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Evaluation of pneumonia management effectiveness associated with internal medicine management changes in the emergency department: a retrospective cohort study using a historically controlled group

대한응급의학회지 2020년 31권 2호 p.246 ~ 253
유정우 ( Yoo Jung-Woo ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine

 ( Ryu Seung ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
정원준 ( Jeong Won-Joon ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
조영철 ( Cho Yong-Chul ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
안홍준 ( Ahn Hong-Joon ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
조성욱 ( Cho Seong-Wook ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
오세광 ( Oh Se-Kwang ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
박정수 ( Park Jung-Soo ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine
유연호 ( Yoo Yeon-Ho ) - Chungnam National University College of Medicine Chungnam National University Hospital Department of Emergency Medicine

Abstract


Objective: In Korea, many hospitals have recently changed the process of internal medicine management in the emergency department (ED) because of reduced manpower, raising concerns regarding the decreased quality of medical care. The process of medical management in the ED was streamlined to resolve the reduced manpower. Thus, this study compared the pneumonia treatment effectiveness before and after the process changes.

Method: This study included patients who were diagnosed with pneumonia in the ED and hospitalized from January 2014 to December 2016. They were divided into two groups based on before and after the changes. The disease severity, management adequacy, and prognosis were compared using the initial quick sequential organ failure assessment score (qSOFA), systemic inflammatory response syndrome criteria (SIRS), CURB-65 score, door-to-antibiotic time (DAT), length of stay (LOS), hospitalization period (HP), and in-hospital mortality, were collected retrospectively from the medical records.

Results: The qSOFA, SIRS, and CURB-65 scores did not differ between the two groups. The median (interquartile range) DAT, LOS, and HP were reduced after the process changes: DAT (160.0 minutes [111.0-230.0] vs. 120.0 minutes [74.0-175.0], P<0.001), LOS (7.6 hours [4.8-15.8] vs. 4.7 hours [3.2-6.8], P<0.001), and HP (9.0 days [6.0-16.0] vs. 8.0 days [5.0-15.0], P=0.011). On the other hand, the in-hospital mortality was similar in the two groups (14.1% vs. 11.2%, P=0.162).

Conclusion: The DAT, LOS, and HP decreased after the process changes, but the in-hospital mortality did not worsen. This shows that pneumonia management in the ED was not compromised, but rather improved, after the changes.

키워드

Door-to-treatment time; Length of stay; Pneumonia; Process assessment
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