危險評估篩選工具在出院準備服務的成效

The Effect of Risk Assessment Screening Tool for Discharge Planning

出院準備服務(discharge planning)能提供病人完整性與持續性的照護，幫助病人順利的出院，並得到適當的後續照護，然而出院準備服務的執行，首先最重要的工作便是早期確認危險群個案，而確認的方法則是透過「評估」。國內醫院在實施出院準備服務所使用的個案篩選評估工具各不相同，在對工具的檢定及成效上，都欠缺研究資料的支持，因此，本研究即是在探討Blaylock在1992年提出的出院準備服務之個案篩選評估工具，簡稱BRASS.量表的信度及運用在出院準備服務上的成效。本研究樣本是以某醫學中心之成人病房的病患為主，收案期間為1998年1月1日到同年12月31日止，共計2000份樣本。研究結果發現：此評估工具具有良好的信度，且評估時間花費不長，平均3.9分鐘，而心血管疾病、內分泌及代謝疾病、神經系統疾病之病人，其所需要花費的評估時間較長。此評估工具對病患的住院日數及後續照護的需求，均具有顯著的關係與預測力。此外，這份評估工具較適用於內科病房的病患，年齡在六十五歲以上的老年人，其疾病診斷為心血管、神經及呼吸系統疾病者，及巴氏量表之依賴程度為中、重度之病患。

Discharge planning can provide the holistic and continued care to the patients, facilitate discharge process, and give the patients after care advice if necessary. However, the first and most important thing of discharge planning is early identification of the risk group. This kind of identification can be achieved through assessment. In Taiwan hospitals, there are many different screening tools for discharge planning. However, research results proving the effectiveness of screening tools are still in need. The purpose of this research is to understand the reliability of BRASS (Blaylock Risk Assessment Screen) scale and it’s effectiveness for discharge planning. The subjects were 2000 patients who were admitted to the adult ward of one medical center in a period from January 1 to December 31,1998. The results indicate that BRASS scale has good reliability and requires less assessment time an average of 3.9 minutes. Patients who have cardiovascular diseases, endocrine and metabolic diseases, and neurogenic diseases need longer time to assess. Moreover, the BRASS scale is significant associating and predicting the length of stay and demand of after care. The BRASS scale is more suitable for patients aging above 65 years old, with diagnosis of cardiovascular, neurogenic and respiratory diseases, and for patients whose dependent level is moderate to severe by Barthel index.