In fact, not only emergency resources, but also the unreasonable allocation of medical resources is very common in the whole medical system of our country, which runs through the medical reform.
Most of the work in the emergency department is not "emergency"
"My emergency department is one of the busiest emergency departments in Beijing. The number of patients per day should be around 500, including all kinds of critically ill, difficult and terminally ill patients. " Director Zhu of the emergency department of Peking University People's Hospital summed up the work of the emergency department with this sentence.
The three situations of "acute and critical illness, incurable diseases and terminally ill patients" mentioned by Director Zhu actually highly summarized the three major functions of the emergency department of Peking University People's Hospital, namely, the emergency rescue center for acute and critical illness, the diagnosis center for incurable diseases and the management center for terminally ill diseases (chronic diseases).
Emergency rescue is the core business of emergency department, and it is also the main work of emergency department in our usual sense. However, according to Director Zhu, in fact, the proportion of core business in actual work is very small. If the emergency department sees 500 patients every day, then there are 10- 15 who actually use the emergency room. A large part of the human resources and space resources in the emergency department are occupied by the latter two businesses.
One of them is the diagnosis of difficult diseases. The existence of this business is mainly related to the development level of medical disciplines and the development model of China's medical and health system. In short, on the one hand, it is difficult for doctors to determine which professional department they should be assigned to in a short time when they first receive patients (especially patients with difficult diseases); On the other hand, under the influence of the national health insurance policy (such as average length of stay, total cost control, hospital bed turnover rate limit, etc.). ), professional departments also lack sufficient carrying capacity.
There is also a big business that many people have not thought of, that is, the management of terminal (chronic) patients. For example, for patients with advanced cancer who have been ineffective and suffered from various treatment methods, professional departments are no longer suitable for receiving these patients. At this time, the emergency department played the role of hospice care and relieving patients' pain. For example, patients with long-term renal dialysis can come to the emergency department if they are in urgent need of dialysis but there is no vacancy in the outpatient dialysis center of a nearby hospital, or if the symptoms are serious and not suitable for outpatient dialysis.
It sounds as if this business does not meet the functional orientation of the emergency department, and the author also expressed such doubts to Director Zhu. In this regard, Director Zhu explained that this is indeed related to the lack of rehabilitation care for the elderly in the construction of China's medical and health system, so not only his Peking University People's Hospital, but also many 3A hospitals are facing the problem that emergency resources are occupied by non-emergency services. According to relevant data, the annual outpatient and emergency department of tertiary hospitals in Beijing has reached 2.35 million person-times. Among emergency patients, the proportion of non-emergency patients is about 30% to 50%, and even some medical institutions are as high as 80%.
To solve the allocation problem of emergency resources, patient grading is only the beginning.
I believe that most people have had the experience of seeing a doctor in a general outpatient clinic. At this time, we usually queue up for treatment according to the principle of "first come, first served".
However, the emergency department is different. In some cases, the emergency department is the last hurdle in a patient's life. If those critically ill patients are not found and disposed of in time, it is likely that patients who should be treated will face the threat of death. Therefore, the Guidelines for the Construction and Management of Emergency Department issued by the former Ministry of Health (for Trial Implementation) and the National Health Industry Standard "Standardized Procedures for Hospital Emergency Department" stipulate that "the emergency department should formulate and strictly implement the triage procedures and triage principles, follow the principle of from heavy to light, and quickly change from illness to relative stability, arrange the order of patients, and give priority to patients with severe illness.
As the author mentioned above, many hospitals, especially the third-class hospitals with a huge number of outpatient and emergency services, are facing the problem that emergency resources are occupied by non-emergency services. In order to improve this situation, Beijing officially launched the "emergency classification" pilot work from May this year 1. According to the requirements of relevant policies, emergency department triage nurses classify patients into 1-4 grades for hierarchical management:
1 The patient is in critical condition, and his life may be in danger at any time, so he should immediately enter the resuscitation room or rescue room for rescue; Grade 2 patients are critically ill or rapidly deteriorating, which is life-threatening, and enter the rescue room for treatment within 10 minutes; Grade 3 patients are in urgent condition and have potential life-threatening, which is prior to grade 4 non-emergency patients for diagnosis and treatment; Grade 4 patients are not in emergency, and the degree of illness is average. According to the guidelines, the waiting time is longer.
In addition, grade 3 or 4 patients need to wait in the designated waiting area, and doctors can only enter the clinic when calling their own clinic number. The triage nurse may also suggest grade 4 patients to go to the outpatient clinic according to the specific situation, so as to get accurate diagnosis and treatment.