回診的急診病患：分析危險因子和回診原因

Revisits to the Emergency Department: Analysis of Risk Factors and Reasons

顏瑞昇(Zui-Shen Yen) ； 石富元(Fun-Yuan Shih) ； 蔡光超(Kuang-Chau Tsai) ； 陳石池(Shyr-Chyr Chen) ； 陳文鍾(Wen-Jone Chen)

《中華民國急救加護醫學會雜誌》 14卷3期 (2003/09) Pp. 93-98

https://doi.org/10.30018/JECCM.200309.0001

摘要

72小時內非預約性的回診急診病患，是一群潛在有醫療和法律上問題的高危險病人。我們進行了一個回顧性的研究，嘗試去發現回診病人的危險因子和導致回診的原因。所有在1995年7月31日到8月31日之間72小時內回診的急診病患都用電腦搜尋出來，另外以隨機亂數挑出一群同時期沒有回診過的病人做為比較。我們發現16歲以下的病人和非創傷的病人比較容易回診。和沒有回診的病患比較起來，回診的病人第一次就診時在急診停留的時間比較短，而且在回診後住院的比例比較高。發燒和感染性疾病分別是回診病患最常見的主訴和疾病。病人的因素、醫師的因素和疾病的因素分別佔了回診原因的40.6%、28.5%和30.9%。我們建議多對急診病患進行離院前的教育，和由較有經驗的急診醫師尤其是小兒急診醫師來做急診病患是否可以離院的決定，可能可以將回診的數目減少。

關鍵字

回診 ； 急診 ； 危險因子

並列摘要

Those patients who make unscheduled returns to emergency department (ED) represent a medical-legal high-risk group. We conducted a retrospective study and tried to identify the risk factors and reasons for the revisits. All patients returning within 72 hours of their initial ED visits, from 31 July to 31 August 1995 were identified. A control group composed of patients who visited the ED during the same period but who did not revisit were selected using simple random sampling. We found that those patients who were under 16 years old and those who visited the ED due to non-traumatic causes were more likely to revisit. Compared with other non-revisiting patients, revisiting patients had shorter mean stays on the first visit and a higher admission rate on the second visit. Among revisiting patients, fever and infectious diseases were the most common chief complaint and disease category, respectively. Patient-related problems, physician-related problems and disease-related problems accounted for 40.6%, 28.5%and 30.9%of the revisiting patients, respectively. We suggests that greater effort at educating patients and precise decision-making by experienced emergency physicians, especially pediatric emergency physicians, could probably reduce the rate of revisits.

並列關鍵字

revisit ； emergency department ； risk factor