北部某區域醫院實施出院準備服務計畫概況與成果

Overview and Results of the Discharge Planning Project in a Regional Hospital in Northern Taiwan

王昭惠(Chao-Hui Wang) ； 陳楚杰(Chu-Chieh Chen) ； 黃肇明(Chao-Ming Huang) ； 馮容莊(Rung-Chuang Feng) ； 柯明中(Ming-Chung Ko) ； 翁林仲(Lin-Chung Woung)

《北市醫學雜誌》 18卷2期 (2021/06) Pp. 195-212

https://doi.org/10.6200/TCMJ.202106_18(2).0010

摘要

目的：本研究旨在了解某區域醫院實施出院準備服務計畫概況與探討出院後3天內重返急診及14天內非計畫性再住院之情形及影響因素。方法：本研究係橫斷面研究，使用描述性統計探討研究對象的基本資料，以簡單邏輯斯迴歸分析各單一自變項對重返急診及非計畫性再住院之關聯性；再以邏輯斯複迴歸分析找出獨立影響一般及高危險群出院準備服務收案病人的相關因素。結果：2017年7月1日至2018年6月30日出院病人共計43,771人次。據統計資料得知，一般和高危險群出院準備服務收案的病人出院後3天內重返急診率分別為1.8％及4.8％，進而分析結果相關性的因子有：男性、年齡越高、居住在寄宿家庭或機構、日常生活活動需依賴他人者；另外，出院後14天內非計畫性再住院率為分別是1.1％及3.0％；其結果再分析後關聯性較高的因子有男性、年齡越高、日常生活活動需依賴他人、有創傷傷口者。結論：從研究結果未來提供醫療機構瞭解，除高危險群病人、一般有照顧需求者重返急診及非計畫性再住院之影響因素，醫療機構相關部門只要遇到評估為有照顧需求的病人都可進行出院準備服務計畫，都能提前發現病人在出院後可能發生的健康問題或照護需求，提供適當的服務與轉介，使病人獲得持續完整照護服務。

關鍵字

出院準備服務 ； 出院後3天內重返急診 ； 出院後14天內非計畫性再住院

並列摘要

Objective: This study aimed to gain an insight into the general status of the implementation of discharge planning in a regional hospital and explore influencing factors of returning to the emergency department within three days after discharge and unplanned re-hospitalization within 14 days after discharge. Method: This study adopted a cross-sectional design. The descriptive statistics method was used to explore the basic information of the research participants. The correlations between single independent variables and returning to the emergency department and unplanned re-hospitalization were analyzed through simple logistic regression. Subsequently, logistics regression analysis was employed to find relevant factors independently affecting general-risk patients and high-risk patients to accept discharge planning. Results: A total of 43,771 persons were hospitalized and discharged from July 1, 2017 to June 30, 2018. According to the statistical results, the emergency room return rates within three days wew 1.8% and 4.8% in the general-risk patients and high-risk patients, respectively. Further analysis indicated that male sex, older age, living in boarding houses or instructions, and dependence on others for daily activities, were factors with higher correlations. Besides, the unplanned re-hospitalization rates within 14 days were 1.1% and 3.0%, respectively. The higher correlation factors included male gender, older age, dependence on others for daily activities, and traumatic wounds. Conclusion: Besides the high-risk patients and general patients who need care and return to the emergency department and subject to unplanned hospitalization, relevant departments in medical institutions may plan discharge planning services for those who need care with the capacity of early detection of possible health problems or care needs, and provide appropriate services and referrals, thereby ensuring a comprehensive care service.

並列關鍵字

discharge planning ； emergency department ； unplanned re-hospitalization