活動式超音波測量膀胱尿量之成本效益

Cost-Effectiveness Analysis of Portable Bladder Scan for Measuring Urine Volume

本研究探討活動式膀胱超音波機與人為判斷患者導尿需求正確性之差異及以超音波機評估尿量之成本效益。地點為某醫學中心神經及直肛外科病房，採立意取樣，個案來源為護理人員判定需要導尿者，導尿前以具信效度之超音波機測量尿量，比較對導尿必要性之判斷，之後以「沒有導尿之品質調整天及願付額」量表評估個案自認導尿對生活品質的影響，並計算減少不必要導尿可節省的成本。共收案88人，導尿次數186次，敏感及特異其性分析顯示超音波機可正確篩檢尿量；可避免的導尿次數約30%，而使用於〝尿管移除後測餘尿〞則可避免的導尿約為50%；另經成本計算，使用超音波機可節省醫療支出，且可增進住院期間的生活品質，75.7%的個案願意自費做檢查以避免導尿。本研究以活動式超音波機做為評估尿量之工具，值得臨床應用。

This research evaluates the use of a portable bladder scan to determine the urine volume. The purposes of this study were to investigate the differences in the patient's need for urinary catheterization as determined by portable bladder scan and by nurses; and the cost-effectiveness of using the bladder scan to evaluate the urine volume. This study was conducted in the neurosurgical and rectal-anal-surgical wards of a medical center. Cases were recruited from those determined by the nurses who needed catheterization. Before catheterization the researcher performed bladder scan to measure the urine volume and to determine the need for catheterization. Questionnaire for patients who received the final catheterization had to state their subjective feelings on the “quality-adjusted days without catheterization and willingness to pay” to evaluate the influence of catheterization for patient's quality of life and calculate the cost saving of unnecessary catheterization. This research consisted of 88 patients who underwent 186 catheterizations. The results of this study were as follows: (1) Sensitivity and specificity analysis data showed that bladder scan could accurately screen the urine volume. (2) When nurses evaluate the patient's need for catheterization with the combination of using the bladder scan, they can reduce unnecessary catheterization by approximately 30%; one of the main reason for catheterization “to evaluate the post-void residual urine amount after the removal of indwelling catheter”, can avoid catheterization by almost 50%. (3) Bladder scan can save the medical expense by cost analysis statistics and improve patient's quality of life during hospitalization, and 75% patients were willing to pay the cost for bladder scan to prevent unnecessary catheterization. By using the portable bladder scan to determine the urine volume, this research deserves utilization in the clinical area.