轉診病人急診室延遲原因分析

Analysis of the Reasons in the Delay of the Interhospital Transfer of Patients in Emergency Departments

楊育純(Yu-Chun Yang) ； 林朝順(Chaou-Shune Lin)

《Journal of Emergency Medicine, Taiwan》 6卷1期 (2004/03) Pp. 261-268

摘要

目的：本研究在探討轉診病人在急診室延遲原因以改善轉診病人之醫療照顧品質。
方法：以新竹一家地區教學醫院急診轉診病人為對象，由轉診記錄表單內所記錄的病人基本資料、到院時問、通知救護車時間、救護車到達時間及病人離院時間為依據，我們可得知病人「急診停留時間」，計算公式為「病人離院時間」－「病人到院時間」。我們設定轉診病人在「急診停留時間」超過90分鐘為延遲，延遲的原因分為五類。
結果：從90年8月起至91年12月止，共有234次轉診，這當中共有男59位(59/234；25%)轉診病人在急診室停留時間超過90分鐘，我們統計延遲原因，依其發生比率高低。分別為： ①病人或家屬因素32次(32/59；54.2%)。 ②急診醫師判斷因素13次(13/59；22.0%)。 ③病情因素8次(8/59；13.6%)。 ④聯絡醫院因素3次(3/59；5.1%)。 ⑤轉送小組因素1次(1/59；l.7%)。
結論：分析轉診病人停留急診室時間延遲的結果，可提供醫師醫療專業教育的參考，也可發現急診管理的問題，例如：轉送小組反應速度之監控、聯絡接受醫院之規劃等。我們建議更多醫院就此議題進行研究，以建立新的、有效的急診病人轉診品管指標。

關鍵字

轉診 ； 緊急醫療網 ； 品管指標 ； 創傷照顧 ； 救護車

並列摘要

Purpose: This study is to investigate the reasons in the delay of the interhospital transfer of patients in emergency departments in order to improve the quality of the medical care of them.
Method: The transfer records of all those patients who underwent interhospital transfer in the emergency department of a teaching hospital in Hsinchu County were analyzed. According to the recorded personal data of each patient, his arrival time at the hospital, the time that the ambulance was noticed and its arrival time as well as the departed time of this patient, the staying time of the patient in the emergency department could thus be calculated. This is the time interval between the arrival and the departure of the patient from the emergency department. A staying time of more than 90 minutes in the emergency department is designated as delay in transferring. There were 5 different reasons in the delayed.
Results: A total of 234 cases of interhospital transfer were analyzed from August, 2001 to December, 2002. Among them, 59 cases (50/234; 25%) of these interhospital transferred patients had a staying time of more than 90 minutes in the emergency department. According to the frequency of occurrence, those reasons are: 1. patient or relatives factors (32/59; 54.2%). 2. decision of the emergency physician factor (13/59; 22.0%). 3. Nature of the illness factor (8/59; 13.6). 4. interhospital communication factor (3/59; 5.1%). 5. Transfer team factor (1/59; 1.7%).
Conclusions: The investigation of the reasons of the prolonged staying time of patients in the emergency department before transferring can provide teaching information for the professional education of doctors. It can also help in the quality control in the emergency department management such as the surveillance of the response speed of the transfer team and the process of contacting the accepting hospital.

並列關鍵字

interhospital transfer ； emergency medical service systems ； quality indicator ； trauma care ； ambulance