摘要
目的城市急诊科拥挤现象日益加剧，但相关研究受到方法学的制约，本研究旨在探寻新的拥挤度评价系统或方法，并进行有效性验证。方法通过建立导致急诊科拥挤的入口、过程、出口3个环节的相关变量库，筛选其中有效变量，编制多维急诊科拥挤评分量表（MEDOS），再进一步与视觉模拟评分法（VAS）和改良国家急诊科拥挤度评分（NEDOCSBJ）进行一致性检验。结果为期6个月研究，共552个拥挤度测量点。以医生和护士VAS均值（VAS—m）作为结局变量，急诊在床治疗患者数／急诊额定床位数（Pbed／B1）、生命支持设备数（X。）、最近一个看医师患者候诊时间（wtime）和流出道梗阻率（ABI）作为自变量，进行多元线性回归分析，得到改良NEDOCS模型（NEDOCSBI）：NEDOCSBJ=83．563×（Pbed／B1）＋7．201×（Xn）＋0．116×Wtime＋0．302×ABI＋2．835。MEDOS均值（n=552）为25．4±5．8；MEDOS与VAS—m、NEDOCSBi显著性相关，r分别为0．664和0．939，P均〈0．001。NEDOCSB1与MEDOS间，组内相关分析（ICC）和Bland—Ahman图显示两者有较好的一致性，两者差值均值为11．96分，可能存在系统性误差，从临床专业角度来看其95％一致性界限（-6．74～30．66，〈40分）和差值均值（11．96分）尚可接受。结论NEDOCSBJ模型对急诊科拥挤度评估和研究具有重要潜在价值，但因其受到自变量易获得性等诸多因素制约，不利于在国内广泛应用；而MEDOS因其直观量化、可即时评估、采集信息点多（均衡性好）等优点，且NEDOCSBJ与具有较好的一致性，在急诊临床管理学研究中具有良好的应用前景。
Objective To establish a practicable and balanced emergency department overcrowding （EDO） assessment system suitable for domestic application in Chinese ED setting. Methods The factors that might affect EDO were evaluated by multiple linear regression analysis. The National Emergency Department Overcrowding Scale （NEDOCS） was modified （ NEDOCSBJ ） . The database of factors which might affect EDO was founded and the Multidimensional ED Overcrowding Scale （MEDOS） items, including 9 objective and 3 subjective were screened. Simultaneously, the EDO assessment data pairs were collected three times a day （1 ： 00, 9： 00, 17： 00） for a period of 6 months. Consistency among the Visual Analogue Scale （VAS）, NEDOCSBj and MEDOS were checked by Bland-Ahmann plot. Results The multiple linear regression was made with VAS （ average value of VAS-physician and VAS-nurse） as outcome variable, Pbed/Bt, X, Wtime and ABI as independent variable. The modified NEDOCS （NEDOCSBj） model was established ： NEDOCSBj=83.563× （Pbed/Bt） ＋ 7.201X （X,） ＋ 0.116xWtime＋ 0.302xABI ＋ 2. 835. It was shown that the average value of MEDOS was 25.4 ± 5.8 （n =552, 5-39） . The correlation analysis showed that MEDOS correlates with VAS （ r = 0. 664, P 〈 0.01 ） and NEDOCSBj （ r = 0. 939, P 〈 0. 01 ） significantly. Intra-class correlation coefficients （ICC） between NEDOCSBJ and MEDOS, as well as Bland-Altman plot （ 95 % limits of agreement ： - 6. 74, 30. 66 ） , was fairly acceptable, which meant the consistency between the two methods. Conclusions It seems that modified NEDOCS （NEDOCSBj） model has potential value for EDO evaluation, yet it is less practical in emergency environment sinee it is difficulties to obtain the primary data, whieh need advanced patient information traek system. MEDOS seems to a promising EDO evaluation method not only because it is intuitive, ready to evaluate, but also because of the availability and good proportionality and balance of the data.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第6期806-813,共8页
Chinese Journal of Emergency Medicine
