某區域教學醫院病患特性與72小時內再返急診之相關性

Abstract

近年來，急診就醫人次不斷增長下，有部分在短時間內重複來到急診就診的病患，不僅造成醫療資源的耗用，其中隱含諸多醫療品質的問題及病患對醫院亦產生負向觀感。依據醫院急診品質指標之監測項目中，最常見的問題為病患於72小時內返診，本研究目的是以病患觀點探討急診病患72小時內非計畫再返之相關因素。本研究方法以量性研究方式進行，研究對象鎖定在新北市某一區域教學醫院急診室之病患，分別研究組為急診病患72小時內非計劃返診之病患，及對照組為急診就醫後依據病患動態，隨機抽樣，共有204位病患參與研究，研究期間2013年7月5日至2013年9月30日。 研究結果發現：病患居住區域及與72小時非計劃性再返診是有顯著相關性 (P =0.005)、藥物濫用習慣與72小時非計劃性再返診是有顯著相關性(P=0.004)。 綜合上述，本研究發現，病患因居住區域、藥物濫用與再返急診有相關，提出以下醫院指標管理上建議：(一)有藥物濫用者個案，多半來自心理及社交上困擾而影響身體不適，急診管理應該妥善安排其醫療需求，給予適當輔導轉介，個案列管追蹤，建議由急診醫師主動提供關懷並給予不當就醫行為的約束、(二)病患所居住的區域與再返診率有關，建議若病患到達急診非緊急狀況下，主動輔導轉介至本院門診後續治療，另於首次出院時給予適當疾病衛教及預約門診服務，強化院間門診後線醫療服務。

Recently, the number of patients visiting the emergency department is increasing. Some of these patients returned shortly after receiving medical attention. This scenario increases medical expenditure and indicates poor medical services, which negatively affect the hospital. A patients’ return to the hospital within 72 h after treatment is one of the emergency department’s quality indicators that should be improved. We aimed to determine the cause of unscheduled return visits to the emergency department through the patient’s perspective. Research was conducted in a regional teaching hospital in New Taipei City from 5 July to 30 September 2013. A total of 204 patients were included in the study. These patients included those who returned to the hospital within 72 h after receiving medical treatment and several randomly selected patients who visited the emergency department during the same period (control group). The patient’s area of residence (P = 0.005) and substance abuse behavior (P = 0.004) were correlated with unscheduled return visits. Based on the results of the research, the following data were obtained. (1) Patients with substance abuse behavior often exhibit poor mental health and lack social support, thereby limiting the improvement in their physical health. Thus, emergency medical treatment should properly address the needs of such patients and offer appropriate services. The hospital may also transfer the patient to professional counseling. Emergency room doctors must provide care and restrain the behavior of such patients. (2) The emergency department’s management should properly handle the patients’ medical demands, including the provision of suitable counseling transfer, case tracing, and referring the patients to doctors that can provide appropriate care. Moreover, restraining the behavior of these patients should be done when such patients demand to see a doctor without following the proper schedule. (3) The region of residence of these patients affects the rate of return visit, thereby suggesting that the patients visit the emergency room under the non-compact, active counseling referral hospital outpatient follow-up treatment. Appropriate health education and information about their disease must be provided to patients during the initial appointment in the hospital outpatient services. Such a decision may strengthen the communication between the patients and the hospital outpatient medical services.