중증상병코드환자의 응급실 재실 시간 평가지표 분석 및 적합성에 대한 고찰
Analysis of emergency department length of stay in patient with severe illness code
백승민, 서동우, 김윤정, 정진우, 강형구, 한갑수, 김수진, 이성우, 김원영,
소속 상세정보
백승민 ( Baek Seung-Min )
Asan Medical Center Department of Emergency Medicine
서동우 ( Seo Dong-Woo )
University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
김윤정 ( Kim Youn-Jung )
University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
정진우 ( Jeong Jin-Woo )
Dong-A University College of Medicine Department of Emergency Medicine
강형구 ( Kang Hyung-Goo )
Hanyang University College of Medicine Department of Emergency Medicine
한갑수 ( Han Kap-Su )
Korea University College of Medicine Department of Emergency Medicine
김수진 ( Kim Su-Jin )
Korea University College of Medicine Department of Emergency Medicine
이성우 ( Lee Sung-Woo )
Korea University College of Medicine Department of Emergency Medicine
김원영 ( Kim Won-Young )
University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
KMID : 0385920200310050518
Abstract
Objective: Emergency department (ED) overcrowding is a global trend that has negative impacts on the clinical outcomes, especially on critically ill patients. Reducing the portion of these critical patients by limiting the ED length of stay (LOS) to less than 6 hours has become one of the most crucial targets of government policy. This could be valuable for resolving overcrowding, but the clinical impacts and applicability had not been evaluated.
Methods: Consecutive emergency patients registered on the National Emergency Department Information System from January 2016 to December 2017 were analyzed. This study included critically ill patients who had a severe illness code, as defined by the government. The in-hospital mortality rate was compared by under or over six hours of ED LOS, in patients with a severe illness code, and intensive care unit (ICU) patients.
Results: Among 18,217,034 patients, 436,219 patients had a severe illness code. The ED LOS in the less than six hours group showed a higher in-hospital mortality rate than that of more than six-hours group (7.1% vs. 6.5%, respectively).
When the rule for the severe illness code to ICU admission was changed, the in-hospital mortality rate showed a remarkable difference between the under and over six-hour group (12.8% vs. 15.0%, respectively). The proportion of critically ill patients admitted within six hours increased when the standard for outlier removal was set higher than the current.
Conclusion: A more suitable quality indicator or criterion for severe illness code is required for improving the clinical outcomes.
키워드
Length of stay; Administration; Healthcare quality indicator
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