Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Increased Length of Stay in Emergency Department in Turkey: Due to Inappropriate Emergency Department Use or Aging?
Acil Serviste Uzun Süreli Yatışlar: Acilin Uygunsuz Kullanımı mı, Yaşlılığın Sonucu mu?
Müge GÜNALPa, Behnan GÜLÜNAYa, Onur POLATa, Serdar GÜRLERa, Arda DEMİRKANa, Meltem AKKAŞb, Nalan METİN AKSUb
aDepartment of Emergency Medicine, Ankara University Faculty of Medicine,
bDepartment of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara
Turkiye Klinikleri J Med Sci. 2014;34(3):273-9
doi: 10.5336/medsci.2013-34423
Article Language: EN
Full Text
ABSTRACT
Objective: Emergency department (ED) crowding has long been recognized as a ''crisis'' in Turkey. The reasons for overcrowding are high number of patients, limited capacity of in-patient clinics, patients aged 65 years of age or older, and a prolonged length of stay in ED. This study aimed to investigate the causes of increased ED stay in a university hospital, in Turkey. Material and Methods: This was a prospective observational study carried out over 3 months. We evaluated the data of the outpatients and patients transferred by ambulance to the ED of a university hospital in Turkey. Age, gender, triage scores, date and time of presentation, discharge date and time, definitive diagnosis time, diagnosis categories, and the length of stay in ED were analyzed. Results: The mean age of 1311patients was 57.68±19.35 years.The mean diagnosis time of the patients was 459.38 minutes (7.39±0.73 hours), and the mean ED stay was 2134 minutes (35.29±3.29 hours). The rate of the patients over 65 years of age (41%) ranked the highest among three age groups. The early discharge rate of the older patients was significantly lower, and their hospitalization duration was significantly higher. At the end of initial 48 hours, 625 patients (47.6%) were discharged; only 55 patients (4,1%) could be transferred and hospitalized in the related clinics, while 545 patients (41.5%) were followed-up at the Observation and Clinical Decision Unit by emergency physicians. Conclusion: In our study, it was determined that longer than 48-hour delay in transferring the patients to the clinics, and the patients ≥ 65 years of age were the most important reasons for prolonged length of stay in the ED.

Keywords: Length of stay; emergency medical services; aged
ÖZET
Amaç: Günümüzde acil servislerdeki (AS) hasta kalabalığı Türkiye'de önemli bir sorun haline gelmiştir. AS'nin aşırı kalabalık olmasının birçok sebebi vardır. Bu faktörlerin bazıları, hasta sayısının fazlalığı, yataklı servislerin kapasitelerinin yetersizliği, ve 65 yaş ve üzeri hasta grubu ve acil serviste uzun süreli yatışlardır. Bu çalışmamızda, AS'de yaşanan aşırı yoğunluğun ve uzun yatışların sebepleri araştırılmıştır. Gereç ve Yöntemler: Ankara Üniversitesi Acil Tıp Anabilim Dalında 01 Temmuz 2010-01 Ekim 2010 tarihleri arasında yürütülen bu prospektif gözlemsel çalışmada, acil servise ayaktan ve ambulans ile başvuran hastaların kayıtları tutulmuştur. Hastalara ait yaş, cinsiyet, triaj skorları, başvuru tarih ve saati, taburcu tarih ve saati,tanılarının ne zaman kesinleştiği ve acil serviste kalış süreleri kaydedilmiştir. Bulgular: 1311 hastanın yaş ortalaması 57,68±19,35 yıl olarak tespit edildi. AS'de hastaların ortalama tanı alma süresi 459,38 dakika (7,39±0,73 saat) ve ortalama kalış süresi 2134 dakika (35,29±3,29 saat) olarak saptandı. Altmış beş yaş üzeri hasta grubu %41 oranla acil servisimize başvuran üç ayrı yaş grubu içinde ilk sırayı aldı. AS'de yaşlı hastaların erken dönemde taburcu olma oranları anlamlı olarak düşük, hastanede kalış süreleri diğer yaş gruplarından anlamlı olarak yüksek bulundu (p<0,001). İlk 48 saatin sonunda; 625 hastanın (%47,6) acil servisten taburcu edildiği, 55 hastanın (%4,1) ilgili kliniklere nakledilebildiği, buna karşın 545 (%41,5) hastanın acil servis gözlem ünitesinde acil doktorları tarafından izlenip tedavi aldıkları saptandı. Sonuç: Altmış beş yaş üzeri hasta grubunun ve tanısı konarak tedavisi sürdürülecek hastaların transferlerindeki 48 saati aşan gecikmenin acil servis kalabalığının en önemli nedeni olduğunu belirlendi.

Anahtar Kelimeler: Yatış süresi; acil tıbbi servisler; yaşlı

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