南部某醫學中心住院病人非計畫性重返手術室相關因素初探

The Exploration of Factors Related to Unplanned Return to the Operating Room of Inpatients in a Southern Medical Center

劉麗珒(Li-Jin Liou) ； 沈延盛(Yan-Sheng Shen)

《醫療品質》 4卷2期 (2011/09) Pp. 29-38

https://doi.org/10.29759/HQ.201109.0003

摘要

住院病人非計畫性重返手術室除住院天數延長外，也使得死亡率增加，更增加醫療資源的耗用。本研究探討非計畫性重返手術室患者之危險因子，瞭解非計畫性重返手術室病人預後及所耗用之醫療成本。自2004.9.1至2005.8.31，執行為期1年之前瞻性觀察研究，運用焦點循環管理手法（FOCUS-PDCA Cycle）擬訂相關措施及對策，收集病歷資料及審查手術記錄加以分析。結果：在手術總人數為12,602位中，非計畫性重返個案數為325位，非計畫性重返率為2.44％。其中202（62.2％）位病人為男性、平均年齡為56.98±19.4歲。前三位高重返率的科別為神經外科、心臟外科及胸膛外科；最常見重返原因是重建呼吸道、感染及出血。非計畫性重返之危險因子為傷口分類中之污染傷口，術前麻醉危險程度評估等級之第3級病人，手術時間長度為3-6時。非計畫性重返病人在住院天數、加護病房天數、總費用及手術費用均較顯著增加。未重返手術病人之死亡率為2％；非計畫性重返手術病人死亡率為12％。本研究證實非計畫性重返手術室病人預後較差且耗用較高醫療成本，此結果將可提供院方做為改善醫療品質之參考。

關鍵字

手術室 ； 非計畫性重返手術室 ； 焦點循環管理手法

並列摘要

The unplanned return to the operating room of inpatients not only prolongs length of stay, but also increases the mortality. Furthermore, it increases the resource consumption of medical care. This prospective observation study was designed to explore the risk factors of inpatients' unplanned return to the operating room, and realize the cost of medical care and prognosis of inpatients of unplanned return to the operating room. The study period was one year from Sep. 1, 2004 to Aug. 31, 2005. Related control measures and strategy were developed by using FOCUS-PDCA Cycle. Patients' data was collected by retrieving patient history and reviewing operation records. The results show there is 325 patients identified as the unplanned return among 12602 patients, the unplanned return is 2.44%, with mean age of 56.98±19.4 years old. 202 patients (62.2%) is male. The top three disciplines are neurosurgery, cardiovascular surgery and thoracic surgery. And the main causes are reconstruction of respiratory tract, infection and bleeding. The risk factors for unplanned return are contaminated wound in wound classification, the ASA risk class III, and the operating lime period between 3-6 hours. The length of slay, the days in ICU, total expense of medical care, medical quality of surgical cost and resource consumption are significantly higher in unplanned return patients. The mortality is 2% for non-return inpatients and 12% for unplanned return inpatients. Our results proved that medical cost in unplanned return inpatients was higher and prognosis of these patients was poor. The data are provided as the reference to improve the quality of medical care.

並列關鍵字

Operating room ； unplanned return to the operating room ； FOCUS-PDCA ； Cycle