運用風險控管縮短急診轉住院病人在急診停留時間之研究 —以臺北市某醫學中心實施專案的經驗為例

Abstract

本論文是以臺北市某醫學中心為了要提高急診轉住院病人占全院住院病人的比率及縮短這些病人在急診的停留時間以減少急診壅塞，於民國98年底至100年1月間實施的品管圈專案內容為藍本。品管圈由相關醫療、護理及行政部門的主管組成跨團隊小組，由醫療副院長擔任召集人，品質管理中心為負責單位。 團隊首先以醫療失效模式與效應分析（HFMEA）就急診病人轉住院流程中，分析每一個失效模式，依其失效原因的危害指數矩陣先做評分；在找出評分高者（

The thesis is based on the implementation of a quality control circle (QCC) with an aim at increasing the admission rate from the emergency department (ED) with respect to the total number of inpatients of the hospital (ARED), and at shortening their length of stay (LOS) so as to alleviate ED crowding in a medical center in Taipei during a period from late 2009 to January 2011. The team was composed of chiefs from related multidisciplinary units such as medical, nursing and administrative departments in which medical vice superintendent acted as the team leader and quality management center was responsible for the project. The QCC team adopted Healthcare Failure Mode and Effect Analysis (HFMEA) to evaluate every failure mode in the process of patients admitted from ED. For those causes of failure mode with a hazard score of 8 or higher (³ 8) from the Hazard Scoring Matrix, the team members attempted to improve the process through face-to-face communication and coordination under the assistance of information technology ( IT ). At the end of the project, the above causes of failure mode improved significantly and the goals were achieved as to ARED, shortening of LOS and the transfer rate. LOS consists of (1) waiting time for physician visit at ED, (2) management time, and (3) waiting time for transfer to ward. LOS can also be viewed equivalently to summation of the time waiting for service and service time at all stations through which a patient passes. In general, waiting time for service includes not only the waiting time before service but also the time the patient waiting for decision from the physician for the next step. The latter is crucial to shortening LOS. The success of the project lies in holding on the latter key factor through face-to-face communication and coordination, attitude and leadership with accountability, and the assistance of IT to alleviate the impact of the factor on and to shorten LOS of the inpatients from ED. Implementation of this project yields some implications in management as follows: first, finding out key factors and their weight (e.g., HFMEA in this project) can facilitate the achievement of the goal; second, flow processes with consensus could be written as standard operation procedure (SOP) with which the members to comply, whereas those not with consensus would need face-to-face mutual communication and “⑃-shaped” coordination; third, attitude and leadership with accountability is of help to reach the goal; and finally, IT should be used to facilitate management.