Zorgconsumptie van ernstig zieke patiënten op de SEH

O'connor G, Geary U, Moriarty J. Critical care in the emergency department. Eur J Emerg Med 2009 Dec;16(6):296-300

ACHTERGROND: Het aantal ernstig zieke patiënten op de spoedeisende hulp afdelingen neemt toe en ook de duur van het verblijf neemt toe. Dit wordt beïnvloed door factoren als case-mix, overbevolking, gebrek aan beschikbaar personeel en intensive care-bedden en een vergrijzende bevolking. Het doel van deze studie was om de klinische activiteit die in verband wordt gebracht met deze patiënten te beschrijven en het zorggebruik door deze groep patiënten te kwantificeren.

BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands

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