週末假日就醫與治療結果之相關探討

The Relationship between Admission on Weekends or Holidays and Treatment Outcome

李麗惠(Li-Hui Lee) ； 薛亞聖(Ya-Seng Hsueh) ； 楊長興(Chiang-Hsing Yang)

《台灣公共衛生雜誌》 25卷2期 (2006/04) Pp. 107-114

https://doi.org/10.6288/TJPH2006-25-02-03

摘要

目標：探討於週末假日期間急診就醫與病患治療結果的相關性。方法：使用國家衛生研究院之全民健康保險資料庫，以2000至2002年間的6,377,556急診人次及712,787急診住院人數為研究對象，採用描述性統計及邏輯斯迴歸模式(logistic regression model)，分析週末、連續假日及農曆春節期間就醫相較於非週末假日是否有較高的住院死亡與急診返診風險。結果：控制病患特性及醫院特性後，週末急診就醫相較於非週末不會有較高的住院死亡風險，但是會有較高的24、48與72小時內急診返診風險；此外，連續假日與農曆春節期間急診住院或就醫相較於非連續假日與農曆春節會有較高的住院1、2與30日內死亡及24、48與72小時內急診返診風險。結論：建議醫院需採更周全的因應及加強連續假日與農曆春節之值班人力以避免不必要的病患死亡及重返急診，以確保於連續假日與農曆春節就醫或住院之急診病患的安全與一致的照護品質。

關鍵字

週末 ； 連續假日 ； 春節 ； 住院死亡 ； 急診返診

並列摘要

Objectives: This study attempts to examine whether there is an association between people being admitted on weekends or holidays and treatment outcome. Methods: The population-based admission and mortality data between 2000 and 2002 were drawn from the National Health Insurance Research Database. There are 6,377,556 visits through ED and 712,787 admissions through ED in this research. Logistic regression model analysis was employed to investigate whether admission on weekends, special holidays, or during Lunar New Year is related to a higher in- hospital mortality and revisits risk. Results: Compared to admission on weekdays, revisits to the ED in 24, 48, and 72 hours after being discharged were significantly higher for those being admitted on weekends. Compared to admission on other days, the mortality of 1, 2, and 30 days after admission were significantly higher for those being admitted during special holidays or during Lunar New Year. Conclusions: Although admission on weekends was found not to link with higher mortality, admission on long weekends and certain holidays tends to be less safe. The implication is more aggressive measures should be considered to protect patients from unnecessary mortality.

並列關鍵字

weekends ； special holidays ； Lunar New Year ； in-hospital mortality ； revisits

參考文獻

Aiken LH,Clarke SP,Sloan DM(2002).Hospital staffing, organization, and quality of care: cross-national findings.Int J Qual Health Care.14,5-13.

Aiken LH,Clarke SP,Sloane DM,Sochalski JS,Silber JH(2002).Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.JAMA.288,1987-93.

Arias Y,Taylor DS,Marcin JP(2004).Association between evening admissions and higher mortality rates in the pediatric intensive care unit.Pediatrics.113,530-4.

Barnett MJ,Kaboli PJ,Sirio CA,Rosenthal GE(2002).Day of the week of intensive care admission and patient outcome: a multisite regional evaluation.Med Care.40,530-9.

Bell CM,Redelmeier DA(2004).Waiting for urgent procedures on the weekend among emergently hospitalized patients.Am J Med.117,175-81.