急診安寧緩和醫療整合照護模式之建立

Establishment of an Integrated Model of Palliative Care in the Emergency Department

賴昭智(Chao-Chih Lai) ； 鄭展志(Chan-Chih Cheng) ； 洪子堯(Tzu-Yao Hung) ； 李彬州(Bin-Chou Lee) ； 林耿孝(Keng-Hsiao Lin) ； 璩大成(Da-Chen Chu) ； 黃勝堅(Sheng-Jean Huang) ； 林宏嶽(Hung-Yueh Lin) ； 黃永忠(Yung-Chung Huang) ； 急診安寧研究小組(Team of Integrated Model of Hospice and Palliative Care)

《北市醫學雜誌》 13卷3期 (2016/09) Pp. 36-47

https://doi.org/10.6200/TCMJ.2016.13.3.05

摘要

目的：台灣即將由高齡化社會進入超高齡社會，建立老年人的緊急醫療及相關的緩和醫療（palliative medicine）是必要的。本研究提出創新之急診安寧緩和醫療照護服務整合模式計畫，來提升與評估急診安寧緩和醫療照護服務能力。方法：本研究為回溯性研究，期間為2015 年1月1 日至2016 年6 月30 日。資料來自急診安寧評估相關資料庫，以SAS 9.4 版進行描述性統計分析。結果：本研究結果如下：民國104 年1 月至105 年6 月到院前心跳停止病患於急診簽屬DNR（不施行心肺復甦術）之人數共計147 人，非心跳停止之一般病患簽署DNR 人數共計186 人。而民國105 年1-5 月非心跳停止之病患簽屬DNR 之人數為171 人，安寧評估總件數為184 件，召開醫病溝通會議142 次，安寧家庭諮詢會議97 次。此外，完成安寧教育訓練（≧ 13小時）之急診醫護人員為90 人（57.3%）。結論：本研究推動的模式完全不同於過去國外推動之模式。首先藉由急診醫護同仁接受乙類或甲類安寧緩和醫療照護訓練，成為安寧緩和醫療之推動種子，因此逐漸增加召開安寧家庭諮詢會議次數，進而凝聚急診同仁對於安寧緩和醫療照護之共識。本研究綜合了過去三種急診安寧照護模式，並且首創在急診建立完整社區安寧評估之資料庫，可針對社區內到院前心跳停止之個案減少無效醫療，更期能透過分析北市聯醫的推動過程、初步成果及初步的經驗分享，提供急診在推動安寧緩和醫療照護之參考。

關鍵字

安寧照護 ； 緩和醫療 ； 不施行心肺復甦術 ； 急診醫學

並列摘要

Objective: Taiwan is moving from the aging society to the super-aged society. It is necessary to set up emergency medical and related palliative care for the elderly. This study presents the innovative integrated program for emergency palliative healthcare services to enhance and assess emergency palliative healthcare service capabilities. Methods: A retrospective study was conducted from January 2015 to June 30 2016. Data were obtained from the database of our emergency palliative healthcare service. A descriptive analysis was performed with SAS software (release 9.4). Results: A total of 147 out-hospital cardiac arrest patients with do not resuscitate (DNR) order and 186 non-cardiac arrest patients with DNR order in the emergency department (ED) from January 2015 to May 2016 were noted. From January 2016 to May 2016, there were 171 noncardiac arrest patients with DNR orders and 184 times of hospice palliative care evaluation. Physician-patient communication meetings were held for 142 times, and palliative hospice family counselling sessions were held for 97 times. Ninety (57.3%) ED staff accomplished their palliative hospice education and training courses (≥ 13 hours). Conclusion: Our hospice and palliative care in ED was different from the past models promoted in foreign countries. First, our emergency medical professionals with Class A or B palliative medical care training became the seeds of emergency palliative care. More family palliative counselling meetings were called to reach consensus on hospice and palliative care among ED staff. Second, our new model combined three previous models. In addition, we established a community database of the emergency hospice palliative care service to reduce futile medical care. Our experience and preliminary results should provide a good example for setting the hospice palliative care service.

並列關鍵字

Hospice care ； Palliative medicine ； DNR ； Do Not Resuscitate ； Emergency medicine