跨團隊合作改善醫院安寧照護能力之成效

目的：本研究之目在探討影響社區型醫院中組織高效能核心安寧共照團隊之因素及其成效。方法：由院區醫務長召集成立安寧照護核心小組，成員包括醫師（含家醫科、外科、胸腔內科、神經內科）、護理師、社工師、心理師定期開會討論安寧共照議題及組成核心安寧照護Line群組。本研究針對2020年2月1日至2021年1月31日醫院內、外科部住院之病人為研究對象，以核心小組未成立前為對照組，小組成立後為實驗組，各收案50人，共計分析100名病人。收集之重要變項包含：住院科別、住院天數、醫師是否具安寧訓練資格、安寧緩和照護需求評估分數、是否召開家庭溝通會議、是否簽署DNR、病人是否死亡等。統計方法以McNemar's卡方檢定分析小組成立前後之差異，並以邏輯迴歸分析影響病人死亡之因素。結果：進一步將小組成立前與成立後之七項指標資料進行McNemar's卡方檢定後發現，小組成立前與成立後在安寧緩和照護需求評估是否大於或等於4分以上之指標變項具有統計學上的顯著差異（P<0.05）；小組成立前安寧需求分數小於4分佔26%，小組成立後分數小於4分佔44%，明顯較高。影響病人死亡之因素主要為安寧緩和照護需求評估分數大於或等於4分（OR=5.23，95CI:1.75－15.60）。結論：核心小組成前，醫師在評估病人是否需要安寧共照時往往會依醫院政策考量安寧緩和照護需求評分是否等於或大於4分以上，自安寧小組成立後，即使安寧評估分數未達4分，只要醫師認為病人有需要就會及早啟動轉介安寧共照，這顯示醫師在辨識潛在生命末期病人的能力上有顯著的進步，因此核心小組對於醫院共照能力之提升確實有幫助。

關鍵字

核心小組；共同照會；安寧緩和照護需求評估分數

並列摘要

Objective: We aimed to explore the factors influencing the efficient core coordinated palliative care group in community hospitals. Methods: The medical chief of the hospital organized a core group of palliative care, including physicians (ex: family medicine, surgery, chest medicine, and neurology), nurses, social workers, and psychologists, and meet regularly to discuss palliative care issues and form a line group. The study subjects were internal medicine patients and patients admitted to the surgical departments admitted between February 1, 2020, and January 31, 2021. A total of 100 patients were collected, including a control group consisting of 50 subjects before the establishment of the core group, and a study group consisting of 50 subjects after the establishment of the core group. The data included the patient's department, length of stay, whether the physician was qualified for hospice training, the Taiwanese version-Palliative Care Screening Tool (TW-PCST) score, and whether family communication meetings held, Do-Not-Resuscitate (DNR) order signed, and whether the patient died. McNemar's chi-square test. was used to compare differences before and after the establishment of the core group, and logistic regression was used to examine the factors influencing patient death. Results: Analyses of the seven variables using McNemar's chi-square test found significant differences (P < 0.05) in TW-PCST (≥ 4) between the two groups. The percentage of TWPCST < 4 in the study group was 44%, significantly higher than the control group, with a percentage of 26%. The main factor affecting the death of patients was TW-PCST ≥ 4 (OR = 5.23, 95CI:1.75-15.60). Conclusion: To comply with hospital policies, physicians often considered the TW-PCST ≥ 4 before the establishment of the core group when evaluating if a patient should transfer to coordinated palliative care. After establishing the core group, a coordinated palliative care referral will be initiated even if the TWPCST score is < 4 as long as the physician believes that the patient needs it, showing significant progress of physicians in identifying potential end-of-life patients. The core group indeed helps promote coordinated palliative care in the hospital.

並列關鍵字

core group ； palliative care ； taiwanese version-palliative care screening tool (TW-PCST)

參考文獻

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