Comparison of Interhospital Transfers in Urban and Rural areas-Hsin Chu County and City Experience

鄉村與都市的急診轉診比較－新竹縣及新竹市經驗

林朝順(Chaou-Shune Lin) ； 謝國雄(Kou-Shiong Hsieh) ； 楊寶珠(Pao-Chu Yang) ； 王玉璋(Yu-Chang Wang) ； 高翔(Hisang Kao) ； 張玉龍(Yu-Long Chang)

《Journal of Emergency Medicine, Taiwan》 6卷1期 (2004/03) Pp. 221-229

摘要

背景：本研究之目的在比較都市地區及鄉村地區轉診型態之差異，以使衛生署能依各區域之特性訂定標凖化轉診流程及凖則。
方法：我們選擇新竹縣及新竹市爲研究地點。研究對象是急診部門的病患中須轉診者，不包括門診及病房的轉診病患。新竹縣市總共10家醫院的急診病患加入本研究族群。每一次轉診都必須填寫「轉院記錄表」三聯單。爲比較都市型及鄉村型之轉診型態，我們分析轉診記錄表，使用的變數如下：轉診病患之基本資料，創傷人數，跨區轉診，轉送小組反應時間，急診停留時間，運送時間，轉診時間，疾病型態及轉診原因。
結果：鄉村地區相較於都市地區，創傷病人較多，轉診小組反應速度較慢，鄉村與都市均有相同之問題：病人在急診停留時間及轉診時間太長，跨區轉診的比例很高。
結論：基於上述分析，急診部門要訂定品管指標項目，針對轉診步驟進行分析，使轉診過程之時間減少。鄉村地區轉送小組應特別加強外傷病患之轉送照顧技巧訓練，及創傷照顧系統之規劃。

關鍵字

創傷系統 ； 轉診 ； 緊急醫療網

並列摘要

Objective: This study compared differences in interhospital transfers between an urban and rural area in northwestern Taiwan. This information can be used to assist the government in drafting guidelines for interhospital transfers according to the geographic characteristics of each area.
Methods: We selected two regions as study sites, one of which represented a rural area and the other an urban area in northwestern Taiwan. The study included patients who were seen in emergency departments (EDs), and who required transfer to another hospital. We retrospectively analyzed the following variables of the transfer records: 1) basic information of the patient transferred; 2) percentage of trauma patients; 3) percentage of interrgional interhosptial transfers; 4) response time of the transfer teams; 5) time spent in the ED; 6) transport time; 7) total interhospital transfer time; 8) types of diseases; and 9) reasons for the transfer.
Results: In the rural area, there were more trauma patients (47% vs. 33%, p＜0.05), and the response time of the transfer team was slower (28% of cases were delayed vs. a 12% delayed, p ＜0.05). In both the rural and urban area, time spent in the ED and total interhospital transfer time were very long, and the percentage of interregional interhospital transfers were high.
Conclusions: Based on the results of this study, we provide the following suggestions: the ED of each hospital should analyze its own interhospital transfer process and reduce the time delays. The government should establish trauma care systems in rural areas where a majority of trauma patients exist in order to decrease the percentage of interrgional transfers.

並列關鍵字

EMS systems ； interhospital transfer ； trauma care system