縮短醫院轉科病歷傳送時間方法之探討

A Study on Shortening the Time for Transfer of Medical Records

病患為了減少就醫時間之浪費，常於同一天內在同家醫院數個專科就診；為此， 常需在次一個專科等待轉科病歷。個案醫院發現病患實際等候轉科病歷的時間，與病患的期望有很大的落差，故進行研究探討。以前一科醫師完診至次科收到病歷之間相距16分鐘，為進行改善的目標。以實地觀測方式收集資料。並透過會議討論，謀求解決方案而進行改善。比較改善前後的成果，發現病歷轉科所需全程時間顯著改善（改善前:17.7 土 9.6分鐘；改善後：12.9 土 6.4分鐘。p < 0.01）。在階段性作業時間的觀察分析中，發現護理人員送出時間的配合最為重要（改善前；8.4 ±9.1分鐘；改善後:4.2 土 5.4分鐘。p < 0.05 ）；而病歷收發員之收發時間已降至極限，能改善的空間有限。本案成功之主因，在於符合管理學上的「霍桑效應」；顯然在服務品質的改進上，合理的監控是必要的。

Outpatients often schedule appointments with several specialists on the same day in order to save their time. However, they must wait for the medical records to be transferred from one office to the next so that the second doctor interview them. We found in our medical center that patients were so unsatisfied with the time taken for transfer of the medical records (TMR), We designed a project with the goal of achieving TMR within 16 minutes after the patient left the first clinic. The methods used in this study were based on the researcher's observation, recording and analysis. Data of TMR time intervals was collected segmentally, with the exception of the time taken by the nurse se to finish the OPD chart, which was estimated by inspection and supposing. (for the detail, please see the text) After ascertaining the time required for TMR before intervention, we had 2 meetings with those representatives of the nursing department to decide the ways for shortening the time intervals. Both the medical-record section and the nursing department then implemented the agreements on procedures. The average time for TMR was changed front 17.7 minutes before into 12.9 minutes after the intervention (p< 0.01) that showed a shortening of 27% in transfer duration and was better than the target of 16-minutes. The major factor in achieving such a success could be mainly the cooperation of the nurses, who shortened their portion of the total TMR with an average of 4.2 minutes that was 88% of the overall reduction. We conclude that the success of the project was due to the ”Hawthome Effect” and recommend ways of maintaining this effect in the future.