急診室病患組合、人力排擠與醫療救治結果

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题名:	急診室病患組合、人力排擠與醫療救治結果
作者:	黃昭逸;Huang, Chao-Yi
贡献者:	產業經濟研究所
关键词:	急診壅塞;輕症患者;醫療人力;ER crowding;mild patients;medical talent
日期:	2020-07-28
上传时间:	2020-09-02 16:59:58 (UTC+8)
出版者:	國立中央大學
摘要:	急診壅塞的問題一直困擾著全世界的許多國家，它不僅造成病患的醫療救治結果變差，更將低醫院急診室的醫療品質。在全民健保制度的落實之下不但降低醫療費用支出，更調降人民的就醫門檻，這使輕、重症的病患都能選擇往急診室求診，使整體的處置時間延長。醫院急診室主要針對急重症患者在有限的時間下進行即時處置而設立。在醫療人力資源有限下，過多非急重症患者前往急診室就醫，不僅容易影響急重症患者的救治結果，更可能讓急診室的醫護人力過度負荷，導致人才流失。本研究使用2000 年及2005 年全民健保資料庫百萬人次抽樣檔，以心肌梗塞、出血性中風及阻塞性中風等重症患者作為研究對象，採用羅吉斯迴歸模型探討急診室輕症患者的人流多寡是否會影響急重症患者的救治結果，特別是在醫學中心層級。另外台灣經常遇上週末與夜間門診休診的狀況，使輕症患者只能選擇前往急診室求診，我們加入時間要素，觀察在週末以及夜間時段下，是否急診輕症壅塞對於急重症患者的醫療救治結果有顯著的影響存在。根據實證結果，整體來看急重症患者的醫療結果受到輕症患者就診率影響並沒有達到統計上的顯著性，特定週末時段與夜間時段中結果都未明顯對急重症患者的醫療結果有顯著的影響。;Emergency department congestion can causes poor medical treatment outcomes for patients worldwide. In addition, it reduces the quality of medical treatment in the emergency room. The implementation of the National Health Insurance System in 1995 in Taiwan lowered medical expenses and the threshold for people to seek medical treatment. It means that high number of patients with mild symptoms can be present in the emergency department, which increases waiting times for all. The emergency room is available for patients with acute and severe symptoms. It is designed to use the limited time for treatment. However, too many non-emergency patients can delay the treatment time of emergency patients and worsen their condition when medical resources are limited. In addition, medical staff can be overworked, which leads to a shortage of medical talent in the emergency department. This study used the National Health Insurance Database from 2000–2005 to assess the effect of the number of patients with mild symptoms on emergency patient outcomes in medical centers. We included patients with myocardial infarction, hemorrhagic stroke, and obstructive stroke. Most patients with mild symptoms choose to visit the emergency department during the weekend and night periods; therefore, we evaluated whether treatment outcomes were affected by emergency department congestion during these periods. Interestingly, we found no significant effect of mild patient numbers on the treatment outcomes of patients with severe disease, including during the weekend and night periods. In summary, there was no effect the number of non-emergent patients on the treatment outcome of severe patients.
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