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頁籤選單縮合
題 名 | 急診轉診直入病房之分級醫療新模式=A New Model of Hierarchical Referral System: Direct Admission from Extra-mural Emergency Department Referral |
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作 者 | 陳秋如; 朱昭美; 林軒璋; 璩大成; 黃勝堅; 黃遵誠; | 書刊名 | 北市醫學雜誌 |
卷 期 | 15:2 2018.06[民107.06] |
頁 次 | 頁59-69 |
分類號 | 419.5 |
關鍵詞 | 轉診; 急診壅塞; 直入式轉診; Referral; Emergency department overcrowding; ED overcrowding; Direct admission; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:為減輕民眾待床辛勞及機構負荷,開創及提升醫學中心轉診區域醫院新模式,提出直入病房之新流程及貼心醫療服務,希望解決醫學中心急診壅塞問題,並提供各醫療機構及衛生機關之參考方向。方法:針對醫學中心急診部醫師評估以檢傷3級病人為主之適合轉入者,詢問病人轉入意願後向區域醫院提出需求;區域醫院聯絡安排可收案醫師及合適床位後回覆;醫學中心備妥病人相關資料,護送病人至區域醫院,區域醫院窗口協助病人直入病房。並進行記錄,去辨別後之資料庫進行統計分析,探討轉診人次前後比較、住院治療結果、接受轉診滿意度。結果:2014年平均每月轉診5±2.4人次;規劃成立直入病房轉診制度後,2015年平均每月轉診34±12.2人次;2016年平均每月轉診40±6.9人次;相較於2014年,2016年每月平均人次成長7-8倍(P<0.001);醫學中心急診留觀人數被詢問比率平均為10.5%;病人同意下轉比率平均為11.3%;成功轉入區域醫院比率平均為80.9%。從2015年1月19日起至2017年6月19日共完成轉診1,000位個案,以65歲以上40.8%、內科系79.4%、臺北市、新北市民眾94.6%為多;曾在本區域醫院就診328人(32.8%),假日進行轉診17人(1.7%)。在醫學中心平均待床達2.4天,但完成轉院平均僅2.0小時。989人(98.9%)直入病房、5人(0.5%)住院過程中返回醫學中心住院者、43人(4.3%)死亡、696人(69.6%)出院後返回區域醫院門診看診。轉診服務構面滿意度91.8%。結論:醫學中心急診轉診直入區域醫院病房,可使民眾獲得舒適安心滿意感受,進而減少民眾待床辛苦及醫學中心壓力。並可能及早可以獲得疾病處置,希望提早出院,使民眾得到最佳醫療服務。本研究期望能拋磚引玉,透過區域醫院與醫學中心攜手共同合作成為典範,共同推廣,以提升病人為中心之服務及醫療理系之完整性。 |
英文摘要 | Objective: In order to reduce patient waiting time and workload in medical centers, we planned a new referral service to triage and transfer boarding patients of the emergency department (ED) in medical centers to nearby regional hospitals for an immediate inpatient care, and subsequently alleviate ED overcrowding condition. Methods: In this new referral system, ED physicians in the medical centers selected suitable patients with agreement (mostly classified as ED triage level 3) for referral. Upon receiving the transferal request, medical staff of the regional hospital matched an appropriate attending physician and allocated inpatient bed for the referred patient. The patient was then escorted to the regional hospital along with their medical records. The referral records were dis-identified, entered into a database and statistically analyzed for number of referral before and after the introduction of new referral system, prognosis, as well as patient satisfaction. Results: In 2014, the number of referrals per month was 5±2.4 patients in average. However, after the Introduction of the new referral system, the mean number of monthly referrals became 34±12.2 and 40±6.9 patients (P<0.001) in 2015 and 2016, respectively. The number of referral per month in 2016 increased 7-8 times compared with that of 2014. A total of 10.5% ED patients in the observation units of the medical centers were asked if they are willing to use this referral service. Among which, 11.3% agreed and 80.9% of them were successfully referred to the regional hospital. There were 1,000 patients admitted via this new referral system during the period from January 19, 2015 to June 19, 2017. Among them, 40.8% were over 65 years old, 79.4% required internal medicine treatment and 64.6% were citizens of the Taipei city or New Taipei city. In addition, 328 referred patients (32.8%) had previous experience of visiting the outpatient clinics of Taipei City Hospital and 17 referred patients (1.7%) were admitted on holidays. The average waiting time for admission was 2.4 days in medical centers, while it took only 2 hours after the patients decided to be referred to the regional hospitals. There were 989 patients (98.9%) admitted directly to the ward without ER visiting at the referred hospital. Only 5 referred patients (0.5%) turned back to medical centers for inpatient care. Forty-three referred patients (4.3%) deceased during their inpatient stay at the referral hospitals, while 696 inpatients (69.6%) were followed up in the outpatient clinics of the referral regional hospital after discharged. The referral satisfaction was 91.8%. Conclusion: The new referral system that admits patients referred from medical centers to regional hospitals has been proved to enhance patient's feeling of ease and satisfaction as well as to decrease their waiting time for inpatient bed while resolving ED overcrowding of the medical centers. Also, this new system shortens the treatment duration and enables the patients to be discharged earlier. We hope that this new concerting effors between medical centers and regional hospitals can be promoted as an example to enhance service quality of patient-centered care, so that the quality of patient-centered service can be improved and the completeness of medical care system elevated. |
本系統中英文摘要資訊取自各篇刊載內容。