중증응급환자의 응급의료센터 재실시간에 따른 중증도 표준화 생존 분석 = Association between the emergency department length of stay and severity-standardized survival among severe emergency patients

다국어 초록 (Multilingual Abstract)

Objective: The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (EDLOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between EDLOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival.
Methods: This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis.
The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed.
Results: A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival.
Conclusion: The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival.

참고문헌 (Reference)

1 백승민 ; 서동우 ; 김윤정 ; 정진우 ; 강형구 ; 한갑수 ; 김수진 ; 이성우 ; 김원영, "중증상병코드환자의 응급실 재실 시간 평가지표 분석 및 적합성에 대한 고찰" 대한응급의학회 31 (31): 518-525, 2020

2 정성필 ; 윤병석 ; 좌민홍 ; 공태영 ; 주영선 ; 고동률 ; 황윤정 ; 박인철 ; 이혜선, "응급실 체류시간 제한이 과밀화 및 진료의 질에 미치는 영향: 체계적 문헌고찰과 메타분석" 대한응급의학회 29 (29): 170-178, 2018

3 한갑수 ; 김원영 ; 김수진 ; 정진우 ; 강형구 ; 이철웅 ; 이성우, "우리나라 응급의료기관 평가제도의 개선방안" 대한의사협회 63 (63): 227-234, 2020

4 Altman DG, "What do we mean by validating a prognostic model?" 19 : 453-473, 2000

5 Jones P, "Towards a best measure of emergency department crowding : lessons from current Australasian practice" 30 : 214-221, 2018

6 Mason S, "Time patients spend in the emergency department : England‘s 4-hour rule-a case of hitting the target but missing the point?" 59 : 341-349, 2012

7 Jones P, "The four hour target to reduce Emergency Department ‘waiting time’ : a systematic review of clinical outcomes" 22 : 391-398, 2010

8 Sullivan C, "The National Emergency Access Target (NEAT) and the 4-hour rule:time to review the target" 204 : 354-, 2016

9 Jang HY, "Suggestions for improvement of ICD-10 based Injury Severity Score(ICISS)based on case-analysis study" 16 : 12-24, 2003

10 Hollis S, "Standardized comparison of performance indicators in trauma : a new approach to case-mix variation" 38 : 763-766, 1995

11 Special Committee for Evaluation System of Emergency Medical Institution, "Research for improvement of national evaluation system for emergency medical institution: analysis of indicators in evaluation for emergency medical institution and review of the compatibility" Korean Society of Emergency Medicine 2019

12 김오현 ; 노영일 ; 김형일 ; 차용성 ; 차경철 ; 김현 ; 황성오 ; 이강현, "Reduced Mortality in Severely Injured Patients Using Hospital-based Helicopter Emergency Medical Services in Interhospital Transport" 대한의학회 32 (32): 1187-1194, 2017

13 Jones PG, "Point prevalence of access block and overcrowding in New Zealand emergency departments in 2010 and their relationship to the ‘Shorter Stays in ED’target" 23 : 587-592, 2011

14 Tenbensel T, "New Zealand’s emergency department target: did it reduce ED length of stay, and if so, how and when?" 17 : 678-, 2017

15 Jones P, "Implementing performance improvement in New Zealand emergency departments : the six hour time target policy national research project protocol" 12 : 45-, 2012

16 Rincon F, "Impact of delayed transfer of critically ill stroke patients from the emergency department to the Neuro-ICU" 13 : 75-81, 2010

17 Geelhoed GC, "Emergency department overcrowding, mortality and the 4-hour rule in Western Australia" 196 : 122-126, 2012

18 Minaeian A, "Emergency department length of stay and outcome after ischemic stroke" 26 : 2167-2173, 2017

19 Morris ZS, "Emergency department crowding : towards an agenda for evidencebased intervention" 29 : 460-466, 2012

20 Jain M, "Does prolonged length of stay in the emergency department affect outcome for stroke patients?" 15 : 267-275, 2014

21 Asplin BR, "A conceptual model of emergency department crowding" 42 : 173-180, 2003

22 한갑수 ; 정진우 ; 강형구 ; 김원영 ; 김수진 ; 이성우, "28개 중증상병 진단군에 따른 재실 시간과 입원 후 사망과의 연관성 분석" 대한응급의학회 32 (32): 77-88, 2021