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J Korean Soc Emerg Med > Volume 31(5); 2020 > Article
Journal of The Korean Society of Emergency Medicine 2020;31(5): 518-525.
중증상병코드환자의 응급실 재실 시간 평가지표 분석 및 적합성에 대한 고찰
백승민1, 서동우2,3, 김윤정2, 정진우4, 강형구5, 한갑수6, 김수진6, 이성우6, 김원영2
1서울아산병원 응급의학과
2울산대학교 의과대학 서울아산병원 응급의학과
3울산대학교 의과대학 서울아산병원 의생명정보학과
4동아대학교 의과대학 응급의학교실
5한양대학교 의과대학 응급의학교실
6고려대학교 의과대학 응급의학교실
Analysis of emergency department length of stay in patient with severe illness code
Seung-Min Baek1, Dong-Woo Seo2,3, Youn-Jung Kim2, Jinwoo Jeong4, Hyunggoo Kang5, Kap Su Han6, Su Jin Kim6, Sung Woo Lee6, Won Young Kim2
1Department of Emergency Medicine, Asan Medical Center, Seoul, Korea
2Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Biomedical Informatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
4Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
5Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
6Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
Correspondence  Won Young Kim ,Tel: 02-3010-3350, Fax: 02-3010-3360, Email: wonpia73@naver.com,
Received: October 20, 2019; Revised: March 10, 2020   Accepted: March 28, 2020.  Published online: October 30, 2020.
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.
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.
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.
A more suitable quality indicator or criterion for severe illness code is required for improving the clinical outcomes.
Key words: Length of stay; Administration; Healthcare quality indicator
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