急診處置效率的影響因子：人力的配置

Factors Affecting Work Performance of Emergency Department：Manpower Allocation

鄭憲鴻(Hsien-Hung Cheng)

指導教授 ： 莊弘毅

高雄醫學大學/健康科學院/職業安全衛生研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00107

摘要

背景：急診是處理及治療重病和危急病人的醫療場所，使急診的效率提升也能夠增進病人照顧的品質，在台灣，因急診病人滯留太多太久，使急診沒有辦法發揮最大的效率，反而可能延遲某些危急病人的醫療處置，為了評估急診改善方案的成效，我們必須先找出影響效率的因子，才能以最少的資源達到最大的效果。
目的：本研究試圖找出影響急診效率的因子，以供日後評估醫療處治、看診效率、及改善方案的參考。
方法：一個成功的腦中風照顧系統對時間的要求很嚴格；針對急性3小時內腦中風的病人，目前均要求醫師能在10分鐘內評估病人。此研究是一觀察型研究，收集了台灣某一依照ACLS指引提供24小時腦中風病人照護的醫學中心的資料，包含病人到院至醫師處置的時間，醫病比和護病比，病人來診量，醫師班別和醫師人數以比較他們之間的關係。統計使用的軟體為Stata 11版。
結果：資料收集的時間為2008年05月至2011年06月，共684人次因3小時內腦中風至急診就診，不論白班、小夜或大夜班的處置時間均無差異。腦中風病人來診當時急診現場當時的病人數和處置時間有顯著相關，和檢傷是否有通知也有顯著相關(p < 0.001)。使用邏輯斯迴歸模式顯示處置時間是否有超過10分鐘的標準也與病人和主治醫師人數比例有統計學上的意義。
結論：初步的結果顯示檢傷是否有通知是影響醫師診治時間的重要因子。再者，急診滯留的病人數目和醫師的處置時間有顯著的相關，病人愈多處置的時間愈延長，效率會降低，可以做為測量急診效率的方法之一，若要改善急診診療的效率，建議可增加主治醫師的人數。

關鍵字

急診 ； 處置效率 ； 人力

並列摘要

Background: The drive to maximize emergency department (ED) efficiency is also ensuring the quality of care. Taiwan’s EDs are constantly at a dangerous breaking point by over-crowded and suffering from poor patient flow, with few resources to bring themselves back from the edge. To evaluate the implementation of strategies for improving patient flow and reducing ED crowding, we need to develop a standard performance measurement in the ED.
Objective: We try to find the factors affecting the work performance in emergency medical professionals.
Methods: The time-sensitive nature of acute stroke care is central to the establishment of successful stroke systems. The management Goals of Initial ED assessment and stabilization must be within 10 minutes. This is an observational retrospective study collecting the data from a tertiary teaching hospital in Taiwan, offering a 24-hour acute stroke treatment service as ACLS guideline. The parameters collected include door-to-ED assessment time, triage and related patients visiting numbers, shiftwork type, and the numbers of nurses and physicians. The statistical analysis was performed using STATA 11 to compare the assessment time between other indicators.
Results: Initial data collected from 2008/05 to 2011/06 with total 684 stroke patients showed no difference between time
IV
assessment and each shiftwork type indicating the standard protocol in management of acute stroke. The correlation coefficient showed significant among the numbers of patients had visited ED in the same shiftwork type, the numbers of patients who are staying at ED while stroke management, numbers of patients visiting in one and two hours, triage notification and the total numbers of physicians in ED (p < 0.001). While using the regression model, the numbers of patients who are staying at ED while stroke management and the ratio of patients to attending doctors in ED remained significant (p=0.001).
Conclusion: We found the major influence factor of initial management time in ED patients is the notification of triage nurse. The initial findings showed that the numbers of patients who are staying at ED significantly delayed the initial assessment time in ED. We need more enrolled patients to confirm the result, and hence, future studies are warranted

並列關鍵字

work performance ； emergency department ； ratio of patients to doctors

參考文獻

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