影響術後病人留滯於恢復室之因素-中部某醫學中心為例

The factors influencing postoperative patients ' detention in recovery room- A practical study in a medical center.

謝慧甄(Hui-Chen Hsieh)

指導教授 ： 蔡雅芳

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2018年)

摘要

研究目的：手術室的營運涉及各種專業人力的配合與資源耗用，手術室成本約佔一位住院病人住院總成本的25%，為醫院耗用最高，也是最賺錢的部門之一，如何提昇手術室生產效率？是醫院管理階層最需優先考量的管理問題之一。如果手術結束而沒有恢復室的床位或護理人員來提供病人的照顧，那麼病人可能必須在手術室內等待恢復。這種情形會讓手術室無法進行下一個手術，甚至於需取消下一個手術，影響手術室的使用效率。如果能夠減少病人在恢復室的停留時間，就可以騰出手術室的資源，減少上述情況的發生。另外，在恢復室的停留時間過長時，也會影響醫療費用。因為在恢復室需要對病人連續監測，所以在恢復室停留兩小時的費用大約相當於24小時的住院費用。因此，降低在恢復室的停留時間有助於手術室的使用，避免取消手術，降低醫療財務支出。本研究目的為：探討影響術後病人留滯於恢復室大於2小時之因素並建立原因別分類系統，作為個案醫院日後改善措施的參考。
研究方法：本研究主要採用質化研究設計，運用焦點群體法，訪談在手術室恢復室工作的醫院員工，透過焦點群體訪談，了解他們認為造成個案醫院病患滯留恢復室時間超過兩小時的原因。除此之外，本研究也收集個案醫院病患滯留恢復室時間超過兩小時的相關量化資料，如個案數的統計資料等，或是推動與該議題相關品管圈歷程的會議紀錄資料或結果報告等，作為研究資料的來源。
研究結果：本研究發現病患滯留恢復室時間大於兩小時的原因有下列三個因素：
因素一：無恢復室滯床處理流程
(一) 床位不足(普通病房及加護病房)需於恢復室等待床位。
(二) 延遲拔管>1小時以上。
（三）麻醉醫師過忙而無法至恢復室評估病人是否適合轉送回病房。

（四）外科醫師要求病人續留置恢復室觀察。
因素二 術後病人事件的處置
(一)術後急性疼痛的反覆性發作與處置
(二)術後低體溫情形
(三) 術後發生噁心嘔吐情形的處置
(四) 麻醉藥物代謝過慢至病人麻醉未醒或脊椎麻醉病人麻醉恢
復程度未完全恢復至第一腰椎以下。
因素三 手術合併症
（一）手術部位傷口感染或異常出血導致病人生命徵象不穩定。
（二）病人本身的過去疾病史，導致麻醉藥物代謝過慢。
（三）因術中大量輸血需於恢復室完成輸血作業流程。
結論：手術室病人的安全，近期受到醫院及各界的矚目，手術全期的照護更為院方所重視，恢復室是手術全期照護的重要一環，恢復室術後病人留滯於恢復室時，將會嚴重影響手術銜接作業流程延遲，會降低手術室資源利用的效率，導致人員加班，增加營運成本影響病患照護的醫療服務品質。若醫院管理者欲改善病患於恢復室停留時間過長建議可以從改善恢復室處理流程、加強術後病患的事件處置與減少病患手術後的合併正著手。

關鍵字

恢復室 ； 質性研 ； 究焦點團體訪談

並列摘要

Purpose: Running operation rooms involves professional human resources cooperation and resources consumption. The cost of operation rooms is about 25 % of hospitalization cost. It is the highest among all hospital costs. Meanwhile, the operation rooms are also one of the most profitable parts in a hospital. Therefore, how to improve the productivity of the operating rooms is one of the priority questions for the hospital administration. If a surgery finished without a bed or nurses in the recovery room to provide patient care, the patient may have to wait in the operation rooms. As a result, the following surgery has to be delay or even cancelled. Namely, the efficiency of the operating rooms is affected. If the duration of staying the operation room reduced, the resource of operation rooms could be used by more patients. Prolonged stay in the recovery room increases total cost due to intensive monitoring. For example, a patient stays for 2 hours in the recovery room costs as much as 24-hours in the ward. Therefore, reducing the time that a patient stays in the recovery room can free up operation room resource and to minimize the incidences such as schedule delay or cancellation and reduce hospital costs. The purpose of this study is to explore and categorize the factors related to a prolonged stay for more than 2 hours in the recovery room postoperatively and to provide information for intervention in the future.
Method: As a qualitative research, this study used focused-group interviewing.We interviewed recovery room staffs to explore the reasons of prolonged recovery room stay for more than 2 hours. In addition, relevant quantitative data, such as the case number, statistical information, past achievements of quality control circle activities were also collected.
Results: In this study, we found three factors related to recovery room prolonged stay for over 2 hours:
Factor 1: Lacking of SOP for dealing vacant beds in recovery rooms.
(1-A) When there is no bed in ward or in ICU, patients wait in the recovery room.
(1-B) Delay extubation for > 1 hours.
(1-C) Anesthesiologists are too busy to evaluate the patients and discharge them from the recovery room.
(1-D) The surgeon asks for further observation of patients in
the recovery room.
Factor 2: To deal with patients’ affairs
(2-A) Managing recurrent acute pain episodes after operation
(2-B) Managing post-operative　hypothermia
(2-C) Managing post-operative nausea/vomiting
(2-D) Waiting for recovery (wakeup in cases of general anesthesia /
sensory recovery above L1 dermatome in cases of spinal
anesthesia.
Factor 3: Surgical complications
(3-A) Surgical site infection or bleeding with unstable vital signs
(3-B) Underlying diseases of the patients leading to slow recovery
from anesthesia
(3-C) Waiting for completing blood transfusion due to significant
surgical blood loss
Conclusions: Surgical patients’ safety catches wide attention recently.
Perioperative care is also emphasized by the hospital administration. The recovery room is a key component in the chain of perioperative case. Prolonged stay of post-operative patients in the recovery room severely occupied the operation room resource utility. It delays the schedule of operation rooms, increases working overtime, increases cost and affects　the quality of care. For the hospital administration, developing a protocol for recovery room congestion, improving patient complaints management, and improving complications management are possible resolutions to cope with the issue of the recovery room prolonged stay.

並列關鍵字

Postoperative Intensive Care Unit ； Qualitative research ； Focus Group

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