解決急診壅塞之政府角色

Abstract

急診壅塞困擾台灣超過20年，至今問題仍在。急診壅塞會影響病人安全、造成病人不便，同時也讓急診護人員過勞、增加工作風險，醫院的營收也會降低。所以急診壅塞是病人、醫護人員、醫院、政府與社會五輸的困境，亟待有效解決。 做為一篇回顧性研究，本文針對急診壅塞相關文獻825篇進行分析，發現急診壅塞的根本原因是緊急醫療資源的供需失衡，其中最主要的問題是基層醫療服務體系的崩解，無法提供民眾就近、適切、即時的醫療服務。導致民眾跨越基層醫療服務體系，直接而集中的尋求大醫院急診協助。同時也因而滯留在大醫院，無法即時返回社區。 本文引用Asplin所提出的輸入面、過程面與輸出面等三個面向架構，整理各家學者提出之急診壅塞相關指標、成因與解決方案，並從中探討政府部門在此議題中所扮演的角色。發現台灣急診壅塞的主因來自於輸出面，其次才是輸入面，過程面最不是問題。而不論是輸出面還是輸入面，都有賴政府各部門系統性的介入解決。 在先進國家，政府部門已從消極監控的狀態，改為積極介入的角色，不允許壅塞問題持續存在。回顧文獻，發現我國政府部門有許多可以參考採行的做為，本文分別就輸入面、過程面與輸出面等三個面向提出政策建議，供相關部門參考。最重要的，是透過各種方式，設法重建基層醫療體系，擴充長照量能，避免醫療需求過度集中於大醫院，這樣才是從根本解決壅塞問題。

Emergency department overcrowding has been plaguing Taiwan for more than 20 years, and the problem remains to this day. ED overcrowding can affect the safety of patients and cause inconvenience to patients. At the same time, it can make emergency staffs overloaded and also increase the risk of working. The hospital's revenue will also decrease. Therefore, ED overcrowding is a dilemma for patients, medical staff, hospitals, the government and the society, and it needs to be effectively resolved. As a review research, this paper analyzes 825 articles related to ED overcrowding. It finds that the root cause of ED overcrowding is the imbalance between supply and demand of emergency medical resources. The most important problem is the disintegration of primary health care system and the inability to provide accessible, appropriate, and immediate medical services, which pushes people to jump over the primary health care system, to seek emergency assistance from large hospitals directly and concentratedly. At the same time, people are also stranded in large hospitals and cannot be returned to the community as soon as possible. This paper adopts the three-put model proposed by Asplin, which include input, throughput and output aspects, as frameworks of study. It organizes the indicators, causes and solutions of ED overcrowding by the three-put model, and discusses the role of government departments in this topic. It is found that the main problem of Taiwan's ED overcrowding is from the output side, followed by the input face, and the throughput aspect is the least problematic. Whether it is the output side or the input side, it accounts on the systematic intervention of various government departments. In advanced countries, government departments have changed from a state of passive monitoring to a role of active intervention, and the problem of ED overcrowding is not allowed to persist. Looking back at the literature, we found that there are many ways government can adopt. This paper proposes several policy recommendations by the input, thorughput and output aspects for the relevant government departments. The most important thing is to try to rebuild the primary health care system in various ways, expand the long-term care capacities, and avoid excessive medical needs in large hospitals. This is the fundamental solution to the problem of ED overcrowding.