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首页> 外文期刊>The Journal of Emergency Medicine >Pediatric emergency department overcrowding: electronic medical record for identification of frequent, lower acuity visitors. Can we effectively identify patients for enhanced resource utilization?
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Pediatric emergency department overcrowding: electronic medical record for identification of frequent, lower acuity visitors. Can we effectively identify patients for enhanced resource utilization?

机译：小儿急诊科人满为患：电子病历，用于识别频繁，低敏度的访客。我们能否有效地识别患者以提高资源利用率？

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The objective of this study was to utilize the electronic medical record system to identify frequent lower acuity patients presenting to the Pediatric Emergency Department and to evaluate their impact on Pediatric Emergency Department overcrowding and resource utilization. The electronic medical records (EMR) of two pediatric emergency centers were reviewed from August 2002 to November 2004. Pediatric Emergency Department encounters that met any of the following criteria were classified as Visits Necessitating Pediatric Emergency Department care (VNEC): Disposition of admission, transfer or deceased; Intravenous fluids (IVF) or medications (excluding single antipyretic or antihistamine); Radiology or laboratory tests (excluding Rapid Strep); Fractures, dislocations, and febrile seizures. All other visits were classified as non-VNEC. ICD-9 (International Classification of Diseases, Ninth Revision) codes from the Pediatric Emergency Department encounters were defined as representing chronic or non-chronic conditions. Patients were then evaluated for utilization patterns, frequency of Emergency Department (ED) visits, chronic illness, and VNEC status. There were 153,390 patients identified, representing 255,496 visits (1.7 visits/patient, range 1-49). Overall, 189,998 visits (74%) required defined ED services and were categorized as VNEC, with the remaining 65,498 visits (26%) categorized as non-VNEC. With increasing visits, a steady decline in those requiring ED services was observed, with a plateau by visit six (VNEC 77% @ one visit, 64% @ six visits, p < 0.001). There were 141,765 patients seen fewer than four times, representing 92% of the patients and 74% of all visits (1.3 visits/patient, 225 visits/day). In contrast, 2664 patients disproportionately utilized the ED more than six times (maximum 49), representing 1.7% of patients and 9.8% of visits (9.4 visit/patient, 30 visits/day, p < 0.001). Excluding patients with chronic illness, 1074 patients also disproportionately utilized the ED more than six times (maximum 28), representing 0.7% of patients and 3.6% of visits (8.6 visit/patient, 11 visits/day, p < 0.001). While representing < 2% of patients, frequent lower acuity utilizers of ED services accounted for nearly 10% of all visits (30/day). Low acuity patients may require only limited additional marginal resources for their individual care. However, in aggregate, inefficiencies occur, especially when systems reach capacity constraints, at which point these patients utilize limited resources (manpower and space) that could more effectively be directed toward the more acutely ill and injured patients. Therefore, identification of these patients utilizing the electronic medical record will allow for targeted interventions of this subgroup to improve future resource allocation.
机译：这项研究的目的是利用电子病历系统来识别出经常出现在小儿急诊科的低视力患者，并评估他们对小儿急诊科过度拥挤和资源利用的影响。从2002年8月至2004年11月，对两个儿科急诊中心的电子病历（EMR）进行了审查。符合以下任何标准的儿科急诊室遇到的事件被归类为“需要就诊的儿科急诊室（VNEC）”：入院，转诊或已故;静脉输液（IVF）或药物（单种退热药或抗组胺药除外）;放射学或实验室检查（快速链球菌除外）;骨折，脱位和高热惊厥。所有其他访问被归类为非VNEC。小儿急诊科的ICD-9（国际疾病分类，第九修订版）代码被定义为代表慢性或非慢性疾病。然后评估患者的使用方式，急诊室（ED）的访视频率，慢性病和V​​NEC状况。鉴定出153,390名患者，代表255,496次就诊（每位患者1.7次就诊，范围1-49）。总体而言，有189,998次访问（占74％）需要定义的ED服务，并且被分类为VNEC，其余65,498次访问（占26％）被归为非VNEC。随着访视次数的增加，观察到需要急诊服务的人数稳步下降，六次访视就达到了稳定水平（VNEC一次访视时为77％，六次访视时为64％，p <0.001）。有141,765名患者被看过少于四次，占患者的92％和所有就诊的74％（每位患者1.3次就诊，每天225次就诊）。相比之下，有2664名患者过度使用ED超过六次（最多49次），占患者的1.7％和就诊的9.8％（每位患者9.4次，每天30次，p <0.001）。除慢性病患者外，还有1074名患者过度使用ED超过6次（最多28次），分别占患者的0.7％和就诊的3.6％（每位患者8.6次就诊，每天11次就诊，p <0.001）。虽然占患者的<2％，但频繁使用急诊服务的低敏度使用者占所有就诊次数的近10％（每天30次）。低敏锐度患者可能仅需要有限的额外边缘资源来进行个人护理。但是，总的来说，效率低下会发生，特别是当系统达到容量限制时，此时这些患者会利用有限的资源（人力和空间），这些资源可以更有效地用于病情严重和受伤较重的患者。因此，利用电子病历对这些患者的识别将允许该亚组的靶向干预，以改善未来的资源分配。

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