對一所教學醫院外科加護病房實施專責重症醫師照護後的成效評估

Effects of Staffing with Intensivists in a Surgical Intensive Care Unit of a Teaching Hospital

廖憲華(Hsien-Hua Liao)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/碩士(2006年)

https://doi.org/10.6834/CSMU.2006.00075

摘要

在醫院的醫療單位中，加護病房是個耗費大量醫療人力及其他醫療資源的地方。在美國，加護病房約佔全部醫院總床數的百分之十，可是加護病房的醫療支出卻使用了高達百分之三十四的醫療資源。大約是耗用了百分之一的國內生產毛額。雖然加護病房挽救了不少病危者的生命，但是我們所付出的成本也節節升高，如何有效的利用這些醫療資源就成為大家所關心的議題。而其中由專責重症醫師來專門負責加護病房病患的醫療照護，已經在一些國內外的研究中証實可以有效的改善病患的預後，降低加護病房的住院天數，減少加護病房的醫療總支出。
這篇研究的目的是對一所教學醫院外科加護病房實施專責重症醫師照護前後，對於病患照護成效，以加護病房住院天數以及死亡率的變化作了實施專責重症醫師照護前後的成效評估。我們針對這個外科加護病房實施專責重症醫師照護制度的前後各一年，收集了從2002年7月到2004年6月共1650位病患資料，其中共有1065位男性及585位女性患者，平均年齡為55.80±0.49歲。使用獨立樣本t-檢定及單因子變異數分析來比較實施專責重症醫師照護前後在住院天數是否有所不同；利用卡方檢定來檢查和死亡率有關的因素。結果顯示，在實施了專責重症醫師照護後，病患的加護病房平均住院天數降低，但是在死亡率上，則不呈現統計上的差異。

關鍵字

加護病房 ； 重症專科醫師

並列摘要

The intensive care unit is a high cost hospital unit. Intensive care encompasses only about 10% of all hospital beds in the United States, but 34% of total medical resources, approximately 1% of the US gross domestic product is consumed in the care of intensive care unit patients. Intensive care units have save a lot of critically ill patients’ lives, but the resources we use keeps increasing. It has become a public concern as to how to use these medical resources efficiently. Many studies have suggested better alternatives and a more efficient utilization of resources by staffing intensive care units with critical care physicians (intensivists), which has reduced ICU stay and resource utilization.
This study collected data from 1650 patients, retrospectively from a surgical intensive care unit at a teaching hospital from July, 2002 to June, 2004 to determine whether the presence of an on-site, organized, intensivist critical care service improved care and decreased resource utilization. We collected data from 1650 patients with 585 females and 1065 males and an average age of 55.80±0.49 years. An independent sample t-test and a one way ANOVA test were used to compare the differences between an ICU stay 1 year before and 1 year after intensivist staffing in July 2003. A Chi-square test was used to analyze the association of mortality. The results revealed a reduction of ICU stay after intensivist staffing, but there was no significant difference in the mortality rate.

並列關鍵字

intensive care unit ； intensivist

參考文獻

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