基層醫療與社區中的地區醫院是民眾健康的第一道防線。了解地區醫院急診室轉診病患特性,作為轉診時維護病人安全之依據,也可作為地區醫院未來發展之參考。本研究採用回溯性調查。以南投縣某地區醫院急診就診病患資料為依據,對轉院與非轉院病患之基本資料,就醫方式與就醫科別等進行描述性統計與卡方檢定分析,並進行邏輯氏迴歸分析,探討病患轉診原因。自民國98年8月1日至8月31日止,某地區醫院共有2446人次急診就診紀錄。排除資料登載不完全之19人次病例個案,共有2427人次進行分析。其中,轉出病患共有71人次,男性占42人次(59.2%)、女性占29人次(40.8%),總轉院率為2.9%。急診初次檢傷分類級數較高(一級與二級)之病患、透過「到院前緊急醫療救護系統」至急診就診之病患有較高之轉院率。不同年齡族群也是影響病患轉院的重要因素之一。地區醫院急診室中轉出病患以老年病患為主,兒科病患轉診比率相對較少。地區醫院急診室應診對老年疾病特性,更加注重轉診之流程與安全。不論是外傷與非外傷病患,地區醫院急診病患的轉出並無明顯差異。地區醫院發展時,也應以老人急重症醫療為優先考量,並重視各科之間共同的發展。
The local hospital stands in the first line to keep the general population health. To explore the characteristics of the patients who were referred from the emergency department (ED) could be a guide of the further development of the local community hospital. This is a retrospective study based on a community local hospital in Nantou County in Taiwan. The basic data, including age and gender, trauma、non-trauma, visiting time and routes were collected via the central computer system. From August 1 to 31 in 2009, there are 2446 visiting records, and 19 were excluded because of incomplete data. The overall referrer rate is 2.9%, including 59.2% male and 40.8% female.。The referral rate is high in patients with higher triage level, and those who are sent to ED via emergency medicine service (EMS). Age is also an important factor. The elderly patients are easily referred from a local community hospital, and the pediatric patients are referred rare. The local community hospital should pay more attention on the elderly care, both in trauma and non-trauma patients. The ED of the local hospital should not only focus on the decreasing in referral but also the safety and standard operation procedure in the current referrer.