專責重症專科醫師對加護病房重症病患照護之成效

The Effects of Intensivists in Caring for Critically Ⅲ Patients in the Intensive Care Unit

鄭高珍(Kuo-Chen Cheng) ； 蔡素貞(Su-Chen Tsai) ； 侯清正(Ching-Cheng Hou)

《中華民國急救加護醫學會雜誌》 16卷3期 (2005/09) Pp. 93-98

https://doi.org/10.30018/JECCM.200509.0001

摘要

加護病房耗費驚人，在美國加護病房佔全部醫院總床數的百分之十，但卻耗費了百分之三十四的醫療資源，所以加護病房的資源必須非常有效率地使用。一位受過良好訓練，學養俱佳，負責重症病患照顧的重症專科醫師是加護病房的關鍵人物。
專責重症專科醫師可協調整合包括護理人員，呼吸治療師，臨床藥師，臨床營養師等專業人員，成為一重症照護團隊，以增進照護品質。專責重症專科醫師亦可使加護病房的管理更上軌道，如床位之分配應用，病患之轉入轉出，單位政策之推廣以及品質之改善等。
許多的研究顯示，有專責重症專科醫師負責照顧的加護病房，其照護品質較佳，資源的利用也較有效率。從我們自己有限的經驗也看出，專責重症專科醫師負責的封閉式內科加護病房，其住院天數縮短，費用下降且死亡率亦降低。但目前在台灣有專責重症專科醫師的加護病房仍不普遍。要增進加護病房的照護品質，僅增加加護病房的硬體設備是不夠的，首要考慮的，應該是能有受過良好訓練的重症專科醫師來負責照顧加護病房之重症病患。

關鍵字

加護病房 ； 重症專科醫師 ； 醫療資源

並列摘要

The intensive care unit (ICU) is a very high cost hospital unit. Despite encompassing only about 10% of all hospital beds in the United States, the ICU consumes as much as 34% of resources, and therefore must be utilized efficiently. A well-trained, dedicated intensivist who is a knowledgable leader and is able to handle the care of critically ill patients is a key person in the ICU.
The intensivist coordinates other specialists, such as nurses, respiratory therapists, pharmacists, and dietitians, to work as a team to improve the quality of care. Unit management, including bed allocation, admission and discharge, development of unit policies, and improvement of quality of care for patients with life-threatening emergencies are also dealt with by the intensivist.
Many studies have shown better outcomes and a more efficient utilization of resources with the input of full-time intensivists in the ICU. Our limited experience also shows that the introduction of full-time intensivists into a closed medical ICU can effectively shorten the patient's ICU stay, decrease ICU costs, and reduce the mortality rate. But full-time intensivists are not common in Taiwan., To insure quality care, better unit facilities are not enough. The introduction of well-trained intensivists into the ICU should be considered first.

並列關鍵字

intensive care unit ； intensivist ； health resources