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Measuring the health and cost conseq...

Wilson, Michael.

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Measuring the health and cost consequences of emergency department overcrowding.

紀錄類型:	書目-語言資料,印刷品 : Monograph/item
正題名/作者:	Measuring the health and cost consequences of emergency department overcrowding./
作者:	Wilson, Michael.
面頁冊數:	271 p.
附註:	Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: 2948.
Contained By:	Dissertation Abstracts International71-05B.
標題:	Economics, General. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3410065
ISBN:	9781109779547

Measuring the health and cost consequences of emergency department overcrowding.
Wilson, Michael.

Measuring the health and cost consequences of emergency department overcrowding. - 271 p.

Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: 2948.

Thesis (Ph.D.)--The Johns Hopkins University, 2010.

A review of the EM literature demonstrates that ED overcrowding is widely seen as having a negative impact on the quality of care offered in hospital based emergency departments. However, there have been few studies outlining the differences in mortality, emergency department (ED) charges, or hospital length of stay associated with ED overcrowding.

ISBN: 9781109779547Subjects--Topical Terms:

1017424
Economics, General.

Measuring the health and cost consequences of emergency department overcrowding.
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245 1 0 $a Measuring the health and cost consequences of emergency department overcrowding.
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500 $a Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: 2948.
500 $a Adviser: Ellen MacKenzie.
502 $a Thesis (Ph.D.)--The Johns Hopkins University, 2010.
520 $a A review of the EM literature demonstrates that ED overcrowding is widely seen as having a negative impact on the quality of care offered in hospital based emergency departments. However, there have been few studies outlining the differences in mortality, emergency department (ED) charges, or hospital length of stay associated with ED overcrowding.
520 $a The study is a retrospective observational study of elderly Medicare patients from the state of Maryland who were admitted to the hospital from an ED between January 2002 and December 2005. The specific medical conditions examined are pneumonia, acute coronary syndrome (ACS) and sepsis. The primary independent variable in this study is the presence of EMS diversion, which is used as a proxy for ED overcrowding. The types of EMS diversion used in this study are yellow alert (when the ED is unable to safely care for more ED patients) and red alert (when the hospital does not have additional beds with telemetry capabilities). The main outcomes of the study are 30 day in hospital mortality, hospital length of stay (LOS), and hospital charges associated with inpatient stay.
520 $a This study demonstrates that ED overcrowding is a pervasive problem in the state of Maryland with hospitals spending 44.45% of the days of the year with some time on yellow alert, corresponding to 12.76% of their entire operating time. These results vary widely between hospitals, with Maryland hospitals spending between 0.27% to 87.13% of the days, and 0.15% and 40.17%.of the hospital's total operating time on yellow alert.
520 $a Sepsis patients in the state of Maryland exposed to yellow alert have a 7.99% (p=0.03) increase in mortality, ranging from 1.65% (p=0.72) to 36.20%. (p=0.10) with increasing exposure to yellow alert. For sepsis patients in the Baltimore City market, the increase in mortality is 12.14% (p=0.13). Furthermore, while there no statewide increase in mortality for ACS patients exposed to yellow alert, in the Baltimore City market, there is a 33.57% (p=0.05) increase in mortality for those patients.
520 $a These results demonstrate that ED overcrowding is a pervasive problem in the state of Maryland and one that leads to excess mortality for patients at most risk of harm.
590 $a School code: 0098.
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791 $a Ph.D.
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