未完成急診就醫程序病人再探

Re-investigating the Patients Discharging From Emergency Department Prematurely

謝偉禎(Wei-Chen Cheah) ； 胡百敏(Pai-Min Hu) ； 金霍歌(Huo-Ko Chin) ； 廖訓禎(Shiuan-Jen Liaw) ； 廖浩欽(How-Chin Liao)

《台灣急診專科醫師期刊》 1卷1期 (2009/12) Pp. 39-49

https://doi.org/10.29749/JTCEP.200912.0005

摘要

本研究根據2000年的研究結果，追蹤在健保制度大幅變革之下，區域醫院急診部門之未完成就醫程序病人在數量、病人特質與各種可能的相關影響因素是否有所變化。
研究之病人群體為2005年4月1日起至7月31日止，對所有至一所區域醫院急診部門求醫後自動出院與診視後自行離院之病人進行全查，並對完成急診就醫程序病人，以100人次為間隔進行系統性抽樣，於樣本病人離院72小時後至三週內，由電訪員以結構式電話問卷進行調查。
整體而言，本研究發現在健保制度變化下，未完成急診就醫病人特質與五年前之調查結果類似，仍呈現年齡較大及疾病嚴重度較高之病人較易發生自動出院的情況，研究結果也再次顯示此三組病人基本上是屬於不同的就醫族群，帶著不同的需求與期望至急診就醫。但在就醫情況部份，病人之急診留置時間變異加倍延長，因等床住院時間過長而決定自動出院之比率大幅增加，以及自行離院者比率較前次增加1.5倍是最值得注意的現象。各醫院急診應對此類病人進行探究，並找出符合自身需求的因應之道。

關鍵字

未完成就醫程序 ； 急診 ； 自動出院 ； 自行離院

並列摘要

This study was developed bases on the results of previous study to understand if the amount, characteristics and other related factors of those patients leaving the emergency department (ED) prematurely changed in a regional hospital ED under the payment system reform of the national health insurance.
All of the patients who visited and left the ED as against advice discharge (AMA) and escape from the study hospital ED between April 1st and July 31st, 2005 were included. Discharge patients were systemic sampled every 100 visits. Telephone survey with constructed questionnaire was conducted by a trained interviewer after patients left the ED 72 hours.
The study revealed that characteristics of patients were similar to the previous report that AMA, escaped and discharged patients were different in age, severity and length of stay (LOS) in the ED, respectively. The elder and critical patients tended to AMA more comparing to the other patients.
The study also discovered that the three patient groups had different satisfaction to the medical services. It demonstrated again that they belonged to different patient populations, so they visited the ED with diverse expectations and demands.
In the medical care environment, the study disclosed that the variation of LOS in the ED was doubled than previous study. The AMA due to wait too long for admissions were increased and the escape rate was raised 1.5 times than previous study.

並列關鍵字

leave prematurely ； emergency department ； against advice discharge ； escape