利用修改後護理EDWIN指數評估急診壅塞之研究－以南部某公立醫學中心為例

背景與目的：衛福部統計資料指出，急診就醫人次近20年來暴增，使真正急重症病患所需的醫療資源遭受耗用。本論文旨利用資料庫系統，將急診工作負荷指數EDWIN公式的醫師人數更改為護理人數，計算出急診護理工作負荷指數，利用即時監測看板呈現，並制定警戒值，資訊主動通報醫院長官，期能適時調派人力支援，以降低醫護人員工作負荷壓力。目的探討護理EDWIN指數是否適用於急診壅塞之評估，並研究護理EDWIN是否比醫師EDWIN指數對於急診壅塞的預測較佳。材料與方法：本論文是回溯性分析研究，收集南部某醫學中心急診一整年資料，每10分鐘收集一筆資料，包含急診病患總人數、反向檢傷分類級數、該時間護理及醫師工作人數、急診所有病床數及已看完診且準備住院人數，以公式計算出醫師EDWIN及護理EDWIN的工作負荷指數，將所取得的資料進行統計分析。結果與結論：本論文共收集52,560筆有效資料。利用相關係數分析上具有正向顯著關係，護理EDWIN是否比醫師EDWIN與急診病床占用率及等候住院比率有顯著相關性，而護理EDWIN較醫師EDWIN更適合用來做為壅塞預測警示的工具。依據分析結果提出以下建議：1)醫院能夠依據護理EDWIN，做出即時監測系統呈現急診壅塞狀況，將資料視覺化，並統一制定壅塞負荷警戒值，主動傳送通報醫療長官，能即時進行支援人力調配；2)醫院能將護理EDWIN指數做為公開急診壅塞訊息發佈的參考指標；3)利用護理EDWIN做為監測護理人力需求的重要參考資訊，期望能做未來醫院評鑑急診護理人力的重要參考指標。

關鍵字

急診工作負荷指數；急診壅塞；人力支援

並列摘要

Background and Goals: The statistics from the Ministry of Health and Welfare indicated that the number of patients visiting the emergency department has increased enormously in the past 20 years, which has caused medical resources utilization needed for critical patients. Kaohsiung Veterans General Hospital Integration Database and Emergency Department Work Index (EDWIN, abbreviated as the physician EDWIN) were applied in the study. The number of physicians in formula of EDWIN was replaced with the number of nurses; the emergency nursing workload index was calculated, and the instant monitoring board was utilized for presenting the data. The warning value was set up, the information could be actively reported to the chief in the hospital, and a timely staff deployment was expected in order to decrease the workload of medical staff. The objective is to investigate whether the nursing EDWIN is suitable for the evaluation of emergency crowding, and whether the nursing EDWIN is better than the physician EDWIN for the prediction of emergency crowding. Materials and Methods: This was a retrospective analysis study which collected data from the emergency department of a medical center in the southern Taiwan. The data was collected every 10 minutes for one year; it included the total number of emergency patients, the reverse triage of emergency, the number of nurses and physicians at the time, the number of beds in the emergency department and the patients who had seen the doctors and been prepare for admission. Using the formula to calculate the workload index of the physician EDWIN and the nursing EDWIN, and the data was analyzed with SPSS18. Results and Conclusions: A total of 52,560 valid data was collected in this study. The results of the correlation coefficient analysis showed that there was a statistical significant difference between nursing EDWIN and physician EDWIN. The nursing EDWIN had a positive relationship than the physician EDWIN, emergency bed occupancy rate, and waiting admission rate; the nursing EDWIN would be a more appropriate tool for the warning of predicting crowding than the physician EDWIN. According to the analysis results, the following suggestions are given: 1) The hospital can establish an instant monitoring system based on the nursing EDWIN to reflect emergency crowding, visualize the data, formulate the warning value uniformly, actively transmit the information to the medical chief, and deploy the staff immediately. 2) The hospital can use the nursing EDWIN as a reference indicator for releasing the information of emergency crowding. 3) Using the nursing EDWIN as an important reference for monitoring the demand on nursing manpower and hoping to be an important reference indicator for the emergency nursing manpower of hospital accreditation in the future.