原标题：大医院急诊普遍压床部分急诊资源被滥用 Original title:Big hospital emergency general press part of the emergency resource abuse

    近日，“‘120’拉病人连跑5家医院因急诊无床得不到收治”的消息，引起了社会的广泛关注。北京市卫生局拟于近日出台《关于进一步加强医疗机构急诊工作的通知》：今后，医院急诊科以“没床没设备”拒接病人，医院拟被降级。

    recently,"‘120’Pull the patient even run 5 hospitals for emergency no bed were not"news,Has been attracting wide attention from society.The municipal bureau of health issued by recently[On further strengthening the work of emergency medical institutions notice]:In the future,Hospital emergency department to"No bed not equipment"Rejected by the patient,The hospital intends to be demoted.

　　记者采访发现，优质医疗资源过分集中、非急诊病患爱上急诊看病、转诊机制未充分发挥作用、公众对门急诊的认识存在误区……种种因素都加剧了急诊资源紧张的现状。

Reporters found that,High quality medical resources too centralized/The emergency patients in love with emergency doctor/Referral mechanism is not fully play a role/The public understanding of this some mistake...Various factors have increased the present situation of emergency resources nervous.

　　

□现状 - status

　　冬季急诊床位尤其紧张 Winter emergency beds especially nervous

　　11月19日中午12点20分，实名认证的北京协和医院急诊科大夫于莺(微博名为急诊科女超人)在微博吐槽，“昨晚抢救室最后一张床进来一个年轻的患者，一进门就开始做复苏，正忙着，护士叫我出去，120又送来一个意识不清的患者。我们没床、没设备提出让他们转送别家，可120告诉我这里已经是第五家了，都没床。看着家属欲哭无泪的脸，心理防线顿时崩塌。”

On 19 November 12 o 'clock at noon in twenty points,This may not be the authentication of the Beijing union medical college hospital emergency department in the doctor(Micro bo called Ed superwoman)In micro bo vomit tank,"Intensive care last night last a bed in a young patients,A door begin to do recovery,Are busy,The nurse called me out,And he sent a unconsciousness of the patients.We have no bed/No equipment that they put forward another,But 120 tell me here is the fifth house,Didn't bed.Look at the face of the family too deep for tears,Psychological defence suddenly collapse."

　　这条微博引起了社会各界的关注，北京市卫生局第一时间表示说，正在考虑建设北京市急救信息联网系统，把120跟医院对接，到时候医院紧急救治的床位情况将会实时传送到急救中心，并指出各大医院的急救科必须与急救人员进行衔接。

This article micro bo aroused the attention of the society from all walks of life,The municipal bureau of health first time said,Considering the construction of emergency information network system,With the 120 hospital butt,When the hospital emergency treatment bed will real-time transmission to the emergency center,And points out that each big hospital emergency department must and first aid staff cohesion.

　　对此，中日友好医院急诊科主任张国强表示，微博当中提到的现象确实存在，特别是在一些大城市的三甲医院当中。好的医疗资源过分集中，导致了在好的医院里面急诊病人一床难求。他说，急诊资源的紧张或者宽松跟季节也有一定关系，现在是冬季，是呼吸系统及脑血管疾病高发的季节，每年这个时候各大医院急诊室一天当中的任何时候都被塞得满满当当的。

this,The sino-japanese friendship hospital emergency department director zhang guiquan said,Micro bo mentioned among the phenomenon does exist,Especially in some big cities of 3 armour hospital.Good medical resources too centralized,Had resulted in good hospital emergency patients in one bed is hard to find.He said,Emergency resources nervous or loose with season also has a certain relationship,It is winter,Is the respiratory system and cerebrovascular disease high season,At this time of the year each big hospital emergency room at any time during a day are packed in.

　　针对急诊床位紧张，病人找床只能凭运气的问题，朝阳医院急诊科医生何新华认为，这不仅仅是医院急诊床位设置总量匮乏的问题。这种状况的形成是由多方面原因导致的。一、患者和家属的需求不断提高，不喜欢去社区医院，更愿意到大医院就诊，“宁愿等待，也要在大医院”。二、一些非急诊急救的病患占据了大量急诊资源；三、随着人口老龄化的加剧，老年患者经常多系统疾病同时存在，某一器官急性发病或者慢性疾病急性发作，一般首选大型综合医院急诊科就诊。因此，管理部门需要从政策上予以倾斜，从政策上分流部分急诊患者。四、二级医院的分担、转诊作用还不能完全发挥，导致很多不适合再留在大医院急诊科的病患继续占据急诊资源。

According to the emergency beds nervous,Patients to bed only in the problem of luck,Chaoyang hospital emergency department doctor qin thought,It is not only a hospital emergency beds total set of problems.This situation is formed by various reasons.a/Patients and families needs improve,Don't like to community hospitals,More willing to to the hospital,"Would rather wait for,In big hospitals".two/Some non emergency first aid patients accounted for a large number of emergency resources;three/As the population aging intensifies,Elderly patients often multisystem disease there at the same time,A certain organ acute onset of the disease or acute attack of chronic disease,Generally preferred a large general hospital emergency department.so,Management department needs from policy to tilt,The policy of shunt part of emergency patients.four/Secondary hospital share/Referral effect are not yet fully able to play,Lead to many not fit to stay in the hospital emergency department patients continued to dominate emergency resources.

　　

大医院急诊普遍压床 Big hospital emergency general press

　　在许多三甲医院急诊科抢救室，很多病人是叠加多种基础病的老年慢性病患者。不少这样的老人度过急性期后依然滞留急诊抢救室，常常超过一周甚至更长时间。

In many 3 armour hospital emergency department intensive care,Many patients are superimposed a variety of elderly patients with chronic diseases based disease.A number of such old man through the acute phase and still stranded emergency intensive care,Often more than a week, even longer time.

　　12月5日，记者在朝阳医院急诊科看见，这里的急诊科压床非常明显。护士告诉记者，急诊科抢救室配置16张抢救床位，但当日中午已经将床位加到了44张。记者在这里看到，床位一个紧挨着一个，护士站的四周也都摆满了临时添加的床位。旁边的急诊留观室也是人满为患，急诊观察室有37张床，但滞留的病人超过了一倍。

On December 5,,Reporter in chaoyang hospital emergency department saw,The emergency department press is very obvious.The nurse told reporters,The emergency rescue of intensive care configuration and a bed,But at noon that day has added to 44 a bed.Press here to see,A bed next to a,Nurse station all around are filled up with temporary add beds.Next to the emergency staying chamber is packed,Emergency observation room have 37 beds,But the retention of patients more than doubled.

　　在急诊输液室，这样的情况也同样存在。输液室门内，密密麻麻地坐着前来输液的患者，门外的休息区也坐满了输液的患者。护士告诉记者：“白天还好一点，晚上门诊关了，来看急诊的人就更多了。”

In the emergency department infusion room,This situation also exists.Infusion room door,Encircled by the infusion to the patient,The rest area is full of infusion of the patients.The nurse told reporters:"The day is better,Evening outpatient shut,To see many more of the emergency."

　　记者注意到，这里的患者以60岁以上的老年人居多，他们中多是心衰、脑梗等老年危重患者。和大多数患者相比，躺在急诊科抢救室护士台边上的38岁患者刘先生显得很年轻。家属告诉记者，昨晚下班后刘先生突然感觉眩晕、并伴有呕吐不止等症状，情况紧急。送到医院后被医生诊断为脑出血。“不管是什么床，只要能住进来就安心了。”家属说。

Reporter noticed,The patients in the older age group is in the majority,They are in heart failure/Cerebral infarction and elderly critically ill patients.And most patients compared with,Lying in the emergency department nurses station on the edge of intensive care patients with age and liu is very young.Family told reporters,After work last night Mr. Liu suddenly feel dizzy/Accompanied by vomiting more than wait for a symptom,An emergency.To the hospital after the doctor diagnosed with cerebral hemorrhage."No matter what bed,As long as can live at ease in the."Family said.

　　何新华坦言，有的老人患多种基础病且病情不稳定，专科病房本身床位也紧张，难以顺利接收住院。也有的老人病情稳定了，但家属不放心转到二级医院康复，宁愿继续留在急诊科。

Qin said,Some old man with a variety of basic disease and illness is not stable,Specialist ward bed itself also nervous,Difficult to smooth receiving hospital.And some of the old man was in stable condition,But families not trust turned to secondary hospital rehabilitation,Would rather stay in emergency department.

　　这种情况在中日友好医院同样存在。12月6日，记者在中日医院急诊科也看到了类似的情景，无论是抢救室还是输液室，到处都是满满当当的。

This kind of situation in the sino-japanese friendship hospital remains the same.On December 6,,Reporter in the hospital emergency department also see a similar situation,Both intensive care or infusion room,Everywhere is full of.

　　张国强认为，多种因素导致复杂慢性病病人滞留在三级综合医院的急诊科。一是现在医院的专科越来越专，从专科到专病，对复杂的多脏器慢性疾病患者不愿收治或无力收治；二是公众对大医院盲目信赖，很多人已被明确诊断为终末期疾病，但家属不信任基层医院的医疗水平，“其实他们需要的是安静的临终关怀，而不是待在抢救室天天靠呼吸机和高级抗生素维持。”

Zhang guiquan think,Many factors lead to chronic diseases patients complicated trapped in tertiary general hospital emergency department.A specialized hospital is now more and more special,From junior to ZhuanBing,For more complicated organs in patients with chronic diseases were treated to or weakness;The second is the public hospitals blind trust,A lot of people have been diagnosed for end-stage disease,But families don't trust grass-roots hospital medical level,"The truth is, they need to quiet hospice care,Not every day to stay in intensive care by breathing machine and senior antibiotics to maintain."

　　张国强和何新华都表示，按照规定，急诊科原本的床位使用率指标是：抢救床24小时轮转、留观床72小时轮转，但目前这一要求“基本无法实现”。近年来，由于病人的急剧增多，急诊科正在“被无限扩张”。

Zhang guiquan and new huadu said,According to the regulation,Ed had bed utilization rate index is:Salvage bed 24 hours cycle/Staying bed 72 hours of rotary,But now this request"Basic unable to realize".In recent years,Due to the patient's sharp increase,Emergency department is"Be infinite expansion".

　

　□解决之道 / solution

　　信息发布易统一调配难 Information release easy unified deployment of difficult

　　不少市民提出，如果参照商场、写字楼智能停车引导的做法，将医院急诊科的床位占用情况实时传送到转运急救车上，情况也许会好一点。对此，张国强表示，这不能从根本上解决问题。

Many people put forward,If the reference market/Office building intelligent parking guide practice,Will the hospital emergency department bed occupancy situation real-time transmission to transfer an ambulance,Circumstances may a bit better.this,Said zhang guiquan,This can not fundamentally solve the problem.

　　“建立一个统一的信息发布渠道简单，但是如何调配却很复杂。”张国强说，这不是一个电话、一条短信就能解决的，它需要统筹信息、统一指挥、权威判断、遵守医嘱等多方面因素达成统一才行。

"Establish a unified information release channel is simple,But how to allocate but very complicated."Said zhang guiquan,This is not a phone call/A message can be solved,It needs to plan as a whole information/Unity of command/Authoritative judgment/Comply with doctor's advice and so on various factors unity to just go.

　　除去患者和家属不遵守调配的这个难题外，如果对病人的情况出现错判，去了不合适的医院进行救治，相关人员的问责也很关键。以香港为例，在某一区域内划定了那些医院为一级救援中心，哪些为二级救援中心，出现急诊病例后会有专人判断你该送往哪个级别的救援中心。

Remove patients and families don't abide by recombined the problem outside,If the patient's condition to appear mistake,Go to the wrong hospital for treatment,Relevant personnel of accountability is the key.In Hong Kong as an example,In a certain area designated hospital for the first aid center,What is the secondary rescue center,In emergency cases will have special judgment you should sent to which level of rescue center.

　　

完善基层医疗提高公众常识 Perfect primary care to improve public knowledge

　　何新华表示，目前我国的基层医疗水平处于逐步提高之中，不能有效地对病人进行出诊和初筛，无法对大医院的拥堵进行有效的疏导。另外，公众还没有养成有病先去社区医疗的诊疗习惯。他认为，解决这个问题不仅是有关部门的责任，还和我们公众健康素养的提高有着密切的关系。“当然这个问题很难在短时间内解决。”

Qin said,At present our country's primary care level in gradually improve in,The patient cannot effectively given and initial screen,Unable to big hospital effectively ease congestion.In addition,The public is not a sick go to community medical diagnosis and habits.He thinks,To solve this problem is not only the responsibility of the relevant departments,And the improvement of our public health literacy have a close relationship."Of course, this problem is difficult to solve in a short time."

　　此外，张国强还认为，公众个人健康知识的提高也是很关键的一步。因为急诊救治的快捷，现在有的人为了节约时间，诸如感冒之类的小病也会到急诊就诊，这种做法不仅占用了急诊通道，为真正有急诊需要的患者就诊带来影响，还会影响个人病情的救治。“这样的病人占到了急诊就诊人数的三分之一左右。”“我们的急诊就这样被无限地扩大了。”张国强说。

In addition,Zhang guiquan also believe that,Public personal health knowledge increase is also a key step.Because of the emergency treatment fast,Now some people in order to save time,Such as the cold weather will also like to emergency clinic,This approach not only take the emergency channel,For real emergency needs of the patients medical effects,Can also affect personal illness treatment."Such patients accounted for about a third of the number of medical emergency.""Our emergency was immensely expanded."Said zhang guiquan.

　　据医院急诊科的护士和医生反映，这个现象下午四五点时更为突出，这主要因为门诊四点半下班，一些挂不上号的人便会来到急诊，还有一些人不愿意在门诊排队，也想走捷径，希望能够在急诊解决问题。

According to the hospital emergency department nurses and doctors reflect,This phenomenon SiWuDian afternoon when is more outstanding,This is mainly because the clinic work half past four,Some hang the number of people will come to the emergency,Some people do not want to line up in the clinic,Also want to go to,Hope to be able to solve the problem in the emergency department.

　　对此，张国强说，像这样急诊与门诊概念混淆的患者不少。其实急诊原则上讲只有两个方面功能：一是“救命”，处理有生命危险或是有潜在生命危险的患者，二是“缓解症状”，有些病人虽然没有生命危险，但症状非常痛苦，急诊可以减轻暂时的痛苦，这就是急诊的任务。

this,Said zhang guiquan,Such emergency and outpatient service concept confusion many patients.In fact speak only emergency in principle two aspects function:One is"help",Processing have dangerous life or potentially dangerous life of the patients,The second is"Relieve symptoms",Some patients even though dangerous without life,But is very painful symptoms,Emergency treatment can reduce the pain of temporarily,This is emergency task.

　　张国强表示，现在急诊科大夫肩负了太多的功能，包括慢性病、常见病的治疗等。建议诊疗疾病要到门诊找专科大夫才行，比如咳嗽一段时间来急诊，急诊医生也只能临时开点止咳药，让稍事缓解症状，但具体是因为气管炎、肺炎，还是心功能不好引起的，还应该到门诊找专科医生具体问题具体解决才行。所以不想在门诊排队，指望急诊大夫把病看好的观念是完全错误的。“这种情况下，看了病不等于看好病。”

Said zhang guiquan,Now the emergency doctor has too many functions,Including chronic disease/The treatment of common diseases, etc.Suggestions to the clinic diagnosis and treatment of disease for junior doctors to just go,Such as cough a period of time to emergency,Emergency doctor can only temporary open some cough medicine,Let themselves to alleviate the symptoms,But the specific because tracheitis/pneumonia,Or cardiac function caused by the bad,Should also be to find a specialist outpatient the concrete problem is made a concrete solution to just go.So don't want to line up in the clinic,Hope the disease emergency doctor promising idea is completely wrong."In this case,See the disease is not equal to value disease."