某區域級教學醫院跌倒傷害嚴重程度之相關性研究－－複合式檢定方法之運用

The Study of Fall Injuries and its Related Factors in a Regional Teaching Hospital- Use of the Hybrid Statistical Methods Approach

近年病人安全相關之研究多數以降低跌倒改善專案或以異常通報事件結合推移圖進行分析，對於同時利用TQIP指標、管制圖與統計方法之研究闕如。過去研究在探討品質指標時所常使用之推移圖確實可方便管理者隨時掌握管理效果或服務品質的主要性能參數動態趨勢，惟，對於服務過程之監控及困難來源卻無法得知，更無法繼之改善服務過程。本研究採回溯性調查分析法，以個案醫院2009年1月至2010年12月期間TQIP有記錄之跌倒指標合併跌倒造成傷害指標為資料，分子為跌倒造成傷害數，分母為住院人日數，以u管制圖檢視。跌倒量表以「台灣病人安全通報系統第五版之病人跌倒事件」為依據，跌倒傷害嚴重度依據TQIP指標定義分成三級，通報事件共169筆，運用卡方檢定探討跌倒特質與嚴重度之相關因素。研究結果發現跌倒傷害率平均值為0.024%、管制上限為0.063%，全臺灣平均值為0.024%，監測期間內處於管制狀態下。跌倒特質中以高齡、平時無陪伴者、健康狀況不佳、一般病房、行走中之發生率最高，傷害嚴重度則以一級傷害最多（p<0.05）。管制圖之使用的確能有效監控醫院指標之變化情形，建議個案醫院應透過跨領域團隊之合作，針對危險因子進行預防措施，加強病人及家屬之觀念，同時加強肌耐力及平衡感訓練之衛教，以降低醫院跌倒之發生率與傷害程度。

Various patient safety related studies recently are focused on either formulating plans for fall prevention or combining unusual case notification with run charts, but few examined this domain using Taiwan Quality Indicator Project (TQIP), control charts, and statistical methods concurrently. It is true that the use of run charts for investigating quality indicators, as shown in previous studies, can indeed enable managers to better control the dynamic patterns of major performance parameters of managerial effects or service quality at all time. Nevertheless, run charts are useless for monitoring service process or detecting source of difficulties, and as a result, it is not good for service process improvement. This study adopted the retrospective survey analysis, and the studied data were recorded fall indicators combined with fall-induced injury indicators in TQIP between January 2009 and December 2010. The value of fall-induced injury was treated as the numerator, inpatient days were treated as the denominator, and the results were viewed using u control charts. The adopted fall scale was based on Taiwan’s Patient Safety Notification System: Cases of Patient Fall (Fifth edition), and the degree of severity of fall injury was classified into three levels according to TQIP. The total number of notified cases was 169, and the chi-square test was adopted to analyze factors related to fall characteristics and severity levels. The results suggested that Centerline (CL) of fall injury level is 0.024%, while the upper control limit is 0.063%, and the means for Taiwan overall is 0.024%. The monitoring period was conducted under control and regulation. As for fall characteristics, majority patients are live alone senior citizens with poor conditions, and the occurrence of fall is the highest among patients staying in general wards or while walking. For the severity level of injury, Level 1 injury is the most common level (p<0.05). The study Control Charts used can indeed effectively monitor changes in hospital indicators. The researchers suggested that the case-study hospitals should adopt multidisciplinary teamwork to stress the importance of risk factors, to launch prevention measures, and to educate patients and their family about this matter. Meanwhile, it is important to enhance patients’ muscle strength and sense of balance in order to reduce the occurrence of fall in hospitals and the level of injury.