IR@PKUHSC  > 北京大学第九临床医学院
学科主题临床医学
CAUSES OF EMERGENCY DEPARTMENT OVERCROWDING AND BLOCKAGE OF ACCESS TO CRITICAL SERVICES IN BEIJING: A 2-YEAR STUDY
Wang, Zhen1,2; Xiong, Xiaying1,2; Wang, Shuang1,2; Yan, Junguo1,2; Springer, Martin3; Dellinger, R. P.4
通讯作者Wang, Zhen(1,2)
关键词emergency department overcrowding observation emergency department-boarded patients
刊名JOURNAL OF EMERGENCY MEDICINE
2018-05-01
DOI10.1016/j.jemermed.2018.02.009
54期:5页:665-673
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Emergency Medicine
研究领域[WOS]Emergency Medicine
关键词[WOS]CHINA ; MEDICINE ; FUTURE
英文摘要

Background: Emergency department (ED) overcrowding is a serious issue worldwide. Objectives: This study was done to evaluate the degree of overcrowding in local "teaching hospitals′′ in Beijing, and to ascertain the apparent root causes for the pervasive degree of overcrowding in these EDs. Methods: This is amulticenter cross-sectional study. The studied population included all ED patients from 18 metropolitan teaching hospital EDs in Beijing for calendar years 2013 and 2014. Patient characteristics, and the primary reasons that these patients sought care in these EDs, are described. Results: The total numbers of annual emergency visits were 1,554,387 and 1,615,571 in 2013 and 2014, respectively. High acuity cases accounted for 4.6% and 5.5% of the total annual emergency visits in 2013 and 2014, respectively. The percentage of patients placed into "Observation′′ beds, which were created to accommodate patients deemed to have problems too complex to be treated in an inpatient bed, or to accommodate patients simply needing chronic care, was 11.9% and 13.1% in 2013 and 2014, respectively. The ED-boarded patients accounted for 2.71% and 2.6% of the total annual emergency visits in 2013 and 2014, respectively. The average waiting time to admit the ED-boarded patients was 37.1 h and 36.2 h in 2013 and 2014, respectively. Respiratory symptoms were the most common presenting complaints, and an upper respiratory infection was the most common ED diagnosis. Patients who had pneumonia or various manifestations of end-stage diseases, such as advanced dementia or multiple organ dysfunction, were the most common characteristics of patients who had stays in "Observation′′ units. Conclusions: One principal reason for ED crowding in Beijing lies in the large numbers of patients who persist in the expectation of receiving ongoing care in the ED for minor illnesses. However, as is true in many nations, one of the other most important root causes of ED crowding is "access block,′′ the inability to promptly move patients deemed by emergency physicians to need inpatient care to an inpatient bed for that care. However, in our system, another challenge, not widely described as a contributor to crowding in other nations, is that doctors assigned to inpatient services have been empowered to refuse to admit patients perceived to have overly "complex′′ needs. Further, patients with multisystem illnesses or end-stage status, who need ongoing chronic care to manage activities of daily living, have begun to populate Beijing EDs in increasing numbers. This is an issue with various root causes. (C) 2018 Elsevier Inc. All rights reserved.

语种英语
WOS记录号WOS:000432484600019
通讯作者邮箱eyjdb6380@163.com
ISSN0736-4679
引用统计
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/141841
专题北京大学第九临床医学院
北京大学第一临床医学院_儿科
作者单位1.Beijing Capital Univ, Beijing Shijitan Hosp, Beijing, Peoples R China;
2.Peking Univ, Clin Med Coll 9, Dept Emergency Med, Beijing, Peoples R China;
3.Beijing United Family Healthcare, Dept Emergency Med, Beijing, Peoples R China;
4.Univ Med & Dent New Jersey, Cooper Univ Hosp, Robert Wood Johnson Sch Med, Dept Crit Care Med, Camden, NJ USA
推荐引用方式
GB/T 7714
Wang, Zhen,Xiong, Xiaying,Wang, Shuang,et al. CAUSES OF EMERGENCY DEPARTMENT OVERCROWDING AND BLOCKAGE OF ACCESS TO CRITICAL SERVICES IN BEIJING: A 2-YEAR STUDY[J]. JOURNAL OF EMERGENCY MEDICINE,2018,54(5):665-673.
APA Wang, Zhen,Xiong, Xiaying,Wang, Shuang,Yan, Junguo,Springer, Martin,&Dellinger, R. P..(2018).CAUSES OF EMERGENCY DEPARTMENT OVERCROWDING AND BLOCKAGE OF ACCESS TO CRITICAL SERVICES IN BEIJING: A 2-YEAR STUDY.JOURNAL OF EMERGENCY MEDICINE,54(5),665-673.
MLA Wang, Zhen,et al."CAUSES OF EMERGENCY DEPARTMENT OVERCROWDING AND BLOCKAGE OF ACCESS TO CRITICAL SERVICES IN BEIJING: A 2-YEAR STUDY".JOURNAL OF EMERGENCY MEDICINE 54.5(2018):665-673.
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