RESUMO
Objective To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.Methods The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform.The research subgroups consisted of pre-medical reform group,intra-medical reform group and post-medical reform group,according to the date 20 days before the medical reform,20 days after the medical reform and 21-40 days after the medical reform.During this period,The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00,14:00,18:00 in the Emergency Department of Peking University Third Hospital every day,the mean of which assessed the degree of crowding.The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding.All statistical analyses were performed using SPSS version 25.0.Continuous data presented as means ± standard deviation (normal distribution),analyzed by t-tests or median ± quartile(abnormal distribution),analyzed by Mann-Whitney U test.Results The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68,P＜0.05).The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group,but the difference was not statistically significant (380.83 vs 339.68,P＞0.05).The number of ventilated patients (Rn) significantly increased after the reform (P＜0.05).Conclusions The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017.The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.
RESUMO
Objective To establish a practicable and easily mastered emergency department overcrowding (EDO) assessment system suitable for domestic ED setting by determining the validity and usefulness of the national emergency department over-crowding study (NEDOCS) tool in a 2000-bed tertiary care academic institution in China in comparison with visual analogue scale (VAS) in order to address the worldwide grave concern of EDO.Methods In a period of 6 months,data of subjective and objective EDO assessed simultaneously three times a day (1:00,9:00,17:00) were collected.The data were analyzed by using Bland-altmann method and Kappa test to determine the coincidence between VAS and NEDOCS assessments.Results The VAS-p value evaluated by physicians was significantly lower than VAS-n value evaluated by nurses [(6.49 ± 1.82) vs.(7.12 ± 1.78),P ＜ 0.01].The reliability analysis showed that Kappa value was as low as 0.112 (P ＜0.01) suggesting there was a great discrepancy between VAS-p value and VAS-n value.VAS-m (average value of VAS-p and VAS-n) was taken for comparing different evaluation systems.The significant correlation was found between the VAS-m and NEDOCS (r =0.7l4,P ＜0.01).However,the Bland-Altman plot showed the 95％ limit of coincidence was in an extensive range (-32.47 to 71.42) suggesting discrepancy existed between two methods.Conclusions The present study suggested there was a significant discrepancy between the two subjective assessments of ED crowding (VAS-p vs.VAS-n).There might be a fatal flaw existed in the assumptions of the original VAS method for EDO measurement.Using the Bland-Altman plot analysis,the results showed that NEDOCS did not authentically reflect the staff' s sense of overcrowding in the ED.It is very important and urgent to establish an objective and effective EDO evaluation system for ED management.