Evaluation Of Patient Hospitalization By Emergency Physician Authorization: A Single Center-Retrospective Study

Öz

Giriş ve Amaç: Acil servis doğası gereği 7/24 hizmet sunmaktadır ve acil servislerin rahatlatılmaya çalışılması global bir amaçtır. Bu amaçla yatması gereken ancak acil serviste kalmaya devam eden hastaların yatışı için acil hekimlerine verilen yatış yetkisi uygulamasının hasta sonlanımı üzerine etkisini ve uygunluğunu araştırmak amaçlandı. Gereç ve Yöntem: Tek merkezli retrospektif bir çalışmadır. 01.05.2023-31.12.2023 tarihleri arasında Türkiye’de üçüncü basamak bir akademik acil serviste, acil servis hekimi insiyatifi kullanılarak servislere yatışı yapılan hastalarla çalışıldı. Bulgular: Çalışma süresince acil servisten hastaneye yatan hasta sayısı 11927 olarak bulunuldu. Bu hastalar arasında yatış kararı acil tıp uzmanı tarafından insiyatif olarak belirlenen hasta sayısının yatan hastalara oranı yaklaşık olarak %1’dir (n=119/11927). İnsiyatifle yatırılan hastaların yaş medianı (IQR) 75 (65-83) olup, %47,9 ’u (n=57) erkekti. En sık yatış tanısı Pnömoni %16,8 (n=20), en sık konsültasyon yapılan bölüm enfeksiyon hastalıkları %47,9 (n=57), ve en sık yatış yapılan bölüm iç hastalıkları %23,5 (n=28) idi. Çalışmadaki tüm hastaların ortalama hastanede kalış süresi (OHKS) yedi gün idi. Yatışından sonra bölüm değiştiren hastaların OHKS otuz gün idi (p=0.004) Sonuç: Acil servisin kalabalığını önlemek için ülkemizde acil hekiminin hasta yatırma yetkisi vardır. Tüm yatan hastaların yaklaşık %1 oranında bu yetkiye ihtiyaç duyulmaktadır. Yetki kullanılarak yatan hastaların hastane kalış sürelerinin uzunluğu göz önüne alındığında yatışların doğru ve uygun amaçlarla yapıldığı görülmektedir.

Anahtar Kelimeler

• Acil Tıp
• kalabalık
• insiyatif

Evaluation Of Patient Hospitalization By Emergency Physician Authorization: A Single Center-Retrospective Study

Öz

Background: By its very nature, the emergency department provides a 24/7 service, and it is a global goal to try to relieve the burden on emergency departments. To this end, we aimed to investigate the impact and appropriateness of the practice of giving emergency physicians authorization to hospitalize patients who require hospitalization but remain in the emergency department on patient outcomes. Methods: This is a single center retrospective study. The study was conducted in a tertiary academic emergency department in Turkey between 01/05/2023 and 31/12/2023, with patients admitted to the wards on the initiative of the emergency physician. Results: The number of patients admitted from the emergency department during the study period was 11927. Among these patients, the ratio of patients whose admission decision was made by the emergency physician was approximately 1% (n=119/11927). The median (IQR) age of patients admitted by initiative was 75 years (65-83) and 47.9% (n=57) were male. The most common admission diagnosis was pneumonia 16.8% (n=20), the most common department consulted was infectious diseases 47.9% (n=57), and the most common department admitted was internal medicine 23.5% (n=28). The mean length of hospital stay (LOHS) for all patients in the study was seven days. The mean length of stay for patients who transferred departments after admission was thirty days (p=0.004). Conclusion: In order to prevent overcrowding in emergency departments, emergency physicians in our country are authorized to admit patients. This authorization is needed for about 1% of all hospitalized patients. If we look at the length of stay of patients admitted with this authorization, we can see that they are admitted for the right and appropriate purposes.

Anahtar Kelimeler

• Emergency room
• crowding
• initiative

Kaynakça

1. 1. T.C. Sağlık Bakanlığı. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ. Resmi Gazete. 2022.
2. 2. Pines JM, Griffey RT. What We Have Learned from a Decade of ED Crowding Research. Vol. 22, Academic Emergency Medicine. 2015.
3. 3. Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Academic Emergency Medicine. 2011;18(12).
4. 4. Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency Department Crowding, Part 1-Concept, Causes, and Moral Consequences. Ann Emerg Med. 2009;53(5).
5. 5. Hospital-based emergency care: at the breaking point. Choice Reviews Online. 2008;45(05).
6. 6. Hoot NR, Aronsky D. Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Vol. 52, Annals of Emergency Medicine. 2008.
7. 7. Pines JM, Shofer FS, Isserman JA, Abbuhl SB, Mills AM. The effect of emergency department crowding on analgesia in patients with back pain in two hospitals. Academic Emergency Medicine. 2010;17(3).
8. 8. Pines JM, Pollack C V., Diercks DB, Chang AM, Shofer FS, Hollander JE. The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Academic Emergency Medicine. 2009;16(7).

9. 9. Hong KJ, Shin S Do, Song KJ, Cha WC, Cho JS. Association between ED crowding and delay in resuscitation effort. American Journal of Emergency Medicine. 2013;31(3).
10. 10. Ackroyd-Stolarz S, Read Guernsey J, MacKinnon NJ, Kovacs G. The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: A retrospective cohort study. BMJ Qual Saf. 2011;20(7).
11. 11. Demir MC, Akkas M. Awareness of risks associated with the use of plain X-ray, computed tomography, and magnetic resonance imaging among emergency physicians and comparison with that of other physicians: A survey from Turkey. Medical Science Monitor. 2019;25.
12. 12. Ilhan B, Kunt MM, Damarsoy FF, Demir MC, Aksu NM. NEDOCS: Is it really useful for detecting emergency department overcrowding today? Medicine (United States). 2020;99(28).
13. 13. Demir Mc, Ağaçkıran İ, Özdamar Y, Boğan M. The pandemic’s effect on discharge against medical advice from the emergency department. Journal of Surgery and Medicine. 2021;5(5).
14. 14. Asplin BR, Magid DJ, Rhodes K V., Solberg LI, Lurie N, Camargo CA. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42(2).
15. 15. Gilligan P, Winder S, Singh I, Gupta V, Kelly PO, Hegarty D. The Boarder in the Emergency Department (BED) study. Emergency Medicine Journal. 2008;25(5).
16. 16. FitzGerald G, Jelinek GA, Scott D, Gerdtz MF. Emergency department triage revisited. Vol. 27, Emergency Medicine Journal. 2010.
17. 17. van der Linden MC, Meester BEAM, van der Linden N. Emergency department crowding affects triage processes. Int Emerg Nurs. 2016;29.
18. 18. Göransson KE, Ehrenberg A, Marklund B, Ehnfors M. Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid Emerg Nurs. 2006;14(2).
19. 19. Erenler AK, Akbulut S, Guzel M, Cetinkaya H, Karaca A, Turkoz B, et al. Reasons for overcrowding in the emergency department: Experiences and suggestions of an education and research hospital. Turkiye Acil Tip Dergisi. 2014;14(2).
20. 20. Ağaçkıran M, Avsarogullari L, Şenol V. Factors Assocıated Wıth Reasons, Characterıstıcs And Frequency Of Workplace Vıolence Towards Emergency Department Staff. Turkish Journal of Health Science and Life. 2023;6(3).
21. 21. Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Medical Journal of Australia. 2006;184(5).
22. 22. Savioli G, Ceresa IF, Gri N, Piccini GB, Longhitano Y, Zanza C, et al. Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. Vol. 12, Journal of Personalized Medicine. 2022.
23. 23. Cha WC, Shin S Do, Cho JS, Song KJ, Singer AJ, Kwak YH. The Association Between Crowding and Mortality in Admitted Pediatric Patients From Mixed Adult-Pediatric Emergency Departments in Korea. Pediatr Emerg Care. 2011;27(12).
24. 24. Kurihara M, Kamata K, Tokuda Y. Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study. BMJ Open. 2022;12(4).