白天急診病患就醫流程之分析

Analysis of the Daytime Emergency Department processes

陳建光(Chian-Kuang Chen) ； 廖訓禎(Shiumn-Jen Liaw)

《中華民國急診醫學會醫誌》 2卷2期 (2000/09) Pp. 15-22

摘要

過去有關急診流程的研究多是片段性的報告。這些報告都是依據病歷的記載，或是採用電話訪查。但是“到急診看病”是一個連續性的程序，而且每個環結又彼此影響，這些片段性的報告並不能提供臨床上整體的考量。作者嘗試以前瞻性方法做現場採樣，以即時的時間測量，去完整的探討國內繁忙的急診就醫流程，包括掛號和檢傷、候診、醫師看診、以及醫囑執行時間。並討論可能影響的因素〔如檢傷分類、醫師職級、醫護人數、病患總數、用餐時段〕，瞭解各因素對急診就醫流程的影響。
本報告介紹林口長庚醫院急診所採用“急診無掛號無領藥無批價作業”的簡化流程，建議檢傷護士由資深者擔任，改進檢傷護士的理學檢查步驟；加強資淺醫師對開立醫囑的熟悉度，尤其是電腦化醫囑的使用；週末、例假日安排較多醫護人員；平日用餐時段以觀察區主治醫師支援現場看診，護理人員以各區輪流支援模式協助用餐時段醫囑的執行。用餐時持續將已診病患轉入觀察室以減輕現場醫護人員的負擔，減少病患的候診時間。我們希望藉由縮短急診病患診治流程的經驗，能對台灣其他醫院急診作業有所助益。

關鍵字

檢傷分類 ； 候診時間 ； 看診時間 ； 醫囑執行時間

並列摘要

Most studies of ED processes are sectional, based on either medical records or telephone investigations. In contrast, “to visit the ED” is a continuous process, where each section can affect another. Sectional reports fail to encompass the entire ED process. Using a prospective, real-time sampling method, we attempted to approach the whole process of a busy ED in our country, including registering, triage, waiting for examination, examination, and execution of initial treatment orders. Associated factors possibly affecting the patients in the ED that may have influenced the ED process such as triage, official doctors’ the numbers of doctors and nurses, the total count of patients a day, and the duration of lunch were also examined.
This report proposes a simplified process for ED registration. We propose that senior nurses may be better qualified in triage and should be well versed in checking vital signs. Junior doctors should be adept at using medical charts, particularly computerized records. More doctors are needed on Saturday and Sunday. At lunch the Vs working in the observation room should help with ED patient care allowing the nurses to change. Continuously sending patients to the observation room to reduce the load may decrease the waiting time. In this way, ED processes may be shortened, and hospitals throughout Taiwan may benefit from such changes.

並列關鍵字

triage ； waiting time ； examination time ； executing initial order