Study On The Condition And Related Factors And Countermeasures Of Length Of Stay In Emergency Red Zone For Critical Patients

Objectives:To investigate the condition of prolonged emergency red zone length of stay (ERZLOS) for critical parients in a tertiary hospital and analyze related fators and put forward coping measures,and to provide data and evidence for emergency department to shorten ERZLOS and accelerate the diversion of patients in ERZ and further enhance the emergency service quality.Methods:Data of critical patients from the emergency red zone in a tertiary hospital from July 2014 to December 2015 were prospectively studied. A descriptive analysis was taken about the overall conditions of ERZLOS.ERZLOS was compared among patients treated by different arrival time,different ages,different departments and with different destinations of shunt.Binary Logistic regression analysis was used to determine possible factors related to length of stay more than 6 hours. And survival curves were drawn about the main related factors using Kalpan-Meier survival analysis.The data was analyzed with the statistic package for social science (SPSS) 19.0.Results:1.7849 critical patients were treated in the emergency red zone from July 2014 to December 2015 and the ERZLOS was (0.5-729) h(hour),The interquartile range was 2.8 (1.6-5.6) h. Of these patients, about 23.2%(1821) patients with an ERZLOS more than 6 h and 7.2%(565) over 24 h and 2.8%(220) over 72 h.Patients had the longest ERZLOS 3.1(1.7-6.3) h with treated at 0:01-8:00. The older the Patients, the longer LOS and Patients older than 65 years old had the longest ERZLOS 3.5(1.9-8.1)h. Patients in emergency internal medicine had the longest ERZLOS 3.3 (1.7-7.1) h. Patients discharged from hospital automatically had the longest ERZLOS 5.1 (2.0-12.0) h.2. In the univariate Logistic regression analysis, the factors associated with prolonged LOS were arrival time,visit month, gender, age, sent by 120, the number of initial diagnosis, department of bearing main responsibility of treatment,way of cost,Patients with people,treatment adherence,degree of critical illness, need multiple departments,destinations of shunt.3. In the multivariate Logistic regression analysis, the factors contributing to LOS over 6 hours were arrival time,visit month, gender, age, sent by 120, the number of initial diagnosis, department of bearing main responsibility of treatment,treatment adherence, degree of critical illness, need multiple departments,destinations of shunt. While way of cost,patients with people were not related factors.4. The major factors contributing to LOS over 6 hours were arrival time,treatment adherence, degree of critical illness, need multiple departments,destinations of shunt. Of them, Patients visiting at 0:01-8:00 had the highest risk over 6 hours, and so the high-acuity patients and patients with the poor treatment adherence. The risk for patients who stayed more than 6 hours needing multiple departments was 5.950 times more than not. Patients who stayed in an observation room had the minimum risk over 6 hours,while the retention rate for patients who were discharged by themselves was higher than others.Conclusion:It was not optimistic for the tertiary hospital with an excessive LOS.The patients had a prolonged LOS and a high proportion of patients with LOS over 6 hours. The main realated factors contributing to LOS over 6 hours were arrival time,visit month, gender, age, sent by 120, the number of initial diagnosis, department of bearing main responsibility of treatment,treatment adherence, degree of critical illness, need multiple departments,destinations of shunt. We should take more targeted measures to accelerate throughput of emergency patients.