急診各種檢傷分級病人之照護需求、滿足程度與照護品質感受之相關性

背景：病人面臨重大疾病威脅時，急診為提供緊急醫療處置的場所，但是急診的病人常因感覺等候時間久，無法立即接受治療及缺乏良好溝通，對急診照護品質感到不滿意。然而，並非每位病人來到急診都處於危害生命且需要立即急救的緊急狀態。目的：本研究探討急診不同檢傷分級病人之照護需求及需求滿足程度之差異，並分析此差異是否影響其對照護品質的感受。方法：採描述性相關研究設計，於重度急救責任醫院針對不同檢傷分級之急診病人進行方便採樣，以結構式問卷於102年6月至103年6月進行調查共收集167名個案，包括檢傷為緊急(1-2級)67人及非緊急(3-5級)100人。結果：檢傷分類緊急與非緊急病人在需求重要性上無顯著性差異，但緊急病人因病情較危急及複雜，經檢傷分類後須優先進行醫療處置，所接受的醫療照護也較多，所以在需求滿足程度得分較高，對醫療照護品質的滿意程度也較高。外傷科病人對醫療照護品質的滿意程度較高。照護需求與滿足感受的分數差異愈大，對醫療照護品質的滿意程度愈低。急診醫療照護品質的變異可由下列因素解釋：(1)外傷科，解釋變異量5.8%、(2)檢傷是否為緊急(1或2級)，解釋變異量2.5%、(3)照護需求與滿足感受程度的差異，解釋變異量11.8%。建議：應加強民眾對急診就醫時檢傷分類之概念，急診醫療團隊對於非緊急病人應加強溝通及疾病訊息，以緩解其焦慮；善加說明急診檢傷不同級數的處置方式和候診時間，以避免對急診醫療照護需求有不切實際的期待。未來應可進一步探討就醫態度及檢傷分類認知程度對醫療品質感受的實質影響。

關鍵字

急診檢傷分類；照護需求；需求滿足；照護品質感受

並列摘要

Background: When a patient is facing threats of a major disease, emergency department (ED) is the place to search for urgent help. Yet, people often dissatisfied with the quality of care in the ED, due to long waiting time, not receiving immediate treatment, or lack of communication. However, not every patient requires immediate survival treatment. Purpose: This study explored the differences between "emergency" and "non-emergency" triage patients, in terms of their care needs and satisfaction of the needs, and analyzed the impact on the patients’ perceived care quality in the ED. Methods: Using descriptive correlational study design, this study surveyed 67 emergency triage patients and 100 non-emergency triage patients, during June 2013 to June 2014, at the ED in a medical center. The structured questionnaire included the basic demographics, perceived care needs and perceived satisfaction on the needs, and perceived quality of care. Results: There are no significantant differences between the emergency and non-emergency triage patients on the perceived care needs. The group of emergency triage patients received priority care because of their critical and complex conditions. Thus they had higher score on satisfaction to care needs, so does the degree of their satisfaction on the quality of ED care. Likewise, trauma patients had higher satisfaction on the quality of care. The more discrepancies between the perceived care needs and satisfaction to the needs, the less satisfaction on the quality of ED care. The variance of satisfaction on the ED care quality can be explained by the following factors, (1) trauma patients, of which the explained variance was 5.8%; (2) emergency triage, of which the explained variance was 2.5%; (3) the differences of expectation between care needs and perceived satisfaction to the needs, of which the explained variance was 11.8%. Recommendation: It is necessary to publicize the concept of triage at the emergency department. When facing the non-emgerency triage patients, the healthcare professionals should alleviate their anxiety level through communication with clear messages. Lucid triage policy and implication to the practice have to be addressed and reinforced in order to avoid irrealistic expectations. Future research is suggested to explore the actual impact of triage attitude on perceived quality of ED care.