目的 探讨成立基本外科急诊手术团队在疏散急诊拥堵、加快急诊手术周转、减轻患者医疗负担中的作用。 方法 回顾性分析2019年8月1日至2021年7月31日所有就诊于北京协和医院急诊外科的患者。比较急诊手术团队成立前后留观患者总数与流水患者总数的比值,基本外科急诊的病情严重程度分级、手术量、术前准备时间、术后转入ICU的比例、住院时间>30 d的占比、并发症发生率,按手术级别和病情危重级别比较住院时间和住院费用。采用多元线性回归探究急诊手术患者住院费用的影响因素。 结果 急诊手术团队成立后,留观患者总数与流水患者总数的比值从11.6%下降至7.3%(P=0.000),每月基本外科平均手术量由26例上升至77例,术前准备时间由(1.5±0.7) d下降至(0.7±0.9) d(P=0.000),术后转入ICU的比例由37.9%下降至23.7%(P=0.000),住院时间>30 d的患者占比由5.7%下降至0.5%(P=0.000),并发症发生率无明显变化,住院时间及住院费用均明显减少。多元线性回归显示,成立基本外科急诊手术团队是降低急诊手术患者住院费用的独立影响因素,病情危重、住院时间长、转入ICU病房为增加住院费用的独立影响因素。 结论 成立基本外科急诊手术团队可一定程度上解决目前急诊难题,如疏散急诊拥挤、加快急诊手术周转、减轻患者医疗负担,提高急诊诊疗效率。
Objective To explore whether the establishment of general surgical emergency team can evacuate emergency congestion, increase emergency surgery turnover rate and reduce the medical burden. Methods All patients attending our emergency surgery from August 1,2019 to July 31,2021 were retrospectively analysed. The disease severity grading, the ratio of the observation and flow, the number of surgery, preoperative preparation time, the ratio of transfering to ICU, the ratio of patients staying more than 30 days, and complication rate before and after the establishment were compared. Length of stay and hospitalization costs were compared by surgical grading and disease severity grading. Analyse the factors affecting hospitalization costs in emergency surgery patients using univariate and multiple linear regression. Results: After the establishment of the surgical team, the ratio of observation decreased from 11.6% to 7.3% (P=0.000), the operation number increased from 26 to 77 monthly, preoperative preparation time decreased from (1.5 ± 0.7) days to (0.7 ± 0.9) days (P=0.000), the ratio of transfering to ICU decreased from 37.9% to 23.7% (P=0.000), the ratio of patients staying more than 30 days decreased from 5.7% to 0.5% (P=0.000). There was no significant change in complication rate. The average length of stay and cost of the third and forth grade surgery were significantly reduced. The establishment emergency surgery team can reduce the hospitalization cost, while serious disease, long hospitalization time, transfering to ICU and high surgical grading can increase the hospitalization cost. Conclusion The establishment of emergency surgery team can solve the current problem of emergency in some degree, such as evacuating emergency congestion, increasing emergency surgery turnover rate and reducing the medical burden on the premise of ensuring medical safety, so as to improve the efficiency of emergency treatment and benefit both doctors and patients.