한국응급구조학회지 (The Korean Journal of Emergency Medical Services)

  • 제26권1호
  • /
  • Pages.151-166
  • /
  • 2022
  • /
  • 1738-1606(pISSN)
  • /
  • 2384-2091(eISSN)
한국응급구조학회 (The Korea Society of Emergency Medical Services)
권호 표지
DOI QR코드

DOI QR Code

응급실에 내원한 환자의 한국형 중증도 분류 결과

Comparative length of emergency department stay of patients with different Korean Triage and Acute Scale severities: A descriptive analysis

  • 투고 : 2021.11.16
  • 심사 : 2022.04.26
  • 발행 : 2022.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The severity classification in association with the time of visit to and the appropriateness of using a public ambulance for visiting the emergency department (ED) have not been thoroughly evaluated, and we aimed to evaluate these aspects. Methods: In this descriptive research, we retrospectively reviewed and analyzed the medical records of patients who visited the ED of the B General Hospital, Seoul from January to December 2019. Results: Of the 54,297 patients who were included in the analysis, 34,629 (63.8%) and 14,065 (25.9%) visited the ED directly and through public ambulances, respectively; 10,328 (73.4%) patients who used public ambulances were discharged home. In the daytime and nighttime, 24,891 (45.8%) and 29,406 (54.2%), respectively, visited the ED. The mean length of ED stay (LoS) of emergency and non-emergency patients was 326 and 159 minutes, respectively, and of patients classified as Korean Triage and Acuity Scale levels 1 and 2 was 427 and 430 minutes, respectively, which was longer than the total of 236 minutes. Conclusion: Patients who visited the ED using public ambulances constituted nearly 25% of all ED visits, and more than 70% of these patients were discharged home. Patients with high severity had a longer mean LoS, and daytime ED visits were characterized by higher numbers and severity of patients than nighttime ED visits.

키워드

참고문헌

  1. Hardern RD. Critical appraisal of papers describing triage systems. Acad Emerg Med 1999;6(11):1166-71. https://doi.org/10.1111/j.1553-2712.1999.tb00121.x
  2. Kuriyama A, Urushidani S, Nakayama T. Five-level emergency triage systems: variation in assessment of validity. Egerg Med J 2017;34(11):703-10. https://doi.org/10.1136/emermed-2016-206295
  3. Gilboy N, Travers D, Wuerz R. Re-evaluating triage in the new millennium: a comprehensive look at the need for standardization and quality. J Emerg Nurs 1999;25(6):468-73. https://doi.org/10.1016/S0099-1767(99)70007-3
  4. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7(3):236-42. https://doi.org/10.1111/j.1553-2712.2000.tb01066.x
  5. Grouse A, Bishop R, Bannon A. The Manchester Triage System provides good reliability in an Australian emergency department. Emerg Med J 2009;26(7):484-6. https://doi.org/10.1136/emj.2008.065508
  6. Parenti N, Reggiani MLB, Iannone P, Percudani D, Dowding D. A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. Int J Nurs Stud 2014;51(7):1062-9. https://doi.org/10.1016/j.ijnurstu.2014.01.013
  7. Jelinek GA, Little M. Inter-rater reliability of the National Triage Scale over 11,500 simulated occasions of triage. Emerg Med 1996;8(4):226-30. https://doi.org/10.1111/j.1442-2026.1996.tb00277.x
  8. Murray M, Bullard M, Grafstein E. Revisions to the Canadian emergency department triage and acuity scale implementation guidelines. CJEM 2004;6(6):421-7. https://doi.org/10.1017/S1481803500009428
  9. Park J, Lim T. Korean triage and acuity scale (KTAS). J Korean Soc Emerg Med 2017;28(6):547-51.
  10. Kim JY, Hong DY, Kim SY, Kim JW, Park SO, Lee KR et al. Reliability of Korean Triage and Acuity Scale-based triage system as a severity index in emergency patients. J Korean Soc Emerg Med 2017;28(6):552-6.
  11. Shin JW, Lee SH, Lee DS, Kim HB, Jo YM, Bae BG et al. Validity of the newly developed Five Level Pediatric Triage System implemented in a children's hospital emergency department. J Korean Soc Emerg Med 2017;28(6):557-63.
  12. Lee KJ, Park MH, Suh J, Jung SY, Lee SJ, Cha M-i. Triage results of children who visited the emergency department via emergency medical service providers: an observational study in a regional emergency medical center. Pediatr Emerg Med J 2017;4(1):18-24. https://doi.org/10.22470/pemj.2017.00017
  13. Lim T, Park J, Je S. Pediatric Korean triage and acuity scale. Pediatr Emerg Med J 2015;2(2):53-8. https://doi.org/10.22470/pemj.2015.2.2.53
  14. Kim HI, Oh SB, Choi HJ. Inter-rater agreement of Korean Triage and Acuity Scale between emergency physicians and nurses. J Korean Soc Emerg Med 2019;30(4):309-17.
  15. Moon S, Shim JL. Triage Accuracy of Pediatric Patients using the Korean Triage and Acuity Scale in Emergency Departments. JKAIS 2018;19(11):626-34. https://doi.org/10.5762/KAIS.2018.19.11.626
  16. Sovso MB, Christensen MB, Bech BH, Christensen HC, Christensen EF, Huibers L. Contacting out-of-hours primary care or emergency medical services for time-critical conditions-impact on patient outcomes. BMC Health Services Research 2019;19(1):813. https://doi.org/10.1186/s12913-019-4674-0
  17. Sariyer G, Ataman MG, Kiziloglu I. Factors affecting length of stay in the emergency department: A research from an operational viewpoint. Int J Healthc Manag 2018:1-10. https://doi.org/10.1080/20479700.2018.1489992
  18. Andrew E, Nehme Z, Cameron P, Smith K. Drivers of increasing emergency ambulance demand. Prehosp Emerg Care 2020;24(3):385. https://doi.org/10.1080/10903127.2019.1635670
  19. Wang IJ, Cho SJ, Yeom SR, Bae BK, Cho YM, Lee KH et al. Relationship between emergency department disposition, level of emergency base on Korean Triage and Acuity Scale, visit mode. J Korean Soc Emerg Med 2018;29(2):144-51.
  20. Hinson JS, Martinez DA, Schmitz PS, Toerper M, Radu D, Scheulen J et al. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Int J Emerg Med 2018;11(1):3. https://doi.org/10.1186/s12245-017-0161-8
  21. Moreno-Carrillo A, Arenas LMA, Fonseca JA, Caicedo CA, Tovar SV, Munoz-Velandia OM. Application of Queuing Theory to Optimize the Triage Process in a Tertiary Emergency Care ("ER") Department. J Emerg Trauma Shock 2019;12(4):268-73. https://doi.org//10.4103/JETS.JETS_42_19
  22. Azeredo TRM, Guedes HM, de Almeida RAR, Chianca TCM, Martins JCA. Efficacy of the Manchester Triage System: a systematic review. Int Emerg Nurs 2015;23(2):47-52. https://doi.org/10.1016/j.ienj.2014.06.001
  23. The Korean Society of Emergency Medicine. Reliability and validity verification study of the Korean Triage and Acuity Scale [Internet]. Sejong: Ministry of Health and Welfare; 2014 [cited 2020 March 4]. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=1&research_id=1351000-201400241&left-MenuLevel=160&cond_research_name=한국형+중증%.
  24. Kim MH, An HG. Classification of emergency room usage patterns according to the type of insurance in patients visiting an emergency medical center in Seoul, Korea. Korean J Emerg Med Ser 2020;24(1):25-36. https://doi.org/10.14408/KJEMS.2020.24.1.025
  25. Pearson C, Kim DS, Mika VH, Imran Ayaz S, Millis SR, Dunne R et al. Emergency department visits in patients with low acuity conditions: Factors associated with resource utilization. Am J Emerg Med 2018;36(8):1327-31. https://doi.org/10.1016/j.ajem.2017.12.033
  26. Hegenberg K, Trentzsch H, Pruckner S. Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport. BMJ open 2019;9(9):e030636. https://doi.org/10.1136/bmjopen-2019-030636
  27. Hettinger AZ, Cushman JT, Shah MN, Noyes K. Emergency medical dispatch codes association with emergency department outcomes. Prehosp Emerg Care 2013;17(1):29-37. https://doi.org/10.3109/10903127.2012.710716
  28. Wong HT, Lin TK, Lin JJ. Identifying rural-urban differences in the predictors of emergency ambulance service demand and misuse. J Formos Med Assoc 2019;118(1, Part 2):324-31. https://doi.org/10.1016/j.jfma.2018.05.013
  29. Norberg G, Wireklint Sundstrom B, Christensson L, Nystrom M, Herlitz J. Swedish emergency medical services' identification of potential candidates for primary healthcare: Retrospective patient record study. Scand J Prim Health Care 2015;33(4):311-7. https://doi.org/10.3109/02813432.2015.1114347
  30. Wankhade P. The crisis in NHS Ambulance Services in the UK: Let's deal with the 'elephants in the room'!! Ambulance Today.2018;15(1):13-7.
  31. O'Cathain A, Knowles E, Bishop-Edwards L, Coster J, Crum A, Jacques R et al. Understanding variation in ambulance service non-conveyance rates: a mixed methods study. Health Serv Deliv Res 2018;6(19). https://doi.org/10.3310/hsdr06190
  32. Snooks H, Dale J, Hartley-Sharpe C, Halter M. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature. Egerg Med J 2004;21(2):212-5. https://doi.org/10.1136/emj.2003.005199
  33. Coster J, O'Cathain A, Jacques R, Crum A, Siriwardena AN, Turner J. Outcomes for patients who contact the emergency ambulance service and are not transported to the emergency department: A data linkage study. Prehosp Emerg Care 2019;23(4):566-77. https://doi.org/10.1080/10903127.2018.1549628
  34. Lee J, Ahn B. Factors associated with multiple emergency department visits: focused on general hospital level regional emergency medical center. Korea Public Health Research 2018;44(44):3129-46.
  35. Yun HW, Lee J, Choi JW. A delphi study on charging for 119 emergency medical services. J Korean Soc Emerg Med 2017;28(2):190-200.
  36. Duvald I, Moellekaer A, Boysen MA, Vest-Hansen B. Linking the severity of illness and the weekend effect: a cohort study examining emergency department visits. Scand J Trauma Resusc Emerg Med 2018;26(1):72. https://doi.org/10.1186/s13049-018-0542-x
  37. Hirose T, Kitamura T, Katayama Y, Sado J, Kiguchi T, Matsuyama T et al. Impact of nighttime and weekends on outcomes of emergency trauma patients: A nationwide observational study in Japan. Medicine (Baltimore) 2020;99(1):e18687-e. https://doi.org/10.1097/MD.0000000000018687
  38. Seo JH, Lee H, Park EJ, Kim H, Lee H, Kim SH. The factors affecting the level of urgency in the frequent users of the emergency department. J Korean Soc Emerg Med 2019;30(6):473-83.
  39. Yoon BS, Choa MH, Kong TY, Joo YS, Ko DR, Hwang YJ et al. The effect of time target on overcrowding and clinical quality in the ED: a systematic review and meta-analysis. J Korean Soc Emerg Med 2018;29(2):170-8.
  40. Williams P, Csipke E, Rose D, Koeser L, McCrone P, Tulloch A et al. Efficacy of a triage system to reduce length of hospital stay. Br J Psychiatry 2014;204(6):480-5. https://doi.org/10.1192/bjp.bp.113.141051
  41. Kwon H, Kim YJ, Jo YH, Lee JH, Lee JH, Kim J et al. The Korean Triage and Acuity Scale: associations with admission, disposition, mortality and length of stay in the emergency department. Int J Qual Health Care 2018;31(6):449-55. https://doi.org/10.1093/intqhc/mzy184
  42. Kim JH, Kim JW, Kim SY, Hong DY, Park SO, Baek KJ et al. Validation of the Korean Triage and Acuity Scale compare to triage by emergency severity index for emergency adult patient: preliminary study in a tertiary hospital emergency medical center. J Korean Soc Emerg Med 2016;27(5):436-41.
  43. Lee I, Kim O, Kim C, Oh J, Lim T, Lee J et al. Validity analysis of Korean triage and acuity scale. J Korean Soc Emerg Med 2018;29(1):13-20.
  44. Hocker MB, Gerardo CJ, Theiling BJ, Villani J, Donohoe R, Sandesara H et al. NHAMCS validation of emergency severity index as an indicator of emergency department resource utilization. West J Emerg Med 2018;19(5):855. https://doi.org/10.5811/westjem.2018.7.37556