影響急診壅塞關鍵因素之探討

急診壅塞為全國各家醫院及衛生福利部之關注議題，台灣大型醫院急診室人滿為患，民眾早已見怪不怪了，台灣有一半以上的醫院急診室壅塞的等級面臨到[危機]和[嚴重]，問題較小者延長等候時間、問題大者因為等候導致病患延遲診療救治時機。由於台灣健保優勢之下醫療就醫的可近性，急診為醫療體系中唯一對外提供24小時全方位服務單位，守護民眾緊急重大傷病時之生命與健康照護。患者可自行選擇就醫醫院，易導致醫學中心急診過度壅塞，因為醫策規劃欠佳，導致中小型醫院萎縮，病患灌爆了大型醫院的急診室，甚至癱瘓急診，導致急診啟動滿載機制，大型醫院的急診每天都在上演壅塞戲碼，導致急診醫護人力徒增無形的壓力，人員流動率攀升，壅塞與人力不足等問題環環相扣，原因複雜，需加強急診團隊合作訓練，強化醫病溝通能力，降少醫糾產生，降低抱怨件數，整體考量需從制度面、法規面、人力層面及健保給付方面進行全面探討。為協助醫院排解急診室壅塞之狀況，本研究透過文獻回顧，蒐集急診室之業務流程，及各種急診室壅塞因素，並透過質性研究訪談法彙整各項壅塞因素，且藉由層級分析法[AHP]賦予架構權重值，以建置能為實務界所使用之架構與量表。本研究之成果除能幫助急診室了解問題之根本，亦能提升決策效率之外，更有效整合過去學者之學術成果，達到學術與實務整合之效益。

關鍵字

急診壅塞；關鍵因素；質性訪談法；層級分析法

並列摘要

Crowding in the emergency department (ED) is an issue that is under close scrutiny by both Taiwan’s ministry of health and hospitals all over Taiwan. ED crowding has become daily occurrences in Taiwan’s major teaching hospitals, half of which reach to a degree of ‘severe’ or ‘critical’ crowding. ED crowding not only prolongs the waiting time, but also affect patients’ outcome. National health insurance of Taiwan provided unrestricted access to ED in Taiwan. ED is the most important portal of medical care access for most critically ill patients, and provides 24-hour urgent medical care services to all residents in Taiwan. Factors influencing ED crowding in Taiwan can be analyzed in different dimensions. In the policy dimension, the unrestricted access to ED policy may over flood ED with less-severe patients. In addition, the number of small community hospitals in Taiwan has decreased substantially after the execution of National Health Insurance programs. So patients are forced to visit ED of large hospitals. The hours of ambulance diversion are steadily increased. Daily ED crowding poses great pressure on the healthcare provider, and increase the ED staff burn out rate. The solve the complex ED crowding problem, the regulation, human resources, and health insurance reimbursement should be re-designed in a systematic way. Our study aims to find the key factors influencing the ED crowding. We will perform systemic review of related literature, collect information on ED healthcare services, and make qualitative interview with the experts. Collected information will be ranked by analytic hierarchy process, and will be used to establish a clinically useful structured instrument. We hope our study will help improve ED crowding and narrow the gap between managerial practice and academic research.

並列關鍵字

emergency department overcrowding ； critical factors ； qualitative research interviews and analytic hierarchy process

參考文獻

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影響急診壅塞關鍵因素之探討

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