| Research BackgroundInjury refers to the destruction of tissues or organs on human body caused by external mechanical factors,which has high incidence and serious harm.The China Injury Research Work Report(2011)showed that the annual death of various types of injuries had reached 700,000 in Chinese,injury was accounted for the fifth place among all causes of death,and it was the leading reason for the death and disability in population that under 45 years old.Due to the factors affecting injured patients' outcome are complex,and timely and effective emergency treatment can affect injured patients' mortality.Therefore,it is important to analyze the factors influencing injured patients' outcome and to optimize the human resources allocation in emergency department.Research Purposes and SignificanceThe aims of this paper were to examine how to reduce the death risk of injured patients from two aspects(the medical staff aspect and the hospital manager aspect).First,through the retrospective analysis,we could observe the demographic characteristics,injury characteristics and treatment information of injury,conduct a comparative analysis of the distribution between single-region injury and multiple injuries,explore the risk factors that affect injured patients' outcome,and provide some constructive opinions for medical staff to improve the treatment ability for injured patients.Second,through the exploratory study of emergency treatment process for injured patients,we could analyse the effect of human resources adjustment on emergency treatment efficiency.So as to improved the rescue ability when the medical demand of emergency was surged,and to provide theoretical support for hospital managers to take a rational human resources allocation pattern that based on the inflow of injury patients and its' injury severity.Research ContentsThe research content consists of two parts:(1)The analysis of influencing factors of 8273 injured patients' outcomeThe retrospective analysis was carry out in three tertiary hospitals in Shanghai,we used the hospital information system(HIS)to collect the medical records of injury patients(including traffic-related injuries;fall from height injuries;penetrating injuries;machinery injuries;ground-level fall injuries;and firearm injuries,during the period from January 2011 to January 2015).Based on the 8273 cases results,we established the injury background database with three dimensions(demographic characteristics,injury characteristics and injury treatment information).Taking use of statistical methods to describe the distribution of injury,and the influencing factors of injured patients' outcome were analysed by univariate analysis and multivariate analysis.(2)Modeling research on human resources allocation in emergency for injured patientsThis study took use of the discrete event simulation method and AnyLogic software to imply the research of human resources allocation in emergency department.Through the analysis and integration of the basic process of emergency injury treatment in tertiary hospitals(including injury patients arrived at hospital,triage,diagnosis and treatment),in order to analyze the impact of expert doctor,general doctor and nurse numbers on emergency treatment effective(the evaluation indicators included patients' mortality,the stay time in emergency and human resource utilization),and to explore the better human resource allocation pattern under different instantaneous injured patients inflows.Research MethodsThis study used literature review,retrospective analysis,statistical analysis,site tracking,interview and discrete event simulation methods.Research Results(1)The distribution of injury patients(8273 cases)A total of 8273 injury patients were included in this study,including 4734 males(57.2%),the male to female rate was 1.3:1,and the population who order than 55 years old had a high incidence of injury.The injury mechanism analysis: ground-level fall(53.5%)and traffic accident(29.0%)were the main cause of injury.The injury condition analysis: fracture and joint injury(85.1%)and skin and soft tissue injury(37.3%)were the most common injury condition.The body region analysis: extremity(67.2%)and head(27.5%)were the most common injury region.The injury severity analysis: patients with minor injuries accounted for 41.4% and patients with moderate injuries accounted for 44.1%.The number of body regions analysis: 6385 cases(77.2%)were single-region injury and 1888 cases(22.8%)were multiple injuries.The further analysis of the distribution of single-region injury and multiple injuries showed that: the population who order than 65 years old had the highest incidence of single-region injury(33.0%),the common population of multiple injuries were 45-64 years old(43.9%).The main injury mechanism of single-region injury was ground-level fall(63.6%),and the main injury mechanism of multiple injuries was traffic(51.5%).The most common injury condition of single-region injury patients was fractures and joint injuries(63.2%).The proportion of fractures and joint injuries,pulmonary contusion,traumatic hemopneumothorax and traumatic organ injuries among multiple injuries patients were 37.9%,10.9%,5.7% and 3.6%,respectively.95.9% of single-region injury patients had the AIS scores less than 3 points,and the proportion of serious and critical injuries among multiple injuries patients were 27.0% and 22.9%,respectively.Among the 1888 multiple injuries patients,the proportion of disturbance of consciousness,bacterial infection,paraplegia and hemorrhagic shock were 31.4%,11.8%,8.2% and 8.0%,respectively,and the patients with severe coma accounted for 3.3%.The treatment information analysis: emergency department admission(60.3%)was the main admission pathway of injury patients.The pre-hospital time of injury patients was generally longer,only 2.3% of patients whose pre-hospital time ?1 hour.59.7% of injury patients whose length of stay were between 4 to 7 days,and the median of the length of stay among the ground-level fall injuries,fall from height injuries,penetrating injuries,machinery injuries,and traffic-related injuries were 9 days,11 days,8.5 days,12 days and 13 days,respectively.67.9% of injured patients were cured and 1.7% were died.The highest incidence complications were disturbance of consciousness(15.4%),followed by bacterial infection(4.6%)and paralysis(3.5%).(2)The analysis of influencing factors of injured patients' outcome(8273 cases)The analysis of influencing factors of 8273 injured patients' outcome suggested that coma,admission pathway,complications and hypertension were closely related to injured patients' outcome.The risk of death in patients with severe coma was 4.340 times to awareness patients(OR = 4.340,95% CI: 1.910,9.864).The risk of death for patients who were emergency department admission was higher than that in patients who were referral from other hospitals in shanghai.In addition,patients with hypertension,apnea,acute renal failure,multiple organ dysfunction syndrome and bacterial infection would increase the death risk of injury patients.The analysis of influencing factors of the outcome for patients with single-region injury suggested that coma,admission pathway,multiple organ dysfunction syndrome and bacterial infection had association with patients' outcome,and that was consistent with the statistical outcome of 8273 injured patients.For multiple injuries patients: injury mechanisms,pre-hospital time and complications(apnea,acute renal failure and multiple organ dysfunction syndrome)were the risk factors of patients' outcome.Compared to traffic injuries,multiple injuries patients who were caused by ground-level fall had a higher death risk(OR = 17.971,95% CI: 1.207,267.656).The death risk of multiple injuries patients with pre-hospital time ?1 hours was lower than that in patients with pre-hospital time >24 hours.The existing of apnea,acute renal failure and multiple organ dysfunction syndrome would increase the risk of death in patients with multiple injuries.(3)Modeling research on human resources allocation in emergency for injured patientsUnder the premise of the composition of injury severity in patients was fixed,when the instantaneous inflow of 20 people,the simulation result of health resources allocation adjustment suggested that a reasonable increase in the number of expert doctor can significantly affect the mortality of serious injured and critical injured patients and its' emergency detention time.Excessive increasing in the number of general doctor and nurse had no significant effect on injury patients' mortality and retention time,but the reasonable adjustment of the number of general doctor and nurse could reduce the death risk of critical injured patients and short the emergency detention time.Additionally,when the number of doctor fixed,compared to the default nurse number,the increase of nurse number had a small effect on injury mortality and retention time.Under the premise of a clear hospital service target and the instantaneous inflow of 20 people,compared to the default plan(expert doctor 3,general doctor 6,nurse 10),the better human resource allocation pattern was experts' number increased by 66.7%,doctors' number increased by 33.3% and nurses' number decreased by 10.0%.When the instantaneous inflow of 30 people,compared to the default plan(expert doctor 5,general doctor 9,nurse 15),the better human resource allocation pattern was experts' number increased by 60.0%,doctors' number increased by 11.1% and nurses' number decreased by 13.3%.When the instantaneous inflow of 40 people,compared to the default plan(expert doctor 7,general doctor 12,nurse 18),the better human resource allocation pattern was experts' number increased by 85.7%,doctors' number increased by 50.0% and nurses' number increased by 22.2%.Research ConlusionIn order to reduce the risk of injury patients' death,medical staff should consider the impact of coma,complications and hypertension on patients' outcome when provide targeted prevention and treatment measures,improve the treatment ability of emergency admission patients,and pay attention to treatment of multiple injuries patients.For improving the efficiency of emergency treatment,the related study could proceed with the angle of hospital manager,hospital managers should arrange the allocation of expert doctor,general doctor and nurse base on the change of injury patients' inflows and its' injury severity timely,so as to improve the treatment efficiency of emergency department. |
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