加護病房非計劃性重返與疾病嚴重度間之相關性探討

葉淑玲

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加護病房非計劃性重返與疾病嚴重度間之相關性探討

The Relationship between the Unplanned Readmission and Severity of illness in the Intensive Care Units

葉淑玲 , Masters　　Advisor：張文英　　

繁體中文

加護病房；非計劃性重返；疾病嚴重度； Intensive care units(ICU) ； unplanned readmission ； severity of illness

Abstract │ Reference (32) │ Times Cited (1) │ Altmetrics

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Parallel Abstract 〈TOP〉

Owing to severity of illness and the unplanned readmission are the important criteria to inspect patents’ condition when in Intensive Care Unit (ICU), but relevant researches are very few. Therefore, the objective of this search would try to: (1) understand the distribute of characteristics and severity of illness between unplanned and non readmission patients; (2) explore the difference and relevance between characteristics, severity of illness and readmission patients; (3) detect unplanned readmission patents’ valve value of Sensitivity and Specificity, which was examined by APACHE II score.
Backtracking design was adapted by this research. It contains unplanned readmission (43 people) and non-readmission (129 people) as the sampling groups, who are patients of MICU in one medical center in Northern Taiwan. Moreover, the questionnaire that made by the author is the tool of data collection, that helps to provide patients information for coding as well. Finally, all these data would be conducted by SPSS version 13.0 English edition to process some data analyses, including Descriptive Statistics, Chi-Square test, Independent t-test, Logistic Regression, and ROC curve.
The findings showed the two sets in the comparative of patients’ characteristics, which has showed that only the experience of returning and the time of returning have significant difference. In addition, under the estimation in the level of severity of illness（APACHE II）, arterial oxygen（p＝0.000）、white blood cells（p＝0.008）Glasgow coma scale (GCS)（p＝0.0047）、acute physiology score (APS)（p＝0.000）、yet the levels of severity of illness（p＝0.000）have dramatically divergences（< 0.05）. On the other hand, the ones have significant differences, only the numbers of white blood cell count and the levels of severity of illness are able to predict the issue of readmission in 48 hours. Then based on the readmission group of the levels of its illness lined ROC curve, the area under ROC curve is 0.689, which was under the confidence interval of 95%（0.598, 0.780）. That is to say, diagnosing by the levels of severity of illness（APACH II）is more accurate and estimated that its valve value was 18.5（the Sensibility was 39.5% while Specificity was 86%）. Once if exceeding this value, the percentage of unplanned readmission in 48 hours will easily occur.
The results of this study might provide clinical ICU team with some decision-making evidence to carefully evaluate whether patients were able to transfer from ICU or not. Furthermore, the assessment evidence of disease severity score could let patient’s family members understand beforehand, that what dangerous probabilities of unplanned readmission might happen.

Reference ( 32 ) 〈TOP〉

陶阿倫、薛亞聖（2000）•加護病房評估疾病嚴重度之資料正確性•醫療品質雜誌，2（1），13-18。
連結：
蔡淑蘋、楊福麟、彭台珠、邱艷芬、李茹萍（2004）•加護病房非計劃性重返概論•慈濟護理雜誌，3（2），26-30。
連結：
Angus, D. C. (1998). Grapping with intensive care unite quality：Does the readmission rate tell us anything？. Critical Care Medicine, 26(11), 1779-1780.
連結：
Ashton, C. M., Kuykendall, D.H., Johnson, M. L., Wray, N.P., & Wu, L. (1995). The Association between the Quality of Inpatient Care and Early Readmission. Annals of Internal Medicine, 122(6), 415-421.
連結：
Ball, C., Kirkby, M., & Williams, S. (2003). Effect of the critical care outreach team on patient survival to randomized population based study. BMJ, 327(7422), 1014.
連結：

Times Cited (1) 〈TOP〉

林麗敏(2010)。內科加護病房非計畫性再轉入影響因素之評估與探討。臺灣大學醫療機構管理研究所學位論文。2010。1-122。

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