急診部二次檢傷可行性及對病人影響之探討

由於各大醫院急診部門病人過度擁擠已是常態，由於有些病人的情況真的緊急，為了避免在候診時病情惡化，因此在病人等候就診時間以前接受病情再評估相對的就非常重要。本研究昌在探討病人在急診候診時接受二次檢傷可行性及對病人之影響。本研究為非隨機臨床試驗研究，以便利取樣方式於台北市某一所醫學中心急診部二、三級病人共3333名中，選取500名符合資格病人做二次檢傷。二次檢傷評估比率為15.0%；經二次檢傷後發現檢傷級數提升之病人數有6人（1.2%），其中2人由2級提升至1級；4人由3級提升至2級，檢傷三級病人級數提升比率為檢傷二級病人之2.7倍。藉由二次檢傷作業，讓病人於候診中能及時獲得最妥適的醫療處置，以確保病人醫療之時效性與安全性，對臨床照護將有極大的助益。依本研究發現，建議二次檢傷可由診間護理師接受訓練後和檢傷護理師共同擔任，及藉由電腦資訊系統提示二次檢傷病人之啟動時間，以便即時進行評估。

關鍵字

二次檢傷；檢傷分類；過度擁擠；急診

並列摘要

Overcrowding has been a general problem for emergency departments in major hospitals. Most patients who come to emergency department must be with a serious condition. To avoid emergency patient's condition getting worse, it will be quite precious and essential of effectively utilizing the period while patients waiting for medical treatment to re-evaluate their relative condition. The study is a non-randomized clinical experiment. Five hundred qualified patients were given secondary triages, which were conveniently sampled from 3,333 eligible patients in an emergency department of medical center in Taipei, Taiwan. The ratio of the secondary triage is 15%. After the secondary triage performed, 1.2% of patients, i.e. six people, were triaged more serious than the previous one, in which two people whose scales were altered from 2 to 1, and four people whose scales were altered from 3 to 2. The alteration rate of scale 3 is 2.7 times of that of scale 2. By implementing a secondary triage process, the patients could obtain timely and proper medical treatment, which greatly ensure patients' safety and benefit to give clinical care in time. According to the study results, it is suggested that the process could be taken over by well-trained examination nurses and triage nurses. Moreover, the timing for the secondary triage should be triggered by computer system so as to ensure providing timely assessment.

並列關鍵字

secondary triage ； triage classification ； overcrowding ； emergency department

參考文獻

邱曉彥、陳麗琴、林綉珠等：台灣急診檢傷新趨勢－五級檢傷分類系統。護理雜誌2008;55:87-91。[Chiu HY, Chen LC, Lin SJ, et al: Current Trends in Emergency Triage in Taiwan: The Five-Level Triage System. The Journal of Nursing, 2008;55:87-91.]

陳麗琴：中文版五級急診檢傷分類電腦化系統之建構與臨床應用評估。未發表的碩士論文。臺北醫學大學護理學研究所碩士論文，2006。[Chen LC: Development and Clinical Application Assessment of the Chinese Version of Five-Level Computer Triage System in the Emergency Department. Master Thesis, Graduate Institute of Nursing, Taipei Medical University, 2006.]

蔡哲福、蔡哲宏、李怡慶等：急診檢傷分類等候制度與病人知覺等候時間之相關性研究－以某區域教學醫院為例。澄清醫護管理雜誌2013;9:20-28。[Tsai CF, Tsai CH, Lee YC, et al: The Relationship between a Triage System and Patients' Perceived Waiting Time in a Regional Teaching Hospital Emergency Department. Cheng Ching Medical Journal 2013;9:20-8.]

Carter EJ, Pouch SM, Larson EL: The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh 2014;46:106-15.

Sun BC, Hsia RY, Weiss RE, et al: Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med 2013; 61:605-11.e6.

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急診部二次檢傷可行性及對病人影響之探討

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