AbstractObjectivePatient crowding and boarding in the emergency department (ED) is associated with adverse outcomes and has become increasingly problematic in recent years. We investigated the impact of an ED patient flow countermeasure using an early warning score.MethodsWe conducted a cross‐sectional analysis of observational data from patients who presented to the ED of a Level 1 Trauma Center in Pennsylvania. We implemented a modified version of the Modified Early Warning Score (MEWS), called mMEWS, to address patient flow. Patients aged ≥18 years old admitted to the adult hospital medicine service were included in the study. We compared the pre‐mMEWS (February 19, 2017–February 18, 2019) to the post‐mMEWS implementation period (February 19, 2019–June 30, 2020). During the intervention, low MEWS (0–1) scoring admissions went directly to the inpatient floor with expedited orders, the remainder waited in the ED until the hospital medicine admitting team evaluated the patient and then placed orders. We investigated the association between mMEWS, ED length of stay (LOS), and 24‐hour rapid response team (24 hour‐RRT) activation. RRT activation rates were used as a measure of adverse outcome for the new process and are a network team response for admitted patients who are rapidly decompensating. The association between mMEWS and the outcomes of ED length of stay in minutes and 24 hour‐RRT activation was assessed using linear and logistic regression adjusting for a priori selected confounders, respectively.ResultsOf the total 43,892 patients admitted, 19,962 (45.5%) were in the pre‐mMEWS and 23,930 (54.5%) in the post‐mMEWS implementation period. The median post‐mMEWS ED LOS was shorter than the pre‐mMEWS (376 vs 415 minutes; P < 0.01). After accounting for potential confounders, there was a 4.57% decrease in the ED LOS after implementing mMEWS (95% confidence interval [CI], 4.20–4.94; P < 0.01). The proportion of 24 hour‐RRT did not differ significantly when comparing pre‐ and post‐mMEWS (33.5% vs 34.4%; P = 0.83).ConclusionThe use of a modified MEWS enhanced admission process to the hospital medicine service, even during the COVID‐19 pandemic, was associated with a significant decrease in ED LOS without a significant increase in 24 hour‐RRT activation.

中文翻译：

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定制的早期预警评分增强了 COVID-19 大流行中急诊科患者流程和临床结果


摘要目的急诊科 (ED) 的患者拥挤和寄宿与不良后果相关，并且近年来问题日益严重。我们使用早期预警评分调查了急诊科患者流动对策的影响。方法我们对宾夕法尼亚州 1 级创伤中心急诊科就诊的患者的观察数据进行了横断面分析。我们实施了改良早期预警评分 (MEWS) 的修改版本，称为 mMEWS，以解决患者流量问题。年龄≥18岁入住成人医院医疗服务的患者被纳入研究。我们将mMEWS实施前（2017年2月19日至2019年2月18日）与mMEWS实施后（2019年2月19日至2020年6月30日）进行了比较。在干预期间，MEWS（0-1）得分较低的入院患者直接进入住院楼层并接受加急医嘱，其余患者则在急诊室等待，直到医院医学入院团队对患者进行评估，然后下医嘱。我们研究了 mMEWS、急诊科住院时间 (LOS) 和 24 小时快速反应团队 (24 小时 RRT) 激活之间的关联。 RRT 激活率被用来衡量新流程的不良结果，并且是网络团队针对快速失代偿的入院患者的反应。分别使用线性回归和逻辑回归调整先验选择的混杂因素来评估 mMEWS 与 ED 住院时间（以分钟为单位）和 24 小时 RRT 激活结果之间的关联。结果 在总共 43,892 名入院患者中，19,962 名（45.5%）处于治疗状态mMEWS 实施前的人数为 23,930 人（54.5%）。 mMEWS 后的中位 ED LOS 比 mMEWS 前短（376 分钟 vs 415 分钟；P < 0.01）。 考虑到潜在的混杂因素后，实施 mMEWS 后 ED LOS 降低了 4.57%（95% 置信区间 [CI]，4.20–4.94；P< 0.01）。比较 mMEWS 前后的情况，24 小时 RRT 的比例没有显着差异（33.5% vs 34.4%；P = 0.83）。 结论 使用改进的 MEWS 增强了医院医疗服务的入院流程，即使在新冠疫情期间也是如此‐19 大流行与 ED LOS 显着降低相关，但 24 小时 RRT 激活没有显着增加。