| Summary: | 碩士 === 臺北醫學大學 === 傷害防治學研究所 === 98 === Background：Emergency department (ED) crowding represents an international crisis that may affect the quality and access of health care. The international crisis of emergency department (ED) crowding has received considerable attention in health policy setting. Crowding refers to a condition when the needs of the patients in the ED (and patients in the waiting room) exceed the capacity of the department. Commonly studied causes of crowding included non-urgent visits, “frequent-flyer” patients, influenza season, inadequate staffing, inpatient boarding, and hospital bed shortages. Commonly studied effects of crowding included patient mortality, treatment delays, patient elopement, and financial effect. Commonly studied solutions of crowding included additional personnel, observation units, hospital bed access, non-urgent referrals, and crowding measures.
Materal and Method：This study is a retrospectively study.Medical records of patients visited Shuang Ho hospital emergent department were collected from January 2009 to December 2009. The pre-influenza period (from May 2009 to July 2009) were compared with influenza period (from September 2009 to November).We used Independent sample T test and SPSS 12.0 for statistical analysis.
Results：A total of 39861 numbers of patient visited Shouang Ho hospital in the two period. The numbers of patient visited emergency department were more during influenza period then pre-influenza period. Most of them were complaint with medical or pediatric problems and categorized triage Ⅲ. Compared with pre-influenza period, patients returns emergency department and admission rate was incresed from 0.43% to 0.62% within 24 hours, from 0.82% to 1.03% within 48 hours, from 1.18% to 1.46% within 72 hours, respectively, in influenza period. In subgroup analysis, patients with acute stoke sundrome visited emegency department were significant difference in waiting time (P < 0.001), door to brain CT performed (P < 0.001), boarding time (P < 0.001) but not in days of admission (P = 0.359) between two periods. Patients with acute coronary syndrome received immediately PCI were not signifiacnt difference in waiting time (P = 0.440), door to ECG(P = 0.223), door to balloon(P = 0.087), days of ICU(P = 0.054), and days of general ward admission(P = 0.236). However, patients with acute coronary syndrome without received immediately PCI were significant difference in wating time(P = 0.019), door to ECG(P = 0.001), boarding time(P = 0.036), and days of admission(P = 0.024).
Conclusions：In this study, the effect of over-crowding in emergency department, including increased return and admission rate and delayed teratment with critical patients were seen. With this crisis of influenza type A, we emphysized what the importance of over-crowding in emergency department again. We hoped government payed more attention in this issue and health policy setting.
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