降低某醫學中心重症加護室超期停留率

Reducing the Length of Stay in the Respiratory Critical Unit of a Medical Center

郭帝均(Ti-Gen Guo) ； 陳恩惠(En-Hui Chen) ； 謝明格(Ming-Ke Hsieh) ； 廖淑貞(Shu-Chen Liao)

《榮總護理》 32卷4期 (2015/12) Pp. 424-433

https://doi.org/10.6142/VGHN.32.4.424

摘要

加護中心超期停留不僅影響重症病患的收治，也耗費醫療成本。依據國健局「全民健康保險呼吸器依賴患者整合性照護前瞻性支付方式」之規定中明訂：急性呼吸衰竭病人使用呼吸器於加護病房治療天數應≦ 21天。2012年本單位病人平均停留天數達12.3天，停留超過21天之超期停留率達16.7%，高居全院第三名，故成立專案小組，經由病歷回溯、實際觀察及問卷測量，分析出導因為：未落實轉床標準作業流程、醫療團隊對國健局推動之政策認知不足、未及早介入解說氣管造口術及家屬決策困難。經過跨領域團隊討論修正轉床標準作業流程、藉由教育訓練加強醫療團隊對於「全民健康保險呼吸器依賴患者整合性照護前瞻性支付方式」相關政策之認知、及早提供氣管造口術相關資訊及交流平台之介入措施後，本單位病人停留超過21天之超期停留率降至12.2%、平均停留天數降低至10.7天；考慮氣切平均天數由6.5天降至2.15天；醫療團隊認知正確率提升至87.3%，達專案目標。此措施確實能夠降低加護中心超期停留率，並在建立資訊分享平台設立部落格及微電影獲得家屬熱烈迴響，期望能平行推展於同性質醫療單位。

關鍵字

超期停留 ； 氣管造口術 ； 呼吸器依賴患者整合性照護系統

並列摘要

A prolonged stay in the intensive care unit (ICU) can increase the medical cost. According to the policy of the National Health Insurance Integrated Healthcare Delivery system (IDS), treatment for acute respiratory failure patients using a ventilator in the ICU should be concluded within 21 days. In 2012, the average stay of patients in the Respiratory Critical Care Unit (RCU) of Taipei Veterans General Hospital was 12.3 days. However, 16.7% of the patients who remained in the RCU exceeded the duration specified in the National Health Insurance IDS policy, representing the third highest prolonged stay rate at the hospital. Therefore, an interdisciplinary team was established. This team analyzed the medical records of the patients, observed and administered a questionnaire, and identifi ed the possible problems leading to prolonged stays as follows: (1) lack of consensus on transfers among health professionals, (2) lack of understanding and compliance with the transfer protocol, and (3) delay by family caregivers in deciding whether the patient should have a tracheostomy. The aforementioned issues were addressed by first establishing a panel of interdisciplinary health professionals to discuss the transferring protocol and prolonged stay at the RCU. Second, a clinical training program was designed to enhance the knowledge of the RCU care team regarding the National Health Insurance IDS policy. Third, the education program for family caregivers was refi ned to include a tracheostomy care demonstration video and a discussion platform for questions. The prolonged RCU stay rate decreased to 12.2% and the average length of stay decreased to 10.7 days following these interventions. In addition, the decision-making time of family caregivers for tracheostomy decreased from 6.5 to 2.15 days. The results of pre- and posttests on the knowledge regarding the transferring protocol revealed an increase in the cognitive correct rate from 60.5% to 87.3%. Overall, we achieved the goal of our project. Our approaches will provide useful information for reducing the length of stay in the ICU.

並列關鍵字

prolonged stay ； tracheostomy ； integrated delivery system

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