- 期刊
急診醫療之品質管理及電腦化
Total Quality Management and Computerization in the Emergency Department
摘要
欲使產品或服務的品質提升，提高消費者之滿意度，實施全方位品質管理是普世公認的有效方法。但因工作性質的特殊，緊張繁忙的臨床工作，使得急診醫療的品質保證工作格外的艱難。然而慈濟的經驗讓筆者深信，在急診實施全方位品管是可行的。研究者自民88年起推動急診全面電腦化，舉凡檢傷、掛號、看診、病史記載、檢驗申請、報告回來、處置動態等資訊全部進入電腦。醫師輸入病史，護理人員只要輸入留觀動態，其餘均由書記輸入。電腦同時設計了30餘種程式，可統計、列印各式品質指標。該制度之能否成功，關鍵在於：(1)如何說服醫師、護理人員、書記使用電腦作業；(2)指定專人醫師實施質的審核；(3)定期舉辦會議，討論指標所代表的意義，擬定改善計畫。總之，急診全方位品管是一知易行難的工作，成功的關鍵在於有專任的急診主任，且對全方位品管有概念的人，可以提出專業的構想，同時要有堅強的毅力與百折不撓的精神。當然，還得獲取院長的支持才能竟全功。
並列摘要
Total Quality Management (TQM) is a well-recognized method to improve the quality of products or services and to increase consumers' satisfaction. But it is difficult to practice the Quality Assurance (QA) activity in the emergency department (ED), because of its special nature of work and the intensely busy clinical work. However, the experiences in the Tzu-Chi Hospital showed that the carrying out TQM in the ED was feasible. Since 1999, the researchers have computerized the entire emergency work process including triage, registration, history taking and recording, laboratory or imagine examination, reports back, disposition etc. Doctors input patients’ history and nurses input the observation status. While the rest of the information input is left to clerks. There are more than thirty kinds of computer programs designed to analyze and print-out the QA indicators. The keys to the success of the plan include how to persuade doctors, nurses and clerks to work with computers, assign designated doctors for auditing of history records, and held regular meetings to discuss the meanings of the indicators and work out improvement plans. In conclusions, it is much more difficult to carry out than to simply know TQM for the ED. The success of TQM depends on the head of ED who not only understands the concept of TQM well enough to provide professional opinions but also has the character of strong perseverance and pertinaciousness. Besides it also needs the support of the director of the hospital. After all, the fully computerization of the ED is the only workable approaching way to practice the TQM.