探討南部某區域醫院的兒童急診於72小時內返診之危險因素

The investigation of risk factors of 72- hour return visits in pediatrics emergency department -an example from a district hospital of southern Taiwan Abstract

馬震中(Chen-Chung Ma) ； 蘇有村(Yu-Tsun Su) ； 林佟威(Tung-Wei Lin) ； 鄭怡婷(Cheng I-Ting)

《安泰醫護雜誌》 23卷1期 (2017/06) Pp. 13-27

摘要

目的:急診照護中，兒童相關性急診返診率是用於評量兒童急診醫療品質重要的指標，本研究希望藉由分析兒童急診利用與返診之影響因素，以此作為將來制訂兒童急診品質指標改善方案之依據。方法：本研究採回溯性研究設計，運用次級資料分析，資料來源為個案醫院病歷資料，資料收集時間為2015 /01/01至2015 /09/30，共蒐集8,628 筆兒童急診資料，其中273 筆為兒童72小時內相關性返診資料。結果與結論:個案醫院2015年第一季至第三季平均72小時內急診相關性返診率為3.67 %，年齡主要集中於6歲以下(78.3%)；1歲以下相較於年齡較高者其返診風險高出約1.79倍，發燒者相較於非發燒者返診風險高出約1.77倍，傳染病及寄生蟲相關疾病較兒科急診最常見之急病診斷(呼吸系統疾病)高1.49倍的返診風險，周一至周五來急診就醫的兒童其返診風險高於周六至周日就醫兒童的1. 54倍，白班的返診風險較大夜班高出1. 46倍;研究發現1歲以下、發燒或診斷為傳染病及寄生蟲的病人為兒科急診返診的高危險族群，因此本研究建議應針對兒童返診高危險族群之照顧者給予更多衛教關懷以提升兒童急診醫療品質。

關鍵字

兒童急診 ； 72小時內相關性返診 ； 醫療品質 ； 醫療利用

並列摘要

Purpose: In the field of emergency care, the return rate of child-related emergencies is an important index to evaluate the quality of pediatric emergency care. The current study aimed to probe into risk factors affecting the use of pediatric emergency and subsequent return visits, serving as the reference for improvement in regulating pediatric emergency quality indexes. Method: This study adopted a retrospective design and secondary data analysis. Data was collected from medical records of a district hospital in southern Taiwan from 2015/01/01 to 2015/09/30. A total of 8,628 pediatrics emergency medical records were collected, among which 273 were 72-hour return visits in pediatric emergency. Results and conclusions: The average rate of 72-hour emergency return visits of the case hospital from the first quarter to the third quarter in 2015 was 3.67%, in which children under the age of 6 accounted for 78.3%. The risk of return visit of children below the age of 1 was 1.79 times higher than that of elder children. Children with fever had higher risk of return visit than those without fever by 1.77 times. Infections and parasitic diseases resulted in higher risk of return visit than the commonly-seen respiratory diseases by 1.49 times. Return visits on weekdays (Monday to Friday) led to higher risk than those during the weekend (Saturday and Sunday) by 1.54 times. Risk of return visit during the day shift was 1.46 times higher than that during the night shift. The results revealed that children below the age of 1, with fever, infections and parasitic diseases were the high-risk groups in return visits in pediatric emergency. It is suggested that more health education be given to caregivers of high-risk groups to enhance the quality of pediatric emergency care.

並列關鍵字

pediatric emergency ； 72-hour return visit ； medical quality ； medial utilization