運用Input-Throughput-Output model改善急診壅塞專案

An Improvement Project to Reduce Emergency Department (ED) Crowding by Using the Input-Throughput-Output Model

蕭如茵(Ju-Yin Hsiao) ； 楊純怡(Chun-Yi Yang) ； 李月妙(Yueh-Miao Li) ； 蘇佩真(Pei-Chen Su)

《高雄護理雜誌》 36卷1期 (2019/04) Pp. 24-35

https://doi.org/10.6692/KJN.201904_36(1).0003

摘要

急診壅塞會影響緊急醫療品質，本院2015年10至12月急診病人停留大於24小時比率高達3.6％，為本市同級區域醫院之冠，且急診推床耗盡通報高雄市緊急醫療資訊整合中心（EMOC）滿載平均5次／日，運用Input-Throughput-Output model分析，能有效分析急診病人壅塞的原因，找出可行方案緩解急診壅塞。確立問題為Input：返診病人多，Throughput：檢體溶血、等候照會等，Output：待床科別無床、有病房床位未能入住等；研擬對策如Input：預防重返輔導機制，Throughput：勤務支援人員輸送病人措施、降低採血溶血、照會可近性及回饋，Output：病床流用機制、病房迎接新病人配套措施、出院病人提早準備作業等；經改善，2016年10月至2017年3月評值病人停留急診大於24小時比率為0.9％且通報EMOC滿載為平均0.5次／日，皆達目標，醫療品質提升。

關鍵字

急診 ； 急診壅塞 ； 輸入－處理效能－輸出概念模式

並列摘要

Emergency Department (ED) crowding will affect the quality of emergency medical treatment. The rate of the patients who stayed in the ED for more than 24 hours was up to 3.6%, matching the top rate of the same regional hospital in the city, and there was an average of 5 notifications/day to the Kaohsiung Emergency Medical Operation Center (EMOC) that the beds of the ED were fully loaded from October to December 2015 in the hospital. The Input-Throughput-Output model analysis was used in determining how to improve Emergency Department crowding. The identified problems were that Input: many follow-up patients, Throughput: hemolysis samples waiting for re-test and patients are required to wait to see a doctor, and Output: there are no beds available in the crowded departments but there are many beds available in other departments, where beds are available in wards but they are not ready for admission et alia. Strategies such as Input: prevention mechanism for re-entry counseling, Throughput: patient transfer by service support staff, notice accessibility and feedback mechanism, reduction of blood collection and hemolysis rate, and Output: ward renovation and inter-disciplinary bed rotating mechanism, new reward indicator in wards, complementary measures for the medical personnel of the ward meeting new patients, and early preparation for discharge of patients etc, have been developed. The rate of the patients who stayed in the ED for more than 24 hours was 0.9% and the EMOC received an average of 0.5 notifications/day that the beds were fully loaded from October 2016 to March 2017 after improvement, both of which met the target and improved the quality of medical care.

並列關鍵字

emergency department ； emergency department crowding ； Input-Throughput-Output model

參考文獻

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