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중증상병코드환자의 응급실 재실 시간 평가지표 분석 및 적합성에 대한 고찰Analysis of emergency department length of stay in patient with severe illness code

Other Titles
Analysis of emergency department length of stay in patient with severe illness code
Authors
백승민서동우김윤정정진우강형구한갑수김수진이성우김원영
Issue Date
2020
Publisher
대한응급의학회
Keywords
Length of stay; Administration; Healthcare quality indicator
Citation
대한응급의학회지, v.31, no.5, pp.518 - 525
Indexed
KCI
Journal Title
대한응급의학회지
Volume
31
Number
5
Start Page
518
End Page
525
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/131125
ISSN
1226-4334
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.
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