مجله علوم پزشکی پارس

ارزیابی علل تاخیر در تعیین تکلیف بیماران اورژانس از منظر پزشکان، پرستاران، کمک بهیاران و منشی ها در بخش اورژانس بیمارستان قائم مشهد

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه طب اورژانس، دانشگاه علوم پزشکی اجا، تهران، ایران

2 دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 گروه پرستاری، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

4 استادیار گروه طب اورژانس، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

5 دانشیار گروه طب اورژانس، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

6 دانشیار گروه طب اورژانس، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

چکیده

مقدمه: عوامل متعددی روی مدت زمان تعیین تکلیف بیماران تاثیر دارند و باعث طولانی شدن این زمان در بخش اورژانس می شود. هدف از انجام مطالعه حاضر، بررسی علل تاخیر در تعیین تکلیف بیماران بستری شده در بخش اورژانس بیمارستان قائم مشهد از نظر پزشکان، پرستاران، کمک بهیاران و منشی های بخش بود.
روش کار: این مطالعه توصیفی - مقطعی روی 129 نفر از کارکنان اورژانس بیمارستان قائم شهرستان مشهد در سال 1401 انجام شد. ابزار گردآوری اطلاعات شامل دو پرسش نامه اطلاعات جمعیت شناختی و پرسش نامه محقق ساخته ارزیابی علل تاخیر در تعیین تکلیف بیماران اورژانس بود. داده ها با استفاده از نرم افزار SPSS نسخه 21 و آمار توصیفی شامل میانگین، درصد و انحراف معیار تحلیل شدند.
یافته ها: میانگین سنی افراد شرکت کننده 8.0±34.7 سال و سابقه کار آن ها 8.0±8.7 سال بود. 62 نفر (48.1 درصد) پرستار، 34 نفر پزشک (26.4 درصد)، 15 نفر (11.6درصد) بهیار و 4 نفر (3.1 درصد) منشی بودند. شلوغی بیش از حد اورژانس و کمبود نیروی پرستاری، عدم ویزیت به موقع توسط دستیاران ارشد شیفت و پراکنده بودن پرونده ها به ترتیب بیشترین اهمیت را در تعیین تکلیف بیماران داشتند. از نظر پزشکان و پرستاران شلوغی بیش از حد اورژانس و کمبود نیروی پرستاری، از نظر کمک بهیاران تحویل پرونده و دستور پزشک به پرستار، و از نظر منشی ها آغاز درمان/ثبت دارو و آزمایش ها در سیستم مهم ترین علل تاخیر در تعیین تکلیف بیماران بودند.
نتیجه گیری: نتایج این مطالعه نشان داد که شلوغی بیش از حد اورژانس و کمبود نیروی پرستاری و عدم ویزیت به موقع توسط دستیاران ارشد شیفت از علل اصلی تاخیر در تعیین تکلیف بیماران از نظر کادر درمان بوده است.

تازه های تحقیق

-

کلیدواژه‌ها

عنوان مقاله [English]

Evaluation of the reasons for delay in Disposition in the emergency department from the perspective of physicians, nurses, and other personnel at Ghaem Hospital, Mashhad

نویسندگان [English]

  • Masoud Shahabian 1
  • Razieh Hasan Ghasemi 2
  • Abolfazl Rajabi 3
  • Sayyed Majid Sadrzadeh 4
  • Behrang Rezvani Kakhki 5
  • Mehdi Foroughian 6

1 Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran.

2 Student research committee, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran

4 Assistant professor of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Associated professor of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Associated Professor of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

چکیده [English]

Introduction: A number of factors affect the duration of assignment of patients and prolong this time in the emergency
department. The purpose of this study is to investigate the causes of delay in determining the assignment of patients admitted to the emergency department of Ghaem Hospital in Mashhad from the point of view of doctors, nurses, paramedics and department secretary.
Materials and Methods: This cross-sectional descriptive study was conducted on 129 emergency personnel of Ghaem hospital in Mashhad city in 2022. The data collection tool in this study includes two demographic information questionnaires and a researcher-made questionnaire to assess the causes of delay in determining the assignment of emergency patients. Data analysis was done using spss software version 21 and descriptive statistics and inferential statistical tests.
Results: The average age of the participants was 34.7±8.0 years and their work experience was 8.7±8.0 years. 62 patients (48.1%) were nurses, 34 patients were doctors (26.4%), 15 patients (11.6%) were paramedics, and 4 patients (3.1%) were secretaries. Overcrowding of the emergency room and lack of nursing staff, lack of timely visits by senior shift assistants, and scattered cases were respectively the most important in determining patients' assignments. From the point of view of doctors and nurses, overcrowding of the emergency room and lack of nursing staff, from the point of view of paramedics,
handing over the file and doctor's order to the nurse, and from the point of view of the secretary, the initiation of treatment/recording of drugs and tests in the system were the most important causes of delay in determining the patient's assignment.
Conclusion: The results of this study showed that overcrowding of the emergency room, shortage of nursing staff, and lack of timely visits by senior shift assistants are the main causes of delay in determining patients' assignments from the point of view of the treatment staff.
 

کلیدواژه‌ها [English]

  • Physician
  • Nurse
  • Emergency department
  • Congestion
  • Causes of delay
Savioli G, Ceresa IF, Gri N, Bavestrello Piccini G,
Longhitano Y, Zanza C, et al. Emergency department
overcrowding: understanding the factors to find
corresponding solutions. Journal of personalized
medicine. 2022;12(2):279.
2.Salway R, Valenzuela R, Shoenberger J, Mallon W,
Viccellio A. Emergency department (ED)
overcrowding: evidence-based answers to frequently
asked questions. Revista Médica Clínica Las Condes.
2017;28(2):213-9.
3.Rabin E, Kocher K, McClelland M, Pines J, Hwang U,
Rathlev N, et al. Solutions to emergency department
‘boarding’and crowding are underused and may need
to be legislated. Health Affairs. 2012;31(8):1757-66.
علل تاخیر در تعیین تکلیفبیماران اورژانس از منظر پزشکان، پرستاران، کمک بهیارانو منشی هامسعود شهابیان و همکاران
مجله علوم پزشکی پارس، دورهبیستم، شمارهسه،پاییز4154
06
4.Sprivulis P. Estimation of the general practice
workload of a metropolitan teaching hospital
emergency department. Emergency Medicine.
2003;15(1):32-7.
5.Dent AW, Phillips GA, Chenhall AJ, McGregor LR.
The heaviest repeat users of an inner city emergency
department are not general practice patients.
Emergency Medicine. 2003;15(4):322-9.
6.Nagree Y, Ercleve TN, Sprivulis PC. After-hours
general practice clinics are unlikely to reduce low
acuity patient attendances to metropolitan Perth
emergency departments. Australian Health Review.
2004;28(3):285-91.
7.Savioli G, Ceresa IF, Novelli V, Ricevuti G, Bressan
MA, Oddone E. How the coronavirus disease 2019
pandemic changed the patterns of healthcare
utilization by geriatric patients and the crowding: A
call to action for effective solutions to the access
block. Internal and Emergency Medicine.
2022;17(2):503-14.
8.Savioli G, Ceresa IF, Guarnone R, Muzzi A, Novelli
V, Ricevuti G, et al. Impact of coronavirus disease
2019 pandemic on crowding: a call to action for
effective solutions to “access block”. Western Journal
of Emergency Medicine. 2021;22(4):860.
9.Richardson DB, Mountain D. Myths versus facts in
emergency department overcrowding and hospital
access block. Medical Journal of Australia.
2009;190(7):369-74.
10.Derose SF, Gabayan GZ, Chiu VY, Yiu SC, Sun BC.
Emergency department crowding predicts admission
length-of-stay but not mortality in a large health
system. Medical care. 2014;52(7):602.
11.Nippak P, Isaac W, Ikeda-Douglas C, Marion A,
VandenBroek M. Is there a relation between
emergency department and inpatient lengths of stay.
Can J Rural Med. 2014;19(1):12-20.
12.Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA.
Association between waiting times and short term
mortality and hospital admission after departure from
emergency department: population based cohort study
from Ontario, Canada. Bmj. 2011;342.
13.Richardson DB. Increase in patient mortality at 10
days associated with emergency department
overcrowding. Medical journal of Australia.
2006;184(5):213-6.
14.Schull MJ, Vermeulen M, Slaughter G, Morrison L,
Daly P. Emergency department crowding and
thrombolysis delays in acute myocardial infarction.
Annals of emergency medicine. 2004;44(6):577-85.
15.Hwang U, Richardson LD, Sonuyi TO, Morrison RS.
The effect of emergency department crowding on the
management of pain in older adults with hip fracture.
Journal of the American Geriatrics Society.
2006;54(2):270-5.
16.McCarthy ML, Zeger SL, Ding R, Levin SR,
Desmond JS, Lee J, et al. Crowding delays treatment
and lengthens emergency department length of stay,
even among high-acuity patients. Annals of
emergency medicine. 2009;54(4):492-503. e4.
17.Pines JM, Garson C, Baxt WG, Rhodes KV, Shofer
FS, Hollander JE. ED crowding is associated with
variable perceptions of care compromise. Academic
Emergency Medicine. 2007;14(12):1176-81.
18.Pines JM, Iyer S, Disbot M, Hollander JE, Shofer FS,
Datner EM. The effect of emergency department
crowding on patient satisfaction for admitted patients.
Academic Emergency Medicine. 2008;15(9):825-31.
19.Medicine ACfE. ACEM Workforce Sustainability
Survey Report, November 2016. 2016.
20.Asadi P, Kasmaie VM, Zohrevandi B, Ziabari SMZ,
Marzbani B. Disposition of patients before and after
establishment of emergency medicine specialists. Iran
J Emerg Med. 2014;1(1):28-33.
21.Akbari M. Time indices and its related factors in the
emergency department of teaching hospitals affiliated
to Qom University of Medical Sciences, 2017. Iranian
Journal of Emergency Care. 2017;1(3):48-58.
22.Khazaei A, Khatiban M, Saeidi S, Karamporian A,
Soltanian A, KIMIAIE AH, et al. Evaluation of factors
affecting emergency department length of stay. 2015.
23.Derlet RW, Richards JR. Overcrowding in the
nation’s emergency departments: complex causes and
disturbing effects. Annals of emergency medicine.
2000;35(1):63-8.
24.Topacoglu H, Karcioglu O, Ozucelik N, Ozsarac M,
Degerli V, Sarikaya S, et al. Analysis of factors
affecting satisfaction in the emergency department: a
survey of 1019 patients. Advances in therapy.
2004;21:380-8.
25.Forster AJ, Stiell I, Wells G, Lee AJ, Van Walraven
C. The effect of hospital occupancy on emergency
department length of stay and patient disposition.
Academic Emergency Medicine. 2003;10(2):127-33.
26.Ramsey Z, Palter JS, Hardwick J, Moskoff J,
Christian EL, Bailitz J. Decreased nursing staffing
adversely affects emergency department throughput
metrics. Western Journal of Emergency Medicine.
2018;19(3):496.
27.Nasr-Esfahani M, Esmailian M, Nasri M. Causes of
prolonged length of stay for patients referred to the
emergency department; a cross-sectional study. Iran J
Emerg Med. 2014;1(1):45-9.
28.Hoot NR, Aronsky D. Systematic review of
emergency department crowding: causes, effects, and
solutions. Annals of emergency medicine.
2008;52(2):126-36. e1.
29.Ay D, Akkas M, Sivri B. Patient population and
factors determining length of stay in adult ED of a
Turkish University Medical Center. The American
journal of emergency medicine. 2010;28(3):325-30.
.30 Hosseininejad SM, Aminiahidashti H, Pashaei SM,
Khatir IG, Montazer SH, Bozorgi F, et al.
Determinants of prolonged length of stay in the
emergency department; a cross-sectional study.
Emergency. 2017; 5(1);1-6.
مجله علوم پزشکی پارس
دوره 20، شماره 3
مهر 1401
صفحه 60-70