Cluster Utilization of Emergency Department Services by Frequent Users in a Medical Center

前言：在大多數的急診中，少數的高診次病患往往造成與其人數不成比例的急診使用量。本研究乃調查在一所醫學中心高診次急診病患之叢集性使用形態之特徵。方法：蒐集南台灣某醫學中心急診就診資料做回溯性的病歷分析。蒐集於2004年任30天內至急診就診5次或以上之成人非外傷病患。分析這段期間內叢集性高診次急診病患之基本資料及主訴、診斷與處置等臨床使用形態之特徵，並與一般非叢集性之高診次急診病患做比較。結果：研究期間共有67名患者被定義為叢集性高診次急診病患，叢集性就診計675次。相對於非叢集性病患，叢集性病患的年齡較年輕（51歲），並有高度頻繁的急診利用率（15.9次／每人）。大多數的叢集性就診被分類為非急迫性的檢傷三級(87.0%)，而出院率為88.6%，且其中51%為一小時內出院。最常見的臨床問題是肝膽腸胃疾病(32.8%)與癌症(28.4%)，較常見主訴則為要求止痛(52.2%)及因腹水所引起之腹脹(10.4%)。常見的處置則包括止痛劑的使用(55.2%)，抽腹水(10.4%)，以及更換引流管(5.9%)。結論：高診次急診病患之叢集性使用特徵相當獨特，且常為較低疾病嚴重度的慢性問題所引起。當進一步研究疼痛門診、安寧照護、癌症中心、整合治療或處置門診等設施是否可有效降低叢集性使用急診的狀況。

關鍵字

高診次使用者；急診；叢集性就診

並列摘要

Background: A few frequent users disproportionately utilize emergency services. This study investigated the utilization characteristics of cluster emergency department visits by frequent users in a Taiwan medical center. Methods: In this retrospective review study at a tertiary referral medical center, adult non-trauma patients who visited the emergency department ≥5 times within a 30-day period in 2004 were deemed cluster emergency department users. Demographics and utilization characteristics of all cluster visits were analyzed and compared with non-cluster visits of 50 sampled frequent users without cluster emergency department use. Results: Sixty seven cluster emergency department users accounted for 675 cluster visits. When compared with noncluster users, cluster patients were younger (51.3 years old) with a greater emergency department utilization rate (15.9 visits/user). Most cluster visits were triaged as nonurgent category Ⅲ (87.0%) with an overall 88.6% discharge rate. Fifty one percent were discharged within 1 hour. The most common clinical problems of cluster visits were hepatointestinal disorders (32.8%) and malignancy (28.4%). Cluster patients frequently presented with requests for pain relief (52.2%) and ascites-related abdominal fullness (10.4%). Common management included pain control with analgesics (55.2%), ascites tapping (10.4%), and drainage tube change (5.9%). Conclusions: Cluster emergency department visits by frequent users are characterized by great demand for care of chronic clinical problems with low disease severity. Further studies to evaluate the functions of pain clinics, hospice services, cancer centers, drug seeker screening, integrated treatment planning, and outpatient clinics for minor procedures to lower the cluster utilization rate of frequent emergency department patients are indicated.

並列關鍵字

cluster visit ； emergency department ； frequent user

國際替代計量

Cluster Utilization of Emergency Department Services by Frequent Users in a Medical Center

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