探討緊急醫療能力分級醫院於嚴重特殊傳染性肺炎疫情前後緊急醫療品質之差異‒以高雄地區為例

A study on the differences in the emergency medical quality before and after the outbreak of severe special infectious pneumonia in hospitals with emergency medical capacity classification‒An example of Kaohsiung region

范雅芳(Ya-Fang Fan)

指導教授 ： 黃俊哲

義守大學/醫學院/醫務管理學系/碩士(2022年)

摘要

背景：新型冠狀病毒疾病(以下簡稱新冠疾病COVID-19)為引發全球大規模傳播感染，疫情始於2019年12月於中國湖北省武漢市，隨後在2020年初擴散至全球多國，且被世界衛生組織形容為最嚴重的公共衛生危機。因新冠疾病(COVID-19)疫情因素，民眾會擔心醫院收治確診病人，增加其感染風險，故減少至醫院就醫，進而可能減少急診就醫人數。
目的：本研究主要目的：(一)探討緊急醫療能力分級醫院於疫情爆發前後緊急醫療品質監測項目結果的差異。(二)探討重度級、中度級和一般級緊急醫療能力醫院於疫情爆發前後緊急醫療品質監測項目結果的差異。
方法：本研究採回溯性縱貫式研究設計，資料來源取自衛福部緊急醫療管理系統中高雄地區急救責任醫院2018年5月至2021年6月期間醫療服務統計資料檔，而研究對象曾至高雄地區急救責任醫院急診就醫病人。研究變項包括緊急醫療能力分級醫院、教學醫院評鑑層級、所在區域別、嚴重特殊傳染性肺炎疫情爆發前、後期，以及緊急醫療品質監測項目等，並使用配對樣本t檢定廣義估計方程式比較不同緊急醫療能力分級醫院於嚴重特殊傳染性肺炎疫情爆發前、後期對緊急醫療品質監測項目之差異。
結果：本研究結果顯示在控制教學醫院評鑑層級和所在區域別後，相對於疫情爆發前期，不同緊急醫療能力分級醫院於嚴重特殊傳染性肺炎疫情爆發後期對急診檢傷一級、檢傷二級、急診加護病房收治、72小時重返急診、急診會診，以及急診會診超過30分鐘病人數皆有顯著減少。然而，不同緊急醫療能力醫院於疫情爆發後期對院內心跳停止(IHCA)病人數則有顯著增加。另外，相對於一般級緊急醫療能力醫院，重度級緊急醫療能力醫院於疫情爆發後期對急診檢傷一級、檢傷二級、急診加護病房收治、72小時重返急診，以及急診會診病人數仍有顯著增加情形；中度級緊急醫療能力醫院於疫情爆發後期對急診檢傷二級、急診加護病房收治、72小時重返急診，以及急診會診病人數亦有增加，但不具統計顯著。
結論：本研究發現建議衛生主管機關於常態性防疫期間可針對高雄地區不同緊急醫療能力分級醫院執行緊急醫療品質項目持續監測，並進行問題分析及改善，以確保急診病人能獲得適當的處置與照護品質。

關鍵字

新型冠狀病毒 ； 醫院 ； 急診病人 ； 緊急醫療能力分級 ； 緊急醫療品質監測

並列摘要

Background: The novel coronavirus disease 2019 (COVID-19) caused a large-scale global spread of infection. The epidemic started in Wuhan, Hubei Province, China in December 2019, and then spread to many countries around the world in early 2020, and it has been described as the most serious public health crisis by the World Health Organization (WHO). Due to the COVID-19 epidemic, people are worried that hospitals have admitted confirmed patients and increase their infection risk, so the number of hospital visits decrease, which may reduce the number of emergency medical visits.
Objectives: The main purposes of this study: (1) To explore the differences in the results of emergency medical quality monitoring items before and after the outbreak in medical capacity classification hospitals. (2) To explore the differences in the results of emergency medical quality monitoring items before and after the outbreak among severe, moderate and general emergency medical capacity hospitals.
Methods: This study adopts a retrospective longitudinal research design. Data source obtained from the Statistic Database of Emergency Medical Service for Emergency Responsibility Hospitals of the Ministry of Defense and Welfare in Kaohsiung region between May 2018 and June 2021. The subjects included patients who presented to the emergency department of emergency responsibility hospitals in Kaohsiung region. The variables contained medical capacity classification hospitals, accreditation levels of teaching hospitals, regional areas, before and after the outbreak of severe special infectious pneumonia, and emergency medical quality monitoring items. The paired sample t test and generalized estimation equation was used to compare the differences of emergency medical quality monitoring items before and after the outbreak in hospitals with different emergency medical capacity classifications.
Results: The study results showed that after controlling the accreditation levels and regional areas of teaching hospitals, compared with those before the outbreak of pandemic, hospitals with different emergency medical capacity classification had a significant decrease in the numbers of emergency triage level I, triage level II, emergency intensive care unit (ICU) admissions, 72-hour returns to the emergency department (ED), ED consultations, and ED consultations longer than 30-minute patients after the outbreak of severe special infectious pneumonia. However, there was a significant increase in the number of in-hospital cardiac arrest patients in severe emergency medical capacity hospitals after the outbreak of pandemic. In addition, compared with those with general-level, severe-level emergency medical capacity hospitals had the number of emergency triage level I, triage level II, emergency ICU admissions, 72-hour return to emergency department, and emergency consultation patients after the outbreak of pandemic. The number of emergency triage level II, emergency ICU admissions, 72-hour return to emergency department, and emergency consultation patients in those with moderate emergency medical capacity also increased after the outbreak, but it was not statistically significant.
Conclusions: These findings suggests that the health authorities could continuously implement emergency medical quality monitoring for hospitals with different emergency medical capabilities in Kaohsiung region during the normal epidemic prevention period, and conduct problem analysis and improvement to ensure that emergency patients can receive appropriate treatment and quality of care.

並列關鍵字

Coronavirus disease 2019 ； hospitals ； emergency patients ； emergency medical capacity classification ； emergency medical quality monitoring

參考文獻

中文部分

王鳳琴、吳宜珍、陳美杏、林宗憲、葉怡亨、吳彥鴻 (2021)。透過急診病人流分析COVID-19對醫學中心急診之影響。醫療品質，9(2)，9-21。https://doi.org/10.29759/THQA.202106_9(2).0001

江宏倫、王芊淩 (2020年12月30日)。急診等很久有病沒人醫？要去急診前先看這裡！Heho健康。https://heho.com.tw/archives/141357

林雨佑、楊惠君、林慧貞、陳潔、楊智強、嚴文廷、曹馥年、張詩芸、洪琴宣、陳思樺、許佳琦 (2022年8月10日)。COVID-19大事記：從全球到台灣，疫情如何發展？報導者。https://www.twreporter.org/a/2019-ncov-epidemic

郎慧珠 (2021)。COVID-19疫情對於醫療產業及民眾健康之衝擊及反思。人文與社會科學簡訊，22(4)，31-37。