[论文解读] Use of Emergency Departments by Frail Elderly Patients: Temporal Patterns and Case Complexity

Jens Rauch, Mathias Denter+1 more|PubMed|Jun 13, 2019

Emergency and Acute Care Studies参考文献 18被引用 5

一句话总结

本研究利用德国城市急诊科的电子健康记录（EHR）数据，分析了衰弱老年患者的时间模式与病例复杂性。研究发现，衰弱患者在高峰时段（中午和下午）就诊最为频繁，且病例复杂性显著更高，尤其体现在住院率和留观时间方面；然而，复杂性的时间变化较小，表明需在最繁忙时段实施针对衰弱患者的人员配置。

ABSTRACT

Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients' case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.

研究动机与目标

• 识别衰弱老年患者在急诊科（ED）就诊的时间模式。
• 比较衰弱与非衰弱老年患者之间的病例复杂性。
• 评估衰弱患者病例复杂性是否随一天中不同时段而变化，特别是与常规全科医生（GP）工作时间相比。
• 通过识别衰弱老年人高需求时段，为医院人员配置策略提供依据。
• 利用EHR数据实现急诊科精准、时间分辨率的资源规划。

提出的方法

• 采用泊松时间序列回归模型，对一周内衰弱与非衰弱患者每小时的就诊率进行建模。
• 来自一家德国城市教学医院的电子健康记录（EHR）数据提供了就诊时间与临床变量。
• 病例复杂性通过分诊等级、急诊科留观时间（LOS）、住院率及共病负担进行衡量。
• 在包括常规全科医生工作时间在内的不同时间段内，比较衰弱与非衰弱患者的就诊模式。
• 统计建模使我们能够检测出患者数量与复杂性的时间趋势。
• 分析聚焦于详细每小时模式，而非粗略时间区间，从而更精确地识别需求高峰时段。

实验结果

研究问题

• RQ1 衰弱老年患者一天中何时最常前往急诊科就诊？
• RQ2 与非衰弱老年患者相比，衰弱老年患者的临床复杂性如何？
• RQ3 衰弱老年患者的病例复杂性在一天中不同时间段是否存在显著差异？
• RQ4 是否存在特定时间段——尤其是常规全科医生工作时间之外——衰弱患者的复杂性明显更高？
• RQ5 EHR数据能否用于预测衰弱老年患者高需求时段，以指导人员配置决策？

主要发现

• 衰弱老年患者在中午和下午时段更可能前往急诊科就诊，而这些时段本已是高流量时段。
• 衰弱患者的就诊率在最繁忙时段达到最高，表明高危病例在运营高峰时段高度集中。
• 与非衰弱患者相比，衰弱患者病例复杂性显著更高，住院率明显上升，急诊科留观时间也更长。
• 复杂性的时间变化较小，各时段之间仅在分诊等级和急诊科留观时间上存在微小差异。
• 本研究未发现衰弱患者病例复杂性在常规全科医生工作时间之外显著增加的有力证据。
• 这些发现表明，应优先在最繁忙时段实施针对衰弱患者的急诊护理策略，以改善医疗协调与资源分配。