降低超長住院日數之改善專案－－以臺灣東部某醫學中心為例

The Effectiveness of Quality Improvement Team to Decrease Prolonged Length of Stay in a Medical Center of Eastern Taiwan

2009年11月醫院住院30天及以上超長病患比率為14.66%，累積總住院天數高達5,685天，嚴重影響民眾就醫治療權益及即時性，因而引發改善動機，分析導因為：無專責人員追蹤出院進度、不清楚個案為超長住院病患、個案及家屬擔心返家後不會照顧、家屬對個案照顧意見不一，專案執行期間為2009年12月至2010年11月，經成立超長住院品質改善專案小組、增設資訊系統、定期召開會議檢討出院進度、舉行出院準備服務個案討論會，商討個案出院後續照顧細節，確認家屬照顧計畫，增強家屬照顧信心、舉辦教育訓練強化團隊出院準備服務效能。專案實施後住院30天及以上超長病患比率下降至10.51%、累積總住院天數減少為3,221天，達專案目標。醫院政策支持及團隊合作為成功關鍵，本專案執行經驗及措施，可提供其他醫療院所參考。

The aim of this project was to reduce the rate of prolonged hospitalization over 30 days for all inpatients. The trial period was from December 2009 to November 2010.After data analyzing, the problems are related with no follow up after discharged, lacking of informations about prolonged hospitalization, patients and families worried about caring problems after discharge and different opinions of family members about caring. The strategies of improving project included: established a Prolong Length of Stay Team to responsible for follow up after discharge, set monitoring system of prolonged hospitalization, held regular meeting to discuss discharge planning and to promoted family consensum of caring, The result showed that, the total days of hospitalization reduced from 5,685 to 3,221 days and the percentage of prolonged hospitalization reduced from 14.66% to 11.68%. Our experiences can also provide good examples to deal with prolonged hospitalization to other hospitals.