Study Of Disease Spectrum And Attending Behaviors Of The Physical Emergency Department Attendants In Huashan Hospital

Objective: To describe disease spectrum and attending behaviors of the physical emergency department attendants in Huashan hospital, and the disease ratio that can be treated firstly in primary hospital, to explore the reasons that patients take emergency room of the tertiary hospital as their first choice. Meanwhile, suggestion can be provided to save medical costs, to avoid excessive waste of medical resources, as well as to ensure patients to get better health care and to adopt a more reasonable act.Methods: For the first part, using stratified random sampling method and choosing a random week for every month during 2008, the patients' diagnosis and the ratio that can be treated firstly in the primary hospital is recordedFor the second part, using stratified random sampling methods, we record the sex, age, address, diagnosis and others information of prior 10 patients in the investigator' s working days in the first week of every mouth from March 2008 to March 2009, the reasons that they choose the emergency room of our hospital, their past medical experience and factors that determine their choice of hospital.Results: For the first part, from January 2008 to December 2008, data of 13659 cases is collected. 39.5% of these patients can be treated firstly in primary hospital, whose diseases cover respiratory system, digestive system, urinary system and cardiovascular system. Among them, the proportion of patients who suffer from upper respiratory tract infection is the highest. Many diseases show a trend of seasonal fluctuations such as fever, cough, pneumonia, bronchitis, bronchiectasis, acute (suppurative) tonsillitis, stomach (intestinal) diseases, peptic ulcer and etc.For the second part, from March 2008 to March 2009, data of 610 cases is collected (474 is first visit to a doctor, 136 is subsequent visit). There is different distribution such as gender, symptoms and diagnosis between the first visit to a doctor and the subsequent visit. Among the first visit to a doctor, nearly half choose our emergency room as their first choice due to close range, and nearly 1/3 choose our emergency room as their first choice due to trusting to tertiary hospital. Among the subsequent visit, there are 93.4% patients who chose other medical agency is due to near to the hospital, and nearly half of patients got re-treatment in Huashan hospital because of their no recovery during three days. The majority of patients would choose our hospital when they need choose some hospital for subsequent treatment.Conclusion: The proportion of patients who suffer from respiratory disease is the highest. Many diseases show a trend of seasonal fluctuations. Many patients will visit doctor during the first day, even twice during the same day. Most patients will choose a near hospital firstly. However, many patients will think about medical ability of the hospital too, especially when more people have owned their car. The characteristics of a hospital will also affect patients' decision. Among patients who came to tertiary hospital, there are nearly 40% of patients may be treated firstly in primary hospital, and about 30% of them go to our hospital due to no trust to primary hospital. So it is extreme necessary to make sure the responsibility of different medical agency level, to improve medical ability of primary hospital. And implementing emergency access standards strictly is a good way to save medical resource and cost. Primary hospital should improve their medical skill so as to alleviate the medical pressure of tertiary hospitals.