縮短呼吸器依賴患者平均住院日

Shorten Length of Stay for Ventilator-dependent Prolonged Stay in Acute Hospital

楊昭恂(Chao-Hsun Yang) ； 陳玉枝(Yu-Chih Chen)

《醫務管理期刊》 2卷1期 (2001/03) Pp. 56-76

https://doi.org/10.6174/JHM2001.2(1).56

摘要

呼吸器依賴患者在急性醫療後之照護問題，造成醫院及健保局莫大壓力。本院使用呼吸器患者平均住院日142日，其中45.5%住院日超過30日，影響醫療資源之利用；歸納呼吸器依賴患者長期滯院原因包括病患心理與社會經濟、醫療及後送系統等因素。本專案目的在實施整合照護模式並評值其成效。自民國87年至89年期間，運用PDCA模式進行改善，建立院內及院外整合照護方式，包括訂定呼吸器脫離之臨床作業指引及分期照護標準，開拓院外轉介醫院。具體成效為成功輔導106位個案轉院、協助137位個案早期脫離呼吸器，成功率達52%、使用呼吸器患者住院日由142日減為104日；此外，將慢性病患由醫學中心轉住地區醫院對全國醫療費用節制貢獻頗多。

關鍵字

呼吸器依賴患者 ； 整合照護 ； 呼吸器脫離 ； 照護成效

並列摘要

Patients who require mechanical ventilation beyond of an acute illness are currently viewed as the major pressure on hospitals and National Health Insurance. The average length of stay for ventilator-dependent is 142 days in our hospital, of 45.5% ventilator-dependent length of stay over 30 days, impact on the utilization of health care resource. Ventilator-dependents who require prolonged length of stay relating to several factors: patient's psycho-social and financial issues, medical management factor and availability of long-tem care facilities. The purpose of this project was to implement the Ventilator-dependent integrated care model and to evaluate its outcomes. To In the 1998 through 2000 period, using PDCA cycle to establish the intra-hospital and inter-hospital integrated care model, which include the development of ventilator weaning protocol and care standards; contracts with regional hospital and referral process. Results showed that 106 patients were transferred to regional hospitals; 137 patients were weaned from the ventilator thus successful weaning rate is 52%; length of stay decreased from 142 to 104 days. This project has been highly successful in continuing care of ventilator-dependent patients, in additional, the medical charges for care in the regional hospital are less than medical center.

並列關鍵字

ventilator-dependent ； integrated care model ； ventilator weaning ； care outcome