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Application of an Appropriateness Evaluation Protocol for Hospital Admission Patients from the Emergency Department

以入院適當性評估表來評估急診病患住院適當性

摘要


目的:探討急診醫師及護理人員使用入院適當性判定工具作為篩選急診病患住院之可行性。 材料與方法:以前瞻性單盲研究方式,於一家醫學中心急診部門針對具有一般內科或外科疾病之772病患作為研究對象。於一個月研究期間所有研究病患的急診病歷與資料,均由2位急診主治醫師及2位護理長分別根據修訂後之入院適當性判斷工具內所明定符合住院之標準來勾選這些病患是否符合住院之適當性,以4位審查者間判定之信度、效度、及實用性來判斷使用入院適當性判斷工具來評估急診病患住院可行性。 結果:772研究病患平均年齡為55.3歲(範圍17至87歲);男比女為1.9比1。4位審查者間信度平均κ係數為0.694 (95%信賴區間0.638 至0.75),顯示有很好的再現性;在效度評量方面,平均敏感度為81.6% (95%信賴區間69.9%至93.3%),特異度為92.0% (95%信賴區問88.4%至95.7%),正預測值為80.3% (95%信賴區間74.2%至86.4%),負預測值為92.8% (95%信賴區間88.7%至96.9%),整體一致度為89.1% (95%信賴區間85.9%至92.3%),平均κ係數為0.732 (95%信賴區間0.647至0.816)具有極佳同意性效度;在實用性方面,審查者平均審視病歷時間為1.26分鐘(範圍為1-10分鐘)。 結論:本研究結果認為修訂版入院適當性判定工具是一種能夠客觀且有效地用於評估急診部門一般內或外科病患住院適當性之篩選評量準則。

並列摘要


Objective: The purpose of this study was to investigate the use of the Appropriateness Evaluation Protocol (AEP) as a screening tool for the hospital admission patients from the emergency department (ED). Materials and Methods: A prospective, single-blind study of 772 consecutive adult patients with acute general medical and surgical problems were enrolled within a 1 month study period in a tertiary referral medical center. All charts of study patients were reviewed by 2 board-certified emergency physicians (EPs) and 2 senior nurses who evaluated the admission of patients based on a modified AEP. We evaluated the inter-rater reliability, validity, and applicability of the modified AEP for the hospital admission patients from the ED. Results: For all patients, the mean age was 55.3 (range, 17 to 87) years. The ratio of males to females was 1.9 to 1. For the inter-rater reliability test, the mean kappa coefficient (κ) was 0.694 (95% conference interval [CI]:0.638 to 0.750) demonstrating good reproducibility. In the validity test, the modified AEP had a mean sensitivity of 81.6% (95% CI: 69.9% to 93.3%), a specificity of 92.0% (95% CI: 88.4% to 95.7%), a positive predictive value of 80.3% (95% CI: 74.2% to 86.4%), a negative predictive value of 92.8% (95% CI: 88.7% to 96.9%), and a total agreement of 89.1% (95% CI: 85.9% to 92.3%). The mean κ coefficient was 0.732 (95% CI 0.647 to 0.816) with substantial agreement in validity. As to its applicability, the mean time for chart review for the modified AEP was 1.26 (rang, 1 to 10) minutes. Conclusions: Our study findings suggest that this modified AEP can be appropriately used in an objective and efficient way, as a screening tool for the hospital admission of acute general medical and surgical patients from the ED.

被引用紀錄


王立敏(2012)。運用系統模擬規劃急診醫療作業:分配的最合適化及績效評估〔博士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.00446

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