降低急診小兒發燒72小時再返診率

Decreasing 72-hour Re-visiting Rate for Febrile Pediatric Patients in Emergency Room

本專案主要目的是於2004年1月1日至5月15日間為降低急診小兒發燒72小時返診率，選取北部某教學醫院急診以小兒發燒病童家屬及護理人員為收案對象，資料收集工具包括病童家屬及護理人員對小兒發燒處理之認知調查表、護理人員對發燒病童家屬衛生指導執行率監測，認知調查表各為13題，滿分各為13分。經由【降低急診小兒發燒72小時再返診方案】進行改善，其方案內容包括修訂小兒發燒衛生指導手冊、修訂衛生指導流程、推動急診病童（家屬）諮詢專線和出院電訪關懷服務作業及舉辦在職教育及制定人員衛生指導執行監控表等措施，方案介入後結果發現：（1）護理人員及病童家屬對小兒發燒處理之認知，各平均總分由10.9分（84%）及9.2分（70.8%），提升為12.6分（96.9%）及11.9分（91.9%）；（2）護理人員執行小兒發燒護理衛生指導之執行率由3人（12%）提升為22人（88%）；（3）小兒發燒病童72小時再返診的比率由6.8%降至4.9%，較改善前下降1.9%。結果顯示，經由改善方案介入後，72小時再返診的小兒發燒病患減少。因此，期望藉由本專案的執行成效，提供相關疾病照護時參考，並藉由電訪關懷服務及電話諮詢專線的椎行，提供家屬或病患照護指導，而降低再返診率。The purpose of this project was to decrease 72-hour re-visiting rate for febrile pediatric patients in an emergency room (ER). The sample for the project consisted of the families of febrile pediatric patients and nurses in a northern Taiwan teaching hospital from January 1 to May 15, 2004. The instruments for the project included fever-management cognition for families of febrile pediatric patients and nurses. The cognition was 12 items (total score of 12 ) with a Likert 2-point scale. The instrument also included monitoring the performance rate of nurses’ health education for the febrile pediatric families. The improvement program of the project included revising an instruction pamphlet and instruction procedures for febrile pediatric patients, driving follow-up and consultation by telephone for the febrile pediatric families, and holding in-service training and establishing monitor instruction guidelines for the nurses. The results of the project after implementing the improvement program showed that: (1). The average score of fever-management cognition of the febrile pediatric families and nurses increased from a score of 10.9 (84 %) to 12.6 (96.9%) and 9.2 (70.8%) to 11.9 (91.9%), respectively. (2). The performance rate of nurses’ health education for families of febrile pediatric patients raised from 3 nurses (12%) to 22 nurses (88%). (3). The 72-hour re-visiting rate for febrile pediatric patients reduced from 6.8% to 4.9%, a decrease of 1.9% compared to the results of the previous improvement program. The results showed that the improvement program performance obviously decreased the 72-hour re-visiting rate for febrile pediatric patients in ER. Therefore, the results should be provided to nurses as a reference for clinical care of the other similar diseases. In addition, the results should also be provided to families or patients as part of health care instruction; thus decreasing the re-visiting rate via follow-up and consultantion by telephone.