非計畫性重返加護病房之病人特性、危險因子分析—以中部某區域醫院為例

Unscheduled Readmission to Intensive Care Unit—Analysis of Patient Characteristics and Risk Factors : An Example of Regional Hospital in Taichung

顧永隆(ku yung lung)

指導教授 ： 何清松

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

根據研究，加護病房佔了所有醫院床位約7%，卻佔了所有醫院花費達20-30%。在適切的時機及早將病人轉到普通病房可以降低加護病房的住院天數及花費。然而若是過早將病人轉出加護病房，有可能造成病人的病情惡化，重返加護病房。如此，不僅反而增加病人的醫療花費，甚至有可能造成病人的生命危險。因此，將有重返加護病房危險的病人找出來，加強照顧，避免非計畫性重返的發生是相當重要的課題。
本研究針對中部某區域醫院，進行重返加護病房病人之回溯性研究。主要研究目的如下： 描述本研究醫院一年內非計畫性重返加護病房的現況；探討非計畫性重返加護病房的病人特性、常見原因、以及可能的危險因子；研究加護病房非計畫性重返病人是否有較長的住院天數與較高的死亡率。民國94 年7 月1 日至95 年6 月30 日曾住院於本研究醫院三個主要加護病房(內科、外科、心臟科)病人總共2661 人次，其中2063人次順利從加護病房轉至普通病房。總共有192 人次因病情或照顧需求重返加護病房。其中非計畫性重返加護病房的病人共159 人次，非計畫重返率為7.7%。
研究結果發現：非計畫重返組病人的平均年紀為68.3 歲，超過非重返組的63.0 歲(P<0.001)；非計畫重返組病人第一次加護病房的住院天數平均為8.6 日，較非重返組的平均住院日數4.7 日長(P<0.001)；非計畫重返組病人的初次入院APACH II 平均分數為22.2分，高於非重返組病人的16.2 分(P<0.001)；非計畫性重返率，在內科疾病方面以敗血症的重返率為最高(13.9%)，其次為呼吸系統疾病(10.4%)，外科方面以心臟血管外科手術的重返率為最高(25%)。非計畫重返加護病房之病人死亡率為30.2%，為對照組非重返病人(3.0%)之10 倍(P<0.001) 。非計畫重返加護病房病人之總住院天數為40.5 天，亦遠超過非重返組的14.1 天(P<0.001)。總結來說，年紀大的患者、初次加護病房住院PACH II 分數高的患者、以及住院天數長的患者，都較容易發生非計畫性重返。而且這些非計畫性重返的患者死亡率特別高。因此針對有重返危險的病人，在轉出加護病房之前，需要比一般ICU 住院病人更為仔細的評估，轉至普通病房後更需較一般病人密切的照顧。如此才有機會改善非計畫性重返加護病房的問題。

關鍵字

加護病房、重返、非計畫重返

並列摘要

According to previous study in America, the ICU beds account for about 7% of total hospital beds. But the ICU medical expenditure ccount for about 20-30% of total hospital medical expenditure. For the purpose of cutting down ICU medical expenditure. Experts in ICU hope to transfer the patients to ordinary ward earlier whenever suitable. However, if it were too early to transfer patients to ordinary ward, ominous events might happen. Patients might be readmitted to ICU. Thus, the medical expenditure might increase and the patients would be in greater danger,even death. So it’s important to find out the patients who are at risk of readmission, and to prevent their readmission.
This study is a retrospective study in one regional hospital in Taichung. The purposes are as follows: study the readmission events in the hospital; find out the characteristics, causes, risk factors of unscheduled readmission; and calculate the mortality rate and the hospital length of stay.
From July 1, 2005 to June 30, 2006, totally 2661 patients were ever admitted to 3 main ICUs (medical, surgical, and cardiac) in this period. 2063 patients survived their initial ICU admissions. 192 patients were readmitted to ICU, 159 of them were readmitted unexpectedly. The unscheduled readmission rate counted for 7.7%.
Our results are: the mean age of unscheduled readmission patients was 68.3, which was higher then those who were not readmitted (63.0)(P<0.001); the mean initial ICU length of stay of readmitted patients was 8.6, which was longer than those who were not readmitted (4.7) (P<0.001); the mean APACH II score of readmitted patients was 22.2,
which was higher than those who were not readmitted (16.2) (P<0.001).
Patients with sepsis had the highest readmission rate (13.9%) in medical patients, and respiratory problem was the second (10.4%) . Cardiovascular surgery patients had the highest readmission rate 25%) in all surgical patients. The mortality rate of the unscheduled readmitted patients was as high as 30.2%, which was ten times to those who were not readmitted (3.0%). The hospital length of stay was also higher in the readmitted group (40.5 vs 14.1).
In conclusion, those who were older, with higher APACH II score,and longer ICU length of stay were liable to be readmitted to ICU unexpectedly. And those patients had higher mortality rate. It’s important to evaluate those patients with risk of readmission to ICU thoroughly.And detail care should be offered at ordinary ward, in order to reduce the readmission rate.

並列關鍵字

ICU, readmission, unscheduled readmission

參考文獻

1. 財團法人醫院暨醫療品質策進會網站: www://tjcha.org.tw

2. 吳肖琪、吳義勇、朱慧凡等 (2002) 我國醫院醫療品質指標使用之情形。醫療品質雜誌，4 (2)，1-14。

5. 陶阿倫、許天成 (2000) 加護病房評估疾病嚴重度之資料正確性。醫療品質雜誌，3 (2)，13-7。

8. 蔡均婷 (2004) 出院後重返加護病房病人之病人特性及其醫療資源耗用。國立台灣大學公共衛生學院醫療機構管理研究所碩士論文。

1. Alban, RF., Nisim, AA., Ho, J., Nishi, GK., Shabot, MM. (2006)Readmission to surgical intensive care increases severity-adjusted patient mortality. J Trauma, 60(5), 1027-31.