组患者是被分流至门诊的影响因素(P<0.001),等候分诊人数、患者性别则不是影响因素.结论急诊科拥挤对预检分诊造成许多不利影响,导致等候分诊时间和LOS的延长,增加危重患者漏检率,不利于患者安全,给医疗护理带来隐患,应高度重视,改善其对分诊的负面作用.
Objective To explore the influence of crowding in emergency department on precheck triage.Methods Data of 126078 patients admitted to the emergency department of the hospital from January 2017 to June 2017 were retrospectively analyzed.According to the occupancy rate of emergency beds,the patients were divided into crowded group and non-crowded group.The epidemiological data,number of patients waiting for triage,waiting time for triage,length of stay(LOS),delayed triage rate,missed triage rate,missed triage rate of critically ill patients,over triage rate of critically ill patients,disease level,years of service in triage of nurses and the flow of triage were compared between the two groups.Linear regression and Logstic regression were used to analyze patient wait triage,LOS,and factors influencing patient diversion to the clinic.Results The delayed rate of triage,missed rate and missed rate of critical patients in the crowded group were significantly higher than those in the non-crowded group,with statistically significant differences(P<0.01).There was no statistically significant difference in triage accuracy and overtest rate among critically ill patients.Waiting time for triage was significantly coiTelated with the number of waiting patients and the length of service of triage nurses(P<0.01).LOS was significantly positively correlated with the number of patients waiting for triage(P<0.001),and was negatively correlated with the triage nurse triage work year limit(P<0.001).They have nothing to do with the patient's age,disease level and gender.The working years of the triage nurse and the patients in the low age group were the influencing factors for the diversion to the outpatient service(P<0.001).The number of patients waiting for triage and gender were not the influencing factors.Conclusions Crowding in the emergency department causes many adverse effects on pre-diagnosis triage,leading to the extension of waiting time for triage and LOS,increasing the rate of missed tests in critically ill patients,which is not conducive to patient safety and brings hidden dangers to medical care.Therefore,it should be attached great importance to improve its negative effect on triage.
作者
许士海
王进
史菲
单爱军
谢曼英
Xu Shihai;Wang Jin;Shi Fei;Shan Aijun;Xie Manying(Emergency Department,Shenzhen People's Hospital of Guangdong Province,Shenzhen 518200,China)
出处
《国际护理学杂志》
2019年第21期3505-3511,共7页
international journal of nursing
关键词
急诊科拥挤
预检分诊
漏检率
分诊准确率
Emergency department crowding
Pre-diagnosis triage
Missed rate
Triage accuracy
