多角色觀點下之急診經驗與改善需求探索

Abstract

急診醫療具有高度不確定性、時間壓力與流程變動性，病人與陪病者在就醫過程中往往需要面對陌生環境、長時間等待、多重醫療角色互動，以及難以理解的臨床資訊。本研究旨在從多角色觀點探討急診照護歷程中的資訊理解問題，並進一步思考病人端資訊系統如何協助病人與陪病者理解急診流程、等待狀態、臨床處置與後續行動。 本研究採質性研究設計，透過半結構式深度訪談蒐集資料，共訪談19位研究參與者，包括12位病人端利害關係人，以及7位臨床端利害關係人，其中包含5位急診護理師與2位急診醫師。研究以急診歷程作為分析架構，涵蓋檢傷、候診、醫師看診、檢查與治療、觀察與評估、醫療決策，以及離開急診等階段，並以主題分析法歸納病人端與臨床端對急診資訊經驗的理解差異。 研究結果指出，急診資訊問題並非單純來自資訊不足，而是來自病人與陪病者難以將資訊放入自身就醫歷程中加以理解。本研究歸納出兩項主要挑戰。第一為資訊不透明，包含流程進度不明、等待狀態難以判讀、空間移動缺乏說明，以及醫療角色與責任界線模糊。第二為資訊落差，包含病人端難以理解檢傷邏輯、臨床推理、病情嚴重程度、檢查與治療目的，以及醫療資訊揭露時機與自身資訊需求之間的落差。這些問題使病人與陪病者在等待與照護過程中產生焦慮、無助、被遺忘感，並影響其提問、配合照護與參與決策的能力。 基於上述發現，本研究提出一套以急診歷程為核心的資訊可解讀性設計觀點，並發展一個以QR Code進入之病人端網頁原型。原型透過急診歷程地圖、等待狀態說明、檢查與治療目的解釋、觀察資訊追蹤、醫療角色辨識、提問引導與離院摘要等功能，示範如何將急診資訊轉化為病人與陪病者可理解、可定位且可行動的支持。本研究主張，急診病人端資訊系統的設計不應僅追求資訊透明，而應進一步支持歷程層次的資訊可解讀性，使病人與陪病者能理解自己目前位於何處、為何等待、臨床行動代表什麼，以及接下來可以做什麼。

Emergency departments (EDs) are high-pressure and uncertain care environments in which patients and caregivers must navigate unfamiliar workflows, prolonged waiting, fragmented interactions with multiple clinical roles, and medical information that is often difficult to interpret. This thesis explores how ED information is experienced and understood from a multi-stakeholder perspective, and examines how patient-facing information systems may support patients and caregivers in making sense of ED workflows, waiting states, clinical actions, and next steps. This study adopts a qualitative research design based on semi-structured, in-depth interviews with 19 participants, including 12 patient-side and 7 clinical stakeholders. The analysis was structured around the ED journey, including triage, waiting for physician assessment, initial physician assessment, examination and treatment, observation and re-evaluation, clinical decision-making, and disposition. Thematic analysis was used to identify recurring information challenges and interpretive gaps across these perspectives. The findings show that ED information problems stem not merely from the absence of information, but from patients' and caregivers' difficulty in interpreting it within their ongoing care trajectory. Two overarching challenges were identified. The first is information opacity, which refers to unclear workflow progression, hard-to-read waiting states, unexplained spatial transitions, and ambiguous role boundaries. The second is information gaps, which refer to misalignments between clinical reasoning, disclosure timing, and stakeholder needs. These challenges intensify anxiety, helplessness, and the sense of being forgotten, while limiting their ability to ask questions, cooperate with care, and participate in decision-making. Based on these findings, this thesis proposes a journey-level information interpretability perspective for patient-facing ED support and instantiates it in a QR-code-accessed web research prototype. The prototype demonstrates how ED information can be reorganized through journey maps, waiting explanations, test/treatment rationales, observation updates, team identification, question scaffolding, and disposition summaries. Rather than simply making more information visible, the prototype translates ED information into support that is understandable, situated, and actionable. This thesis contributes to healthcare HCI and medical informatics by shifting the design focus of patient-facing ED systems from transparency to interpretability. In high-uncertainty clinical environments, the central challenge is not only whether information is accessible, but whether it can be understood in relation to workflow, timing, responsibility, and action.