fredag 18 november 2011


Crowding är ett begrepp som betyder att patienter som bedöms behöva inläggning till sjukhuset "fastnar" på akutmottagningen främst pga av platsbrist. Man måste förstå att detta är ett systemfel som ej beror på akutmottagningen eller "patienter som inte borde vara där" utan att avdelningarna har dålig eller obefintlig planering för att skriva ut patienter i tid så att de kan ta emot patienter från akuten. ACEP har skrivit ett handlingsdokument om Crowding som ligger under Favoriter här på bloggen. Jag lägger upp ett klipp av detta nedan som är intressant i dessa dagar då chefer i Lund försöker manövrera akutsjukvården:

"Much of the research about “unnecessary” visits was published in the 1980s and early 1990s and consisted of retrospective reviews of the final diagnoses of emergency patients, not their symptoms. Once the diagnoses were known, researchers concluded the visits did not constitute emergencies and were unnecessary. Based on this research, there was a growing sense that many emergency patients were seeking emergency care frivolously, giving rise to attempts to restrict visits, increase co-pays, institute phone screening prior to visit, and other interventions.

However, many people experience the symptoms of a medical emergency, but after a medical examination and diagnostic testing, it is determined they do not have medical emergencies. These visits should not be classified as unnecessary. Just as a “spot” on the lung might mean nothing or indicate a malignancy, a child with a fever might have a simple cold or severe sepsis or meningitis. A “simple sore throat” might be viral or represent impending airway obstruction from epiglottitis; what the patient experiences is the same: a sore throat.
During the 1990s, ACEP began to advocate for a national “prudent layperson standard,” which bases health care coverage on a patient’s symptoms, not his or her final diagnosis, since the general public should not be expected to self-diagnose their medical conditions. In a study by Franaszek,1 patients were asked at triage to assess whether their problem was critical, urgent, or routine. Of the patients whom the physician determined to be critical, 25% believed their problem was routine. Other studies have shown that barriers to care (phone screening, increasing co-pays, etc.) affect those with real emergencies as much as those with minor problems.
The critical question to ask regarding “unnecessary” visits is: “Do nonemergent patients interfere with the care of urgent patients?” Recent studies closely examined the effect of nonemergent patients on the care of critically ill patients and concluded the impact essentially is nonexistent.

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