目的 分析非急症老年患者急诊就诊现况并探索其影响因素。方法 回顾性分析浙江省某三级甲等医院急诊科2020年34 133例就诊老年患者的临床资料,以是否为非急症患者分为两组,对比两组患者临床指标的差异,采用Logistic回归模型分析急诊老年非急症患者的影响因素。结果 29 206例（85.57%）老年患者为非急症患者,4 927例（14.43%）为急症患者。二分类Logistic回归分析显示,就诊科室为外科（OR=2.118）、骨科（OR=4.671）、五官科（OR=6.472）、其他科室（OR=11.914）,入院途径为救护车转入（OR=0.115）或其他途径入院（OR=0.291）,以及夏季就诊（OR=0.783）或秋季就诊（OR=0.568）为非急症老年患者急诊就诊的影响因素（P<0.05）。结论 非急症老年患者急诊就诊率较高,预检分诊人员在急诊拥堵及大量患者候诊情况下应关注步行来院、非内科就诊及夏季、秋季就诊的老年患者,可以尝试将其引导至门诊或其他诊疗场所就诊,以减轻急诊拥挤度。
Objective To analyze the current situation of emergency room visits of elderly non-urgent patients and explore its influencing factors. Methods The clinical data of 34 133 elderly patients in 2020 were retrospectively analyzed. The patients were divided into two groups based on whether they were non-urgent patients. The differences of clinical indicators between the two groups were compared,and the influencing factors of emergency non-urgent elderly patients were analyzed by Logistic regression model. Results 29 206（85.57%）were non-urgent patients and 4 927（14.43%）were urgent patients. Binary Logistic regression analysis showed that medical departments were surgery（OR=2.118）,orthopedics（OR=4.671）and ENT departments（OR=6.472）,and other departments（OR=11.914）,patients who transferred by ambulance（OR=0.115）or other channels（OR=0.291）,summer visits（OR=0.783）or autumn visits（OR=0.568）were influencing factors for emergency visits in elderly non-urgent patients（P<0.05）. Conclusion The emergency visit rate of elderly non-urgent patients in ER is higher,triage personnel should pay attention to elderly patients who come to the hospital on foot,for non-medical treatment,and visits in summer and autumn,and can try to guide them to outpatient clinics or other treatment places to reduce emergency overcrowding.
[1] 中华人民共和国国家统计局. 第七次全国人口普查主要数据情况[DB/OL].(2021-07-01)[2022-08-13]. http://www.stats.gov.cn/tjsj/pcsj/.
National Bureau of Statistics of the People's Republic of China. Seventh national census figures for main[DB/OL].(2021-07-01)[2022-08-13]. http://www.stats.gov.cn/tjsj/pcsj/.
[2] Preston L,van Oppen JD,Conroy SP,et al. Improving outcomes for older people in the emergency department:a review of reviews[J]. Emerg Med J,2021,38(12):882-888.
[3] 蒋灵俊,叶磊. 非急症患者急诊就医的现状分析[J]. 河北医药,2020,42(14):2203-2207.
Jiang LJ,Ye L.Research current situation of non-urgent visits in emergency department[J]. Hebei Med J,2020,42(14):2203-2207.
[4] 施小明. 加强老年流行病研究科学指导老年健康防控[J]. 中华预防医学杂志,2021,55(1):1-3.
Shi XM.Strengthening the researches on geriatric epidemiology to provide scientific guidance on control and prevention strategies for elderly[J]. Chin J Prev Med,2021,55(1):1-3.
[5] 胡滨,王振常,王斯佳,等. 三级甲等医院急诊拥堵和工作效率提升的关键因素相关性分析研究[J]. 中华急诊医学杂志,2018, 27(8):943-948.
Hu B,Wang ZC,Wang SJ,et al.Key factors affecting the correlation between improving work efficiency and emergency department overcrowding in the tertiary level A hospitals[J]. Chin J Emerg Med,2018,27(8):943-948.
[6] Jeyaraman MM,Copstein L,Al-Yousif N,et al.Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding:a scoping review[J]. BMJ Open,2021,11(5):e048613.
[7] Idil H,Kilic TY,Toker İ,et al.Non-urgent adult patients in the emergency department:causes and patient characteristics[J]. Turk J Emerg Med,2018,18(2):71-74.
[8] Procter AM,Gialamas A,Pilkington RM,et al.Characteristics of paediatric frequent presenters at emergency departments:a whole-of-population study[J]. J Paediatr Child Health,2021,57(1):64-72.
[9] 金静芬,陈玉国,朱华栋,等. 急诊预检分诊标准(成人部分)[J]. 中华急危重症护理杂志,2020,1(1):45-48.
Jin JF,Chen YG,Zhu HD,et al.Emergency triage scale(adult part)[J]. Chin J Emerg Crit Care Nurs,2020,1(1):45-48.
[10] 许敬华. 基于“加拿大分诊标尺”的急诊电子分诊系统的优化研究[D]. 上海:上海交通大学,2020.
Xu JH.A study on optimization of emergency electronic triage system based on Canadian triage and acuity scale[D]. Shanghai:Shanghai Jiao Tong University,2020.
[11] 中国气象局. 白天和晚上如何划分[EB/OL].(2015-09-18)[2022-08-13]. https://www.cma.gov.cn/wmhd/gzly/cjwt/202204/t202204-15_4759074.html.
China Meteorological Administration. How to divide up the China Meteorological Administration. Day and night[EB/OL]. (2015-09-18)[2022-08-13]. https://www.cma.gov.cn/wmhd/gzly/cjwt/202204/t20220415_4759074.html.
[12] Dufour I,Dubuc N,Chouinard MC,et al.Profiles of frequent geriatric users of emergency departments:a latent class analysis[J]. J Am Geriatr Soc,2021,69(3):753-761.
[13] Bahadori M,Mousavi SM,Teymourzadeh E,et al.Emergency department visits for non-urgent conditions in Iran:a cross-sectional study[J]. BMJ Open,2019,9(10):e030927.
[14] Al-Otmy SS,Abduljabbar AZ,Al-Raddadi RM,et al.Factors associated with non-urgent visits to the emergency department in a tertiary care centre,western Saudi Arabia:cross-sectional study[J]. BMJ Open,2020,10(10):e035951.
[15] 张雅芝. 某院急诊科非紧急病人流行病学特征分析研究[D]. 北京:北京协和医学院,2018.
Zhang YZ.Epidemiological characteristics of non-emergency patients in emergency department of a hospital[D]. Beijing:Peking Union Medical College,2018.
[16] Goodridge D,Stempien J.Understanding why older adults choose to seek non-urgent care in the emergency department:the patient's perspective[J]. CJEM,2019,21(2):243-248.
[17] 邴婧莹,李熹,李桐瑶,等. 居家养老老年人跌倒现状及影响因素研究[J]. 现代预防医学,2022,49(1):110-114,151.
Bing JY,Li X,Li TY,et al.Study on the status quo and influencing factors of falls among the elderly aged at home[J]. Mod Prev Med,2022,49(1):110-114,151.
[18] 刘亭亭,夏东. 9612例院前急救患者流行病学分析[J]. 中国社会医学杂志,2021,38(6):711-715.
Liu TT,Xia D.Epidemiological study of 9 612 cases in pre-hospital emergency cares[J]. Chin J Soc Med,2021,38(6):711-715.
[19] De Freitas L,Goodacre S,O'Hara R,et al. Interventions to im-prove patient flow in emergency departments:an umbrella review[J]. Emerg Med J,2018,35(10):626-637.
