病患非計畫性重返急診之因素分析—以病人觀點探討

Factors Associated with Unscheduled Return Visits: A Study of the Patient's Perspective

黃金安(Jin-An Huang) ； 賴其勛(Chi-Shiun Lai) ； 翁瑞宏(Rhay-Hung Weng) ； 胡為雄(Wei-Hsiung Hu) ； 楊大羽(Dar-Yu Yang)

《Journal of Emergency Medicine, Taiwan》 6卷2期 (2004/06) Pp. 306-314

摘要

背景： 非計畫性急診返診耗用很多醫療資源，並隱含許多病患錯誤的就醫認知和醫療品質的問題。本研究的目的在於以病人的觀點來分析其急診返診的原因，並探討其與醫師所認定原因之間的差異及其在醫務管理上之意涵。
方法： 本研究地點是在中部一家約1,300床的公立醫學中心。收案期間是2003年3月、4月、9月、10月及11月，所有於72小時內非計劃性急診返診的個案皆納入研究對象。次級資料由醫院資訊系統擷取，返診原因包括醫師由電腦勾選和病人由問卷自行填選。
結果： 總共發出250份問卷，有效問卷共175份，有效問卷回收率為70%。醫師認定和病人認定的最主要返診原因都是與疾病相關的，分別有155例(88.6%)和148例(84.6%)。不同的是醫師認定返診原因與醫師有關的只有4例(2.3%)，而病人認定與醫師有關的返診原因則有12例(6.9%)；相反地，醫師認定返診原因與病人有關的有12例(6.9%)，而病人認定與病人相關的返診原因只有4例(2.3%)。值得注意的是，對於急診返診原因，醫師和病人的一致性認知只有31.4% (55例)。
結論： 病人和醫師對於非計畫性急診返診原因的不同認知，意味著急診醫師應與病人加強雙向溝通，並進一步深入探究認知不一致的原因，以期能提供以病人為中心的急診醫療服務。

關鍵字

急診部門 ； 返診 ； 以病人觀點

並列摘要

Background: Unscheduled return emergency department (ED) visits utilize a substantial amount of medical resources, foster patients’ misperceptions and raise questions about the quality of medical care. The purpose of this study was to identify the factors associated with return visits from the patient’s perspective, to analyze the differences between the reasons given for return visits by patients and physicians and to examine the implications for healthcare service management.
Methods: This study was conducted at a 1300-bed public medical center in central Taiwan in March, April, September, October, and November 2003. All patients returning within 72 hours of their initial ED visits were eligible for the study. Secondary data were retrieved from the hospital information system, and the reasons for return visits were indicated by emergency physicians on computer and by patients on questionnaires.
Results: Two hundred and fifty questionnaires were distributed, and 175 usable questionnaires were obtained. The eligible response rate was 70%. Disease-related factors accounted for most return visits. Of the cases attributed to disease-related factors, 155 (88.6%) were by physicians and 148 cases (84.6%) were by patients, respectively. Physicians attributed 4 cases (2.3%) to physician-related factors and 12 cases (6.9%) to patient-related factors. Conversely, patients attributed 12 cases (6.9%) to physician-related factors and 4 cases (2.3%) to patient-related factors. It is remarkable that the consistency between physicians’ and patients’ reasons for return visits was only 31.4% (55 cases).
Conclusions: Physicians’ and patients’ converse attributions of the reasons for return ED visits imply that emergency physicians need to improve communications with patients, and thereby try to eliminate the reasons for the different perceptions of patient-centered emergency medical care.

並列關鍵字

emergency department ； return visit ； patient perspective