探討72小時內非預期重返急診之風險因子

目標：非計劃性重返急診是病患照護警訊，本研究藉由探討病患72小時內重返急診因子，作為改善重返急診現況之依據。方法：合併某醫院2019年病患72小時內重返急診回溯性資料及2020年7月結構式問卷收集急診醫師資料，依病患是否重返急診，以年齡、性別及身份別經傾向分數予1：2配對，並以卡方及t檢定、邏輯式迴歸進行72小時內重返急診風險因子分析。結果：2019年急診病患返診率4.47%，病患性別、檢傷分類、就診時間、急診壅塞程度、醫師年齡及年資對於病患72小時內重返急診之影響不顯著；病患年齡、身分別（重大傷病）、離院方式、急診滯留時間（6－48小時）、醫師人格特質（神經質）與工作疲勞顯著影響是否重返急診。結論：針對影響病患72小時重返急診之病人、醫院相關風險因子，建議將年老者、重大傷病身份、自行離院、自動出院患者列為衛生教育的重點族群，提前加強出院衛教與溝通；而醫師因素部分可藉由改善醫師人力調派、提供緩解工作疲勞的措施或政策來減輕醫師工作疲勞程度。

關鍵字

非預期重返；急診；人格特質；風險因子；工作疲勞

並列摘要

Objectives: Unexpected revisits to the emergency department (ED) may indicate poor patient care and quality issue. This study investigated factors related to unexpected revisit to the ED within 72 hours of discharge. Methods: This study retrospectively analyzed patient data from an ED system in 2019. Additionally, a structured questionnaire was designed to collect data on physicians' personality and work fatigue. The combined data were matched by age, sex, and type of insurance cover by using propensity score matching with a ratio of 1:2. The risk factors of unexpected return to the ED within 72 hours were evaluated using the chi-square test, independent t-test, and logistic regression. Results: Of the 91,582 included patients, 4,086 patients returned, yielding an unexpected revisit rate of 4.47%. The results found that patients' sex, triage level, arrival shift, ED crowding, physician age, and seniority were not significant indicators of ED revisits within 72 hours. Patients' age, type of insurance cover (severe illness), mode of leaving, a length of stay in the ED (6-48 hours), and the physician's neuroticism and work fatigue were significant predictors of ED revisit. Conclusions: For patient and hospital related factors, patients with advanced age, severe disease, and those likely to leave without notice or against advice should be prioritized for outpatient education. For physician related factors, reforms to reduce the workload of physicians are essential. Further studies should continue to identify risk factors for hospitals to effectively reduce unexpected revisits to the ED within 72 hours.

並列關鍵字

unexpected return visit ； emergency department ； personality ； risk factor ； work fatigue

參考文獻

顏瑞昇、石富元、蔡光超、陳石池、陳文鍾：回診的急診病患：分析危險因子和回診原因。中華民國急救加護醫學會雜誌 2003；14：93-8。doi:10.30018/JECCM.200309.0001。 Yen ZS, Shih FY, Tsai KC, Chen SC, Chen WJ. Revisits to the emergency department: analysis of risk factors and reasons. J Emerg Crit Care Med 2003;14:93-8. doi:10.30018/JECCM.200309.0001. [In Chinese: English abstract]

洪世昌、賴世偉、李亞欣、謝豐年、陳玉如、劉翎玲：急診近期返診之探討：以南投市某地區醫院為例。中華民國急救加護醫學會雜誌 2010；21：21-7。doi:10.30018/JECCM.201012.0016。 Hung SC, Lai SW, Li YH, Xie FN, Chen YR, Liu LL. Survey of emergency department revisits in a local hospital in Nantou. J Emerg Crit Care Med 2010;21:21-7. doi:10.30018/JECCM.201012.0016. [In Chinese: English abstract]

周歆凱、黃興進、蔡明足、翁林仲、蘇喜、陳真吟：運用資料探勘之叢集分析技術探討急診72小時再返診病患特性。澄清醫護管理雜誌 2009；5：13-20。doi:10.30156/CCMJ.200907.0003。 Chou HK, Hwang HG, Tsai MT, Woung LC, Su S, Chen JY. Cluster analysis of data mining technology applied to patient re-visits during a 72 hour period in the emergency department. Cheng Ching Med J 2009;5:13-20. doi:10.30156/CCMJ.200907.0003. [In Chinese: English abstract]

陳楚杰、蔡佳妍、陳靖宜、柯明中、湯淑貞：老人急診病患三天內重返急診相關因素分析。台灣老年醫學暨老年學雜誌 2018；13：205-23。doi:10.29461/TGGa.201811_13(4).0001。 Chen CC, Cai JY, Chen CY, Ko MC, Tang SC. Factors associated with three-day revisit to emergency room among elderly patients. Taiwan Geriatr Gerontol 2018;13:205-23. doi:10.29461/TGGa.201811_13(4).0001. [In Chinese: English abstract]

梁素琴、戴玫瑰、莊玉仙：急診停留時間過長病患之特徵分析。醫務管理期刊 2011；12：237-47。doi:10.6174/JHM2011.12(4).237. Liang SC, Tai MK, Chuang YH. An analysis of the characteristics of patients with prolonged stays in an emergency department. J Healthc Manag 2011;12:237-47. doi:10.6174/JHM2011.12(4).237. [In Chinese: English abstract]

國際替代計量

探討72小時內非預期重返急診之風險因子

全文下載

主題瀏覽