【作者】 王进；

【导师】 金静芬；

【作者基本信息】 浙江大学 ， 护理学， 2012， 硕士

【摘要】 研究目的了解急诊室危重患者滞留时间>6小时的临床特点,并探索急诊室危重患者滞留时间>6小时的影响因素,为急诊管理者制定相关措施提供依据。研究方法回顾性分析一家大型综合性医院2010年1月至2011年6月急诊抢救室危重患者的信息,对患者滞留时间≤6小时和>6小时的临床特征进行描述性分析,并通过二分类Logistic回归方法分析滞留时间大于6小时的影响因素,再进一步对主要影响因素运用Kalpan-Meier分析绘制生存曲线,患者分流曲线的比较采用Log-Rank检验,所有资料均选用SPSS16.0统计软件进行数据的统计分析。研究结果12010年1月至2011年6月急诊抢救室共有患者11468例,抢救室滞留的中位数时间为11h h(3～23h),其中6525例(56.9%)滞留时间大于6h,其中3930例(34.3%)滞留时间6～24h,1606例(14.0%)滞留时间24～48h.600例(5.2%)滞留时间48～72h,389例(3.4%)滞留时间大于72h。2单因素Logistic回归分析显示：就诊月份、就诊时间段、性别、年龄、患者职业、户籍、节假日就诊、主诊科室、收入ICU、绿色通道、120送入、交通事故、离抢去向与滞留时间>6小时相关。3二分类Logistic回归分析显示：主诊科室、绿色通道、就诊时间段、收入ICU、交通事故、120送入、初步诊断个数、离抢去向、性别、节假日就诊、就诊月份是滞留时间>6小时的独立影响因素,而患者的年龄、职业、户籍不是影响患者滞留时间超过6小时的因素。4就诊时间是急诊抢救室危重患者滞留时间>6小时的独立危险因素之一。17：00～23：59就诊的患者滞留时间大于6小时的危险性是8：00～16：59就诊的2.328倍。0：00-8：00就诊的患者滞留时间大于6小时的危险性是8：00～16：59就诊的3.091倍。5不同主诊科室是急诊抢救室危重患者滞留时间>6小时的独立危险因素之一。滞留率由高到低依次为普通内科、神经内科、神经外科、骨科、急诊科、其它、心内科。6是否绿色通道送入也是急诊抢救室危重患者滞留时间>6小时的独立危险因素之一。非绿色通道患者滞留时间>6小时的危险性是绿色通道送入的9.17倍。7不同离抢去向是急诊抢救室危重患者滞留时间>6小时的独立危险因素之一。其中直接住院和自动出院患者滞留率比急诊手术和好转出院患者滞留率高。结论该家医院危重患者在抢救室滞留时间偏长,滞留时间超过6小时的比例偏高。影响的因素有主诊科室、绿色通道、就诊时间段、收入ICU、交通事故、120送入、初步诊断个数、离抢去向、性别、节假日就诊、就诊月份；须根据滞留时间>6小时的特点及主要影响因素制定有效的政策措施,以减少危重患者在急诊抢救室的滞留时间。更多还原

【Abstract】 ObjectiveTo investigate the characteristics and associated factors of length of stay more than6hours of critically ill patients in an emergency room;Based on their clinical characteristics and the risk factors, we can provide basis for the emergency managers about the development of relevant measures.MethodsData of critically ill patients from the emergency room in a tertiary teaching hospital from January2010to June2011were retrospectively studied. A descriptive analysis was taken about clinical characteristics with patients who stay less than6hours and more than6hours. Binary Logistic regression analysis was used to determine possible factors associated with length of stay more than6hours and further draw survival curve about the main factors using Kalpan-Meier survival analysis. Log-Rank test was used to compare survival curve between patients.The data was analyzed with the statistic package for social science(SPSS)16.0.Results1From January2010to June2011a total of11,468patients were seen in the emergency department, the median ER length of stay was11h(3～23h). a number of6525(56.9%) patients stayed in ER more than6h. A number of3930(34.3%) patients stayed in ER between6h and24h. A number of1606(14.0%) patients stayed in ER between24h and48h. A number of600(5.2%) patients stayed in ER between48h and72h. A number of389(3.4%) patients stayed in ER more than72h.2Univariate Logistic regression analysis showed types of wards, green channel, treatment time, admitted to ICU, traffic, sent by120, the number of initial diagnosis, destinations of disposition, sex, holiday visit, visit month, age, occupation, residence.3Binary Logistic regression analysis showed that the main factors contributing to length of stay more than6hours were types of wards, green channel, treatment time, followed by admitted to ICU, traffic, sent by120, the number of initial diagnosis, destinations of disposition, sex, holiday visit, visit month. While age, occupation, residence were not factors.4Treatment time was an independent factor for patients who stayed more than6hours.The risk for patients who stayed more than6hours between17:00-23:59was2.328times more than8:00-16:59. The risk for patients who stayed more than6hours between0:00-7:59was3.019times more than8:00-16:59.5There were significant differences for patients who stayed more than6hours in ER among patients treated by different departments, with the highest retention rate in general internal medicine, followed by neurology department, neurosurgery department, orthopedics, emergency department, other departments,heart medicine.6Green channel was an independent factor for patients who stayed more than6hours.The risk for patients wasn’t sent by green channel was9.17times stayed more than6hours more than patients was sent by green channel.7There were significant differences for patients who stayed more than6hours in ER among patients with different destinations of disposition. The retention rate for patients who were discharged by themselves and admitted to the hospital was higher than patients who requiring emergent operation and discharge.ConclusionThe patients in this hospital has a prolonged length of stay and a high proportion of patients with length of stay more than6hours. The associated factors included the main factors contributing to length of stay more than6hours were types of wards, green channel, treatment time, followed by admitted to ICU, traffic, sent by120, the number of initial diagnosis, destinations of disposition, sex, holiday visit, visit month. We should take effection nursing intervention to reduce the lenth of stay in emergency room.更多还原