Analysis of reason for longer time stay of patients in emergency observation ward

Objective To analyze the influencing factors for longer time stay of patients in emergency observation ward, and to provide practical basis for solving emergency crowding.

Methods The information of all patients was collected and analyzed in the emergency observation ward during January to December 2019, in a hospital with a class Ⅲ grade in Shanghai. According to the number of stay days, patients were divided into two groups: ≤ 7 days in group A, and > 7 days in group B. The difference of age, gender, source, disease classification, medical expenses payment method, outcome and other conditions of patients in these two groups were compared, and the influencing factors of patients' stay time were analyzed by binary multivariate logistic regression, and the causes of long-term stay were summarized.

Results During the study period, 2 211 patients used the emergency observation ward. Their age ranged from 10 to 101 years old with an average age of (67.81 ±18.87) years old. The stay time in emergency observation ward varied from 1 to 2002 days, with the M(P₂₅, P₇₅) as 2.5(1, 9)days. Totally 1 076 cases(48.67%) stayed in emergency observation ward for more than 72 h. The average stay time of patients over 60 years old was more than that of patients under 60 years old, and the difference was statistically significant (P < 0.01). The outcome survey showed that 1 183 cases were in remission and out of hospital, 806 cases were admitted to the ward, 97 cases were transferred to the rescue room, and 125 cases died. The stay time of patients with different outcome was different, shortest for the patients admitted to ward and longest for the death cases (P < 0.01). It was noted that the largest number of neurological patients in group A and the largest number of respiratory patients in group B were in remission and out of hospital. Multivariate logistic regression analysis showed that the probability of staying for more than 7 days increased by 1.293 times for each one year of patients' age increase. Compared with death cases, the possibility of staying for more than 7 days of the patients being discharged, admitted to ward and being transferred to the rescue room was 0.301 times, 0.026 times and 0.183 times, respectively. Taking the patients in the consulting room as the control, the possibility of patients from the rescue room to stay for more than 7 days was 0.754 times.

Conclusion The time of patients' stay in emergency observation ward is closely related to age, disease type and clinical prognosis. The longer stay time of emergency patients may lead to emergency crowding. It is necessary to adjust the national health policy, strengthen the hospital management and service ability, reasonably allocate medical resources, and guide patients to seek medical treatment rationally, so as to improve the emergency room crowding phenomenon in public hospitals.