資訊系統應用於呼吸器脫離評估效益之探討

背景：台灣由於慢性照護機構發展緩慢，因此長期依賴呼吸器患者佔用急性病房或甚至加護病房的情形時有所聞；所以，協助醫院有效透過呼吸器脫離準則（weaning protocol），幫助呼吸器病人儘早進入自發性呼吸測試（spontaneous breathing trial, SBT）是一個重要的研究議題。研究方法設計：本研究以中部某醫學中心之呼吸加護病房病人為研究個案，收案期間為2015年1月至2016年9月共176名個案，並隨機指派為兩組，其中實驗組為呼吸治療師透過資訊系統自動呼吸器脫離評估提醒而進行SBT的個案，共92名，對照組則為呼吸治療師未透過資訊系統提醒，而經加護病房常規透過呼吸器脫離準則進行SBT的病人，共84名。此外，Wilcoxon Two-sample test及邏輯斯迴歸分析則作為評估資訊系統應用於呼吸器脫離準則之效益。結果發現：實驗組個案之平均呼吸器脫離評估時間為4.08天，顯著低於對照組之5.81（p-value=0.0054）；另一方面，加入年齡及性別的效果調整後，實驗組的個案，其可在5天內經呼吸器脫離準則進行SBT的的勝算比為對照組的2.71倍（95% CI：1.45-5.06，p-value=0.0018）。結論與建議：藉由資訊系統自動執行每日評估（daily screen）呼吸器脫離指標，可以降低呼吸器脫離評估天數，而所節省的評估脫離準則的工作時間，可以運用在監測病人實際進行SBT的過程，進而達到儘早脫離呼吸器的目標。再者，學術上研究已證實，呼吸器病人儘早執行SBT，可以減少呼吸器依賴行為，所以未來可精進資訊系統自動評估提醒時機及與進入SBT的即時監控結合，創造資訊系統與臨床作業的更高價值。

關鍵字

醫療管理；呼吸照護；績效管理；資訊系統

並列摘要

Background: Chronic care system is not well developed in Taiwan. Long-term ventilator-dependent patients therefore require costly long-stays in the intensive care unit (ICU). The use of weaning protocols for spontaneous breathing trial (SBT) is an important research topic. Methods: Data were collected from 176 patients staying at a respiratory intensive care unit in a medical center in central Taiwan (Taichung city) from January 2015 to September 2016. Patients were randomly assigned to one of the two groups: (a) experimental group (92 patients) using the respiratory care information system; and (b) control group (84 patients) not using such system. Inter-groups differences were assessed with the Wilcoxon two-sample test, and with logistic regression analyses . Results: Those using the respiratory care information system, had an average assessment time of 4.08 days before ventilator weaning. This time was shorter than thosenot using the system, i.e., 5.81 days (p=0.0054). In addition, after considering factors likeage and gender, the odds of weaning patients using the system was 2.71 comparedwiththose not using the system (95% CI：1.45-5.06). Conclusions: Respiratory care information systemused on a basis of daily screeningwas time-saving for weaning assessment. It also helped monitoring the conditions of actual SBT of patients for timely weaning their respirators and shortened the assessment time of ventilator weaning. Early implementation of SBT for patients with respirators is known to reduce respirator-dependent behavior. We proposed in the future, such information system can be further improved by automatically assessing the reminder time, and in combination with real-time monitoring onpatients whileentering SBT.

並列關鍵字

medical management ； respiratory care ； performance management ； information system

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資訊系統應用於呼吸器脫離評估效益之探討

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