運用跨團隊模式改善小兒急診72小時內 非計畫性返診後之住院率

Abstract

急診醫療品質的提升一直是急診工作同仁努力的目標，小兒科急診72 小時內非計畫性返診及返診後住院的問題，一直是關心急診醫療品質及費用的學者研究的議題。這些非計畫性返診急診的病童，有可能是一群未完成持續性治療，或是有潛在醫療糾紛，或是醫療資源浪費的高危險性病童，我們不可否認衛教對病人整體健康的重要性，但是病人家屬的出院衛教一直是急診醫療很脆弱的一環。本研究希望在小兒急診推行運用跨團隊衛教模式來改善小兒急診72小時內非計畫性返診率及返診後之住院率，並進行探討造成急診病患非計劃性返診的因素及臨床特性。 分析結果發現，研究三個月期間小兒急診72小時內非計畫性返診人數共459人，返診率分別3.8%、3.96%、4.98%，返診後之住院率分別為48%、53%、43.6%，跨團隊衛教模式對於改善小兒急診72小時內非計畫性返診後之住院率，實施前後住院率並無統計學上明顯差異；在「年齡」、「返診原因」、「性別因素」、「檢傷級數」、「就診時段」 這些影響急診返診主要因素中；「年齡」中，初次就診平均年齡，有逐漸下降之趨勢，有統計上的顯著差異。年齡小病童返診占多數，「返診原因」中發生返診機率「症狀未改善」較高；在「性別」中，男性病童返診占多數，在「看診班別」中，「白班」返診後之住院率明顯高於其他班別，但在統計學上並無明顯差異；在「檢傷級數」中，第三級與第四級發生返診機率明顯較高，有統計學上明顯差異。 結論: 跨團隊衛教模式對於改善小兒急診72小時內非計畫性返診後之住院率，實施前後住院率並無統計學上明顯差異

Background: Return visits to the Pediatric Emergency Department (PED) that require admission are frequently reviewed for quality improvement purposes. Patient return could arise from a potential deficiency in the medical advice and/or education provided during the initial visit. Therefore, although the treating team typically educates the patient, it is unclear whether they accurately identify the reason for the patient’s return. Objectives: To assess the characteristics of pediatric return visits to the PED as well as the ability of a cross-team education model to lower the rate of return visit admissions. Methods: We used a cross-team educational model in children who visited the PED over a 3-month period. This study reviewed all returns that occurred within 72 h of the initial visit to a tertiary care PED. Clinical characteristics were collected and analyzed by reviewing patient charts in a computer. The cause of the return was identified, and the number of children admitted to the hospital during a return visit to the PED with 72 h of the initial visit was evaluated. Results: A total of 459 patients returned to the PED within 72 h of their initial admission. The revisit rates were 3.8, 3.96, and 4.98% in months 1, 2, and 3, respectively. The rates of admission during the return visit were 48, 53, and 43.6% respectively. The rate hospital admission after a return visits to the PED within 72 h was unaffected by the cross-team education model. The mean patient age during the initial visit was 4.82 years, and the mean age at return was 4.31 years. The prevalence of unscheduled revisits within 72 h was highest in male and younger patients. The most common reason for revisit was that the clinical symptoms remained. The most common diagnosis was fever. The occurrence of a first visit during the daytime shift increased the probability of a return visit. The admission rate after revisit was not related to gender, age, triage level, the time of the first visit, or diagnosis. Conclusion: The rate hospital admission after a return visits to the PED within 72 h was unaffected by the cross-team education model.