上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (9): 1254-.doi: 10.3969/j.issn.1674-8115.2017.09.011

• 论著（临床研究） • 上一篇    下一篇

上海市某医院老年患者急诊滞留影响因素分析

施晟懿 1*，胡岚 1*，晏菡婷 2，陆一鸣 1, 2，叶静 1, 2   

  1. 上海交通大学 医学院 1. 附属瑞金医院北院急诊科，上海 201821；2. 附属瑞金医院急诊科，上海 200025
  • 出版日期:2017-09-28 发布日期:2017-10-10
  • 通讯作者: 叶静，电子信箱：carlionje8@126.com
  • 作者简介:施晟懿（1986—），女，硕士生；电子信箱：ssy1986@126.com。胡 岚 （ 1981—），男，本科生；电子信箱：nhhl@sina.com。* 为并列第一作者
  • 基金资助:
    上海市教育委员会高峰高原学科建设计划（20161408）

Analysis on associated factors of elderly patients’ stay in emergency department of a hospital in Shanghai#br#

SHI Sheng-yi1*, HU Lan1*, YAN Han-ting2, LU Yi-ming1, 2, YE Jing1, 2   

  1. 1.Department of Emergency, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201821, China; 2. Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University  School of Medicine, Shanghai 200025, China
  • Online:2017-09-28 Published:2017-10-10
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20161408

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摘要： 目的 · 了解老龄化对急诊人群健康状况、病种、就诊压力和急诊滞留时间（EDLOS）的影响。方法 · 回顾性分析上海市某三 级甲等医院 2014—2016 年所有急诊滞留患者信息，包括患者性别、年龄、就诊时间、诊断、EDLOS、转归、是否合并慢性疾病、感 染或肿瘤等，分析影响 EDLOS 的危险因素。结果 · 纳入 15 429 例急诊患者，老年人（≥ 65 岁）占总数 54.96%。老年患者的 EDLOS 显著长于 <65 岁患者 (P=0.000)；老年急诊合并年龄相关性慢性疾病的发生率（67%）明显高于 <65 岁患者（52%）。合并肿瘤或感染 是影响 EDLOS 的独立因素（P=0.000）。老年患者中，急性起病、需明确诊断者占 14%。结论 · 老年急诊患者比例增加是急诊就诊压 力升高的主要原因。老年急诊常涉及多样化的慢性疾病及并发症，延长 EDLOS，占用急救资源。呼吁发展老年学科，给予老年患者 多脏器慢性病整合治疗、慢病急发和病情进展对症治疗等多梯度的家庭—住院—急诊治疗模式。

关键词: 急诊拥挤, 老年患者, 滞留, 急诊滞留时间, 年龄相关性慢性病

Abstract:

Objective · To investigate the effect of population aging on health condition of Emergency Department (ED) visitors, the disease constitution of ED, the pressure of emergency treatment and the emergency department length of stay (EDLOS).  Methods · Patient data from ED of a tertiary hospital in Shanghai from Jan. 2014 to Dec. 2016 were collected and retrospectively analyzed, including gender, age, arrival time, diagnosis, EDLOS, outcome, chronic disease, infection or tumor, etc. Statistics was used to determine possible factors associated with prolonged EDLOS.  Results · A total of 15 429 cases were selected. The number of the elderly patients ( ≥ 65 years old) was 8 480 (54.96%). The elderly patients’ EDLOS was significantly longer than patients younger than 65 years (P=0.000). The incidence of chronic aging diseases was significantly higher in elderly patients (67%) than in who were below 65 years old (52%). Tumor and infection were independent risk factors for EDLOS (P=0.000). The proportion of elderly patients with acute onset and unknown diseases was only 14%.  Conclusion · The increasing proportion of elderly patients in ED is the main reason leading to the pressure of emergency treatment. The elderly patients who had chronic diseases prolong the EDLOS and cost the most medical resources of emergency treatment. So the gerontology should be rapidly expanding. Meanwhile, the complex chronic aging diseases, acute onset of chronic disease and varying severity of disease in the elderly patients should be treated by the new stepping mode “Family- Hospitalization-Emergency”. [

Key words: emergency department crowding, elderly patients, length of stay, emergency department length of stay, chronic aging diseases