Time Survey of Triage Emergency Department Patients during Rush and Non-Rush Periods

急診室之檢傷病患於尖離峰時刻就醫之時間探討

張文瀚(Wen-Han Chang) ； 黃謙瑄(Chie-Hsuan Huang) ； 蔡正河(Cheng-Ho Tsai)

《中華民國急救加護醫學會雜誌》 18卷1期 (2007/03) Pp. 21-30

https://doi.org/10.30018/JECCM.200703.0003

摘要

研究宗旨：本研究的目地在於分析急診各種不同檢傷病患的於急診就醫時間的關係。同時研究當於尖離峰時段就醫時，對不同檢傷患者是否有時間上的影響。
工具與方法：作者蒐集四百位於馬偕紀念醫院就醫之外傷病患，並加以回溯性病歷分析。每本病歷皆記錄疾病處置流程時間，看診時間與檢傷分類。作者統計並計算急診處置流程中，所花費在每個不同階段的時間，包括病人到與離開急診的時間與其他檢傷評估、掛號、醫師診察、傷口處置、實驗室檢驗與報告回覆所花費的時間。
研究結果：比較各組研究發現，檢傷一級的病患在D3，D4，D5，D6與D7的時間耗費上與檢傷二、三級有顯著差異。比較檢傷一級與檢傷二、三級，發現病患檢傷嚴重度除了掛號、等待看診的時間較無明顯差距，其餘時間比檢傷二、三級來的長。而檢傷一級的病患在尖峰時段來就診時花在D3，D5，D6與D7的時間比離峰時段來的就診所花的時間長，檢傷二、三級反而在尖峰時段掛號所花費時間比離峰時段長。
結論：本研究大部份顯示，檢傷一級比檢傷二、三級的病患更加複雜且需要更長的診斷時間。雖然疾病檢傷等級與創傷程度是判斷處理優先順續的原則，但在一般不嚴重的案例中，有時不依照這個原則處置。本研究指出檢傷一級的病患花在醫生看診與實驗室檢驗的時間比檢傷二、三級長，但花在等待醫師看診的時間則較無差別，在尖峰時段也是如此。檢傷二、三級的病患除了檢傷掛號時間，花在接受急診醫師診治、等待檢查、等待報告與留觀的時間，不論是尖峰時段或是離峰時段都差不多。因此，對每一位急診醫師而言，有效改善尖峰時檢傷一級嚴重患者之處置流程，或是為病患建立緊急之創傷團隊，來降低因時間延誤所造成的風險，是非常重要的課題。

關鍵字

檢傷分類 ； 候診時間 ； 尖峰時段 ； 持續品質進步

並列摘要

Study Objective: The aims of this study were to analysis the relationship between the various severity triage levels and time expenditure in an emergency department (ED). This involved the analysis of time expended on the different triage level patients during rush or non-rush periods.
Materials and Methods: The medical records of 400 patients were collected from the ED at the Mackay Memorial Hospital and retrospectively reviewed. The subjects were divided into different stages based on their progress through the ED. Recorded data included triage assessment, the different times expended at the different stages of treatment in the ED including triage assessment, registration, doctor's attendance and laboratory data examination and the arrival/departure times ofr the patients.
Results: When the study groups were compared, there were significant differences between triage levels 1 patients compared to triage level 2 and 3 patients (p＜0.05) for all treatment stage times other than triage/ registration and the wait for initial physician attendance. In addition, overall, triage/registration and waiting for attendance times did not differ between the rush and non-rush periods. However, Level 1 triage patients took longer for all other timings during rush periods compared to non-rush periods (p＜0.05). Furthermore, level 2 and 3 triage patients took longer for triage and registration during rush periods compared to non-rush periods (p＜0.05).
Conclusion: Typically, triage level 1 patients are more complex and require a longer diagnostic times than either level 2 or level 3 patients. Although disease/injury severity determines treatment priority, no such discrimination is used in less severe cases. This study indicates that level 1 cases use up much more time than level 2 and 3 for both doctor and laboratory examinations, but there is no increase in the waiting time for doctors during rush periods. Triage level 2 or 3 patients seem to have similar times for most activities except registration whether the ED is busy or not. It can therefore be concluded that improving procedures or setting up a team specifically for patients who are severely injured and who arrive during a busy periods may be helpful and reduce the risk of any delay in treatment of these patients, which is very important to every ED physician.

並列關鍵字

triage ； waiting time ； rush period ； quality improvement