探討急診滯留48小時之相關因素與介入措施之成效

研究背景：近年來醫護人力窘迫的狀況日益嚴重，許多醫院為了符合醫院評鑑的照護標準，導致病床數日漸減少，造成急診病患暴增。現今病患無法及時疏通，急診部門人滿為患，醫護人員的壓力與工作負荷增長，醫療照護品質令人擔憂。故本研究係為探究急診壅塞的相關因素為何，並探討現行改善措施介入的成效。研究方法：本研究以南部某醫學中心，使用個案醫院的急診病患電腦資訊系統登錄之檢傷資料庫、急診照會資訊系統、社服資訊系統以及連結醫學統計分析及生物訊研究室之醫院研究資料庫，資料收集期間為2007年1月1日至2010年12月31、2014年1月1日至2015年12月31日之間六年資料。統計方法以卡方檢定、獨立T檢定了解不同的病患因素、罹病特質因素、醫院管理因素之差異情形；並以Logistic regression探究急診壅塞的相關因素為何，以及探討現行改善措施介入的成效。研究工具為SPSS 20版本、EXCEL軟體。研究結果：影響滯留大於48小時的相關因素為：病患因素方面以年齡越大(OR=1.01)、男性、低收入戶者(OR=1.96)。罹病特質因素以入院方式為他院轉入(OR=0.81)、其他(OR=1.55)；檢傷二級(OR=1.36)、三級(OR=1.23)、OHCA者(OR=0.2)；檢傷科別為小兒科(OR=0.23)、其他科(OR=0.24)；需住院者且內科最容易滯留、疾病分類為傳染病及寄生蟲疾病分類(OR=1.25)、循環系統疾病者(OR=0.52)、呼吸系統疾病者(OR=1.55)、消化系統疾病者(OR=1.12)；有檢驗檢查者(OR=1.77)；照會科別數目越多(OR=1.98)、照會等候時間越久(OR=1.001)。醫院管理因素以入院為白天班(OR=1.18)、當日急診人次越多(OR=1.0007)、當月全院佔床率(OR=1.05)、決定病患去向醫師年資越資深(OR=0.99)、有社服介入(OR=2.25)。另外，分析個管師協助轉診介入措施有改善病患滯留問題。研究建議：急診壅塞是影響急診品質的重要指標，不僅會影響醫療品質也會造成醫療資源的浪費，藉由分析滯留大於48小時病患之相關因素，建議院方能聘請專責轉院/病床調度員、增設「急性後送病房」、增設病床繳費櫃檯於病房及簡化病患離院手續讓病患能快速離院、增加外科醫師人力解決會診人力不足延遲問題，希望能改善急診壅塞。

關鍵字

急診壅塞；急診停留時間

並列摘要

Background：In recent years, shortage of medical staff has been in more and more severe situation. In order to conform to hospital accreditation standards, many hospitals have to cut the number of beds which considerably results in increasing the amount of patients detained in ED because of lacking of immediate access block. Jam in ED not only leads to great pressure on medical staff but also the quality of medical care. The purpose of this research is to explore related factors of the retention time and the effectiveness of current measures involved. Method：The research data we use, including its Emergency Information System、ED consultation Information System、Social service information System and Hospital Research Database is collected from a Medical Center located in southern part of Taiwan, and the time period is from 2007/1/1 to 2010/12/31, and from 2014/1/1 to 2015/12/31, 6 years in total. Statistical methods are Chi-square test、Independent T test and Logistic regression. Result：The relevance of retention on 48 hours：Factors in patients with older age (OR = 1.01), male, low-income persons (OR = 1.96). Factors in diseased trait with Admission way is from other hospital(OR=0.81) and others(OR=1.55), Triage classification is two(OR=1.36) and three(OR=1.23) and OHCA(OR=0.2), Triage Divisions is Pediatrics (OR = 0.23) and others(OR = 0.24), who requiring hospitalization, Classification of Diseases is Infectious and parasitic diseases classified (OR = 1.25)、Circulatory system diseases (OR = 0.52)、Respiratory diseases (OR = 1.55)、Digestive diseases (OR = 1.12), who has tests and check (OR = 1.77), the number of ED consultation (OR = 1.98) and long waiting time (OR = 1.001). Factors in Hospital management is Daytime into the hospital (OR = 1.18),emergency visits(OR = 1.0007), bed ratio (OR = 1.05), physician seniority(OR=0.99),social service intervention (OR = 2.25). In addition, the analysis of Case Management Division can improve patient retention problems. Suggest：ED residence time is an important indicator of its quality. Lengthy ED residence time not only influences the overall quality of medical care but also causes waste of medical resources. With the result of analyzing the reasons of ED retention time exceeding 48 hours, we recommend hiring a dedicated referral / bed dispatcher, facilitating additional "evacuation acute ward" and additional payment counters at ward. Furthermore, simplify the procedures so that patients can leave hospital quickly. Finally, increasing surgeons to solve consultation delay problem. By above mentioned approaches, we expect to minimize ED residence time.