Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals
Objective To evaluate the impact of the 'point to downstream hospital multi-department' emergency medical consortium model between Peking Union Medical College Hospital (PUMCH) and Beijing Longfu Hospital on the treatment of critically ill patients. Methods Clinical data of ICU patients...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Office of Medical Journal of Peking Union Medical College Hospital
2023-11-01
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| Series: | Xiehe Yixue Zazhi |
| Subjects: | |
| Online Access: | https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2023-0215 |
| _version_ | 1797405543092977664 |
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| author | JIANG Hui HAN Mengmeng XU Jun ZHU Huadong LIU Jihai YU Xuezhong SUN Jia LU Yanli SHI Di |
| author_facet | JIANG Hui HAN Mengmeng XU Jun ZHU Huadong LIU Jihai YU Xuezhong SUN Jia LU Yanli SHI Di |
| author_sort | JIANG Hui |
| collection | DOAJ |
| description | Objective To evaluate the impact of the 'point to downstream hospital multi-department' emergency medical consortium model between Peking Union Medical College Hospital (PUMCH) and Beijing Longfu Hospital on the treatment of critically ill patients. Methods Clinical data of ICU patients at Beijing Longfu Hospital from December 2018 to November 2020 were retrospectively collected. The patients were categorized into two groups based on whether the emergency medical consortium was established: the pre-establishment group (December 2018 to November 2019) and the post-establishment group (December 2019 to November 2020). Clinical data, disease spectrum, examination/treatment utilization, and in-hospital mortality were compared between the two groups. Results A total of 350 ICU patients meeting the inclusion and exclusion criteria were included in this study. The pre-establishment group comprised 126 patients, while the post-establishment group had 224 patients(including 162 transferred via the consortium). In the pre-establishment group, the disease spectrum primarily consisted of common critical illnesses, with the top three diseases being acute cardiovascular diseases (34.1%), severe pneumonia (25.4%), and post-surgical cases (19.0%). In the post-establishment group, there was a greater diversity in the disease spectrum, with the top three diseases being severe pneumonia (31.2%), renal dysfunction (13.8%), and acute cerebrovascular disease (9.8%). Compared to the pre-establishment group, the post-establishment group had a lower average age [68.50(57.00, 79.00) years vs. 78.00(68.25, 84.00) years, P < 0.001], higher acute physiology and chronic health evaluation Ⅱ score [18.00(14.00, 24.00) points vs. 15.00(12.00, 22.75) points, P=0.005] and sequential organ failure assessment (SOFA) score [5.00(3.00, 7.25) points vs. 3.00(2.00, 6.00) points, P < 0.001], higher rates of central venous catheterization (52.7% vs. 20.6%, P < 0.001), continuous renal replacement therapy(22.3% vs. 4.0%, P < 0.001), vasoactive drug use (21.4% vs. 11.9%, P=0.037), and epinephrine usage (17.0% vs. 7.1%, P=0.015), and hospital stay [(11.61±9.41)days vs. (10.06±7.63)days, P=0.260], hospital costs [(18 982.35(9251.80, 51 677.59) CNY vs. 39 113.11(19 500.03, 68 981.90) CNY, P=0.067], and in-hospital mortality (12.1% vs. 10.3%, P=0.753) showed no significant changes. Furthermore, after the establishment of the emergency medical consortium, the ICU of Beijing Longfu Hospital admitted and treated 25 cases of difficult-to-treat patients (no difficult-to-treat patients were seen before the establishment of the emergency medical consortium) and used a number of new technologies, including bedside bronchoscopy in 9 cases and bedside ultrasound examination in 105 cases. Multivariable Logistic regression analysis results indicated that after adjusting for factors such as age and SOFA score, the establishment of the emergency medical consortium had no significant impact on in-hospital mortality among ICU patients (OR=0.994, 95% CI: 0.401-2.464, P=0.990). Conclusions After the establishment of the 'point to downstream hospital multi-department' emergency medical consortium between PUMCH and Beijing Longfu Hospital, the complexity and severity of diseases treated in Beijing Longfu Hospital's ICU increased, but the in-hospital mortality rate did not significantly rise. The emergency medical consortium model may contribute to enhancing the capacity for treating critically ill patients in downstream hospitals. |
| first_indexed | 2024-03-09T03:12:29Z |
| format | Article |
| id | doaj.art-fb9188f18cc94e1f87d37006e9d79aad |
| institution | Directory Open Access Journal |
| issn | 1674-9081 |
| language | zho |
| last_indexed | 2024-03-09T03:12:29Z |
| publishDate | 2023-11-01 |
| publisher | Editorial Office of Medical Journal of Peking Union Medical College Hospital |
| record_format | Article |
| series | Xiehe Yixue Zazhi |
| spelling | doaj.art-fb9188f18cc94e1f87d37006e9d79aad2023-12-04T02:42:37ZzhoEditorial Office of Medical Journal of Peking Union Medical College HospitalXiehe Yixue Zazhi1674-90812023-11-011461231123710.12290/xhyxzz.2023-0215Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream HospitalsJIANG Hui0HAN Mengmeng1XU Jun2ZHU Huadong3LIU Jihai4YU Xuezhong5SUN Jia6LU Yanli7SHI Di8Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Critical Care Medicine, Beijing Longfu Hospital, Beijing 100010, ChinaEmergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaEmergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaEmergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaEmergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Critical Care Medicine, Beijing Longfu Hospital, Beijing 100010, ChinaDean's Office, Beijing Longfu Hospital, Beijing 100010, ChinaEmergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaObjective To evaluate the impact of the 'point to downstream hospital multi-department' emergency medical consortium model between Peking Union Medical College Hospital (PUMCH) and Beijing Longfu Hospital on the treatment of critically ill patients. Methods Clinical data of ICU patients at Beijing Longfu Hospital from December 2018 to November 2020 were retrospectively collected. The patients were categorized into two groups based on whether the emergency medical consortium was established: the pre-establishment group (December 2018 to November 2019) and the post-establishment group (December 2019 to November 2020). Clinical data, disease spectrum, examination/treatment utilization, and in-hospital mortality were compared between the two groups. Results A total of 350 ICU patients meeting the inclusion and exclusion criteria were included in this study. The pre-establishment group comprised 126 patients, while the post-establishment group had 224 patients(including 162 transferred via the consortium). In the pre-establishment group, the disease spectrum primarily consisted of common critical illnesses, with the top three diseases being acute cardiovascular diseases (34.1%), severe pneumonia (25.4%), and post-surgical cases (19.0%). In the post-establishment group, there was a greater diversity in the disease spectrum, with the top three diseases being severe pneumonia (31.2%), renal dysfunction (13.8%), and acute cerebrovascular disease (9.8%). Compared to the pre-establishment group, the post-establishment group had a lower average age [68.50(57.00, 79.00) years vs. 78.00(68.25, 84.00) years, P < 0.001], higher acute physiology and chronic health evaluation Ⅱ score [18.00(14.00, 24.00) points vs. 15.00(12.00, 22.75) points, P=0.005] and sequential organ failure assessment (SOFA) score [5.00(3.00, 7.25) points vs. 3.00(2.00, 6.00) points, P < 0.001], higher rates of central venous catheterization (52.7% vs. 20.6%, P < 0.001), continuous renal replacement therapy(22.3% vs. 4.0%, P < 0.001), vasoactive drug use (21.4% vs. 11.9%, P=0.037), and epinephrine usage (17.0% vs. 7.1%, P=0.015), and hospital stay [(11.61±9.41)days vs. (10.06±7.63)days, P=0.260], hospital costs [(18 982.35(9251.80, 51 677.59) CNY vs. 39 113.11(19 500.03, 68 981.90) CNY, P=0.067], and in-hospital mortality (12.1% vs. 10.3%, P=0.753) showed no significant changes. Furthermore, after the establishment of the emergency medical consortium, the ICU of Beijing Longfu Hospital admitted and treated 25 cases of difficult-to-treat patients (no difficult-to-treat patients were seen before the establishment of the emergency medical consortium) and used a number of new technologies, including bedside bronchoscopy in 9 cases and bedside ultrasound examination in 105 cases. Multivariable Logistic regression analysis results indicated that after adjusting for factors such as age and SOFA score, the establishment of the emergency medical consortium had no significant impact on in-hospital mortality among ICU patients (OR=0.994, 95% CI: 0.401-2.464, P=0.990). Conclusions After the establishment of the 'point to downstream hospital multi-department' emergency medical consortium between PUMCH and Beijing Longfu Hospital, the complexity and severity of diseases treated in Beijing Longfu Hospital's ICU increased, but the in-hospital mortality rate did not significantly rise. The emergency medical consortium model may contribute to enhancing the capacity for treating critically ill patients in downstream hospitals.https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2023-0215emergency medical consortiumreferraldownstream hospitalsequential treatment |
| spellingShingle | JIANG Hui HAN Mengmeng XU Jun ZHU Huadong LIU Jihai YU Xuezhong SUN Jia LU Yanli SHI Di Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals Xiehe Yixue Zazhi emergency medical consortium referral downstream hospital sequential treatment |
| title | Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals |
| title_full | Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals |
| title_fullStr | Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals |
| title_full_unstemmed | Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals |
| title_short | Impact of the Emergency Department Medical Consortium Model on Patients in Intensive Care Units at Downstream Hospitals |
| title_sort | impact of the emergency department medical consortium model on patients in intensive care units at downstream hospitals |
| topic | emergency medical consortium referral downstream hospital sequential treatment |
| url | https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2023-0215 |
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