摘要目的 通过分析急诊过度拥挤的现状及原因,提出有效的缓解策略.方法 利用"入口-过程-出口"模型,采用鱼骨图分析法,详细分析产生急诊过度拥挤的因素,并进行医院、科室、个人三方面的立体干预.结果 急诊滞留>48 h的患者比例从干预前11.9％(15225/127941)下降到干预后的5.3％(7245/136698);抢救室滞留>6 h的患者比例从干预前54.6％(3016/5526)下降到干预后的17.9％(987/5526),差异均具有统计学意义(χ2=3705.04、1186.32,P<0.01);干预前9:00、13:00、21:00、1:00时间点的国家急诊科拥挤度评分表(NEDOCS)指数分别为234.22±62.31、253.55±59.26、303.73±160.24、187.36±25.73;干预后这4个时间点的拥挤度明显缓解,NEDOCS指数分别为193.09±31.87、187.09±22.65、187.36±25.73、154.03±21.56;干预前后2数据比较差异均有统计学意义(t=2.35～4.32,均P<0.05).结论 研究和探讨急诊过度拥挤发生的原因,经过改善环境、优化流程、加强急诊医护人员培训和管理、提高医院辅助支持系统的服务水平等综合措施的积极干预,可有效缓解急诊过度拥挤的发生.

abstractsObjective To investigate the present situation and reasons of emergency department overcrowding, and put forward effective mitigation strategy. Methods By using "input-throughput-output"model and choosing the method of fishbone diagram analysis, detaily analysis factors of emergency department overcrowding, then implement three- dimensional intervention in hospital, department, personal. Results Patients who stay>48 h in the emergency department(ED) decreased from 11.9％(15225/127941) to 5.3％(7245/136698); patients who stay > 6 h in the Frist Aid Room of ED decreased from 54.6％(3016/5526)to 17.8％(987/5526), both have statistically significant (χ2=3705.04, χ2=1186.32, P<0.01);before the intervention the National ED Overcrowding Study (NEDOCS) index at 0900, 1300, 2100, 0100 was 234.22 ± 62.31, 253.55 ± 59.26, 303.73 ± 160.24, 187.36 ± 25.73; after the intervention the degree of crowdedness of ED at this four points of time was significantly alleviated, NEDOCS index was 193.09 ± 31.87, 187.09 ± 22.65, 187.36 ± 25.73, 154.03 ± 21.56;there were significant differences between the two groups before and after the intervention (t=2.35-4.32, P<0.05). Conclusions To study and discuss the reasons of emergency department overcrowding, it can effectively relieve the happening of emergency department overcrowding through comprehensive intervention measures such as improve the environment, optimize the process, strengthen emergency medical personnel training and management, improve the service level hospital auxiliary support system.