To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.

The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform. The research subgroups consisted of pre-medical reform group, intra-medical reform group and post-medical reform group, according to the date 20 days before the medical reform, 20 days after the medical reform and 21-40 days after the medical reform. During this period, The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00, 14:00, 18:00 in the Emergency Department of Peking University Third Hospital every day, the mean of which assessed the degree of crowding. The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding. All statistical analyses were performed using SPSS version 25.0. Continuous data presented as means ± standard deviation (normal distribution), analyzed by t-tests or median ± quartile(abnormal distribution), analyzed by Mann-Whitney U test.

The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68, P<0.05). The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group, but the difference was not statistically significant (380.83 vs 339.68, P>0.05). The number of ventilated patients (Rn) significantly increased after the reform (P<0.05).

The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017. The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.

Crowding; Medical care reform; Emergency department; Overcrowding scale; Critical care medicine