手术患者出院后急诊到访预警系统构建及其在急诊就诊风险因素分析中的研究OA

Objective:To construct a real-time monitoring and early warning system for emergency visits after postoperative patient discharged,and to apply it to analyze key risk factors in emergent treatment,and to improve the level of safety management for patients,and to improve the efficiency of medical quality control.Methods:Based on the real-time monitoring and early warning system that was deployed at Peking Union Medical College Hospital for medical safety,we integrated structured data included the Hospital Information System(HIS)and Picture Archiving and Communication System(PACS).Focusing on the core identification goal("emergency visits within 31 days after patient discharged"),we designed and constructed an emergency visit early warning system after postoperative patients discharged through data integration,event determination,and dual-end push process.A total of 47,561 patients,who underwent surgery and admitted to department of emergency of Peking Union Medical College Hospital within the 31 days after they discharged from January 1 to December 31,2023,were screened by this system.The basic conditions of patients were analyzed by using statistical method,and the relative risk factors that patients received treatment at department of emergency after they discharged were analyzed on the basis of the data of this system.Results:Among 47,561 patients who received surgery,a total of 1,032 patients(2.17%)visited the department of emergency within 31 days after they discharged,and 129 patients(0.27%)of them readmitted to hospital within 90 days after they discharged.Univariate binary logistic regression analysis revealed that age,length of hospital stay,surgical grade,and"transfer to the Intensive Care Unit(ICU)"were risk factors that patients admitted to department of emergency within 31 days after they discharge(OR=1.008,1.048,1.143,3.784,P<0.05).Many times of surgery was risk factor that patients admitted to department of emergency within 31 days and they were diagnosed as complication after they discharged(OR=2.107,P<0.05).Gender,age,length of hospital stay,surgical grade,many times of surgery,and"admitted to department of emergency within 31 days"were risk factors that patients returned to hospitalization after they discharged within 90 days(OR=1.190,1.037,1.565,1.563,1.491,3.491,P<0.05).Conclusion:The constructed real-time monitoring and early warning system for emergency visits for patients who discharge from hospital on the basis of HIS can effectively identify high-risk emergency events of postoperative patients,and analyze potential risk factors,and improve the continuity of medical service,and optimize perioperative management,and reduce the rate of re-hospitalization.