利用變動式顏色標記檢傷分級改善急診病患候診時間

Acuity-Based Color Labeling of Waiting Status Decrease the Physician Waiting Time in the Emergency Department

為建立有效、安全、快速的急診病患候診流程，發展一個變動式檢傷分級制度，以顏色標記顯示於急診電腦診間醫令系統上，輔助急診醫護人員掌握未看診急診病患之檢傷級數與安全等候看診情形，提示急診醫護人員分配臨床工作的優先次序。本專案將檢傷分級條件再細分，並設定預期最長安全等候時間，系統依檢傷護士判定之檢傷級數給予不同顏色標記於電腦診間醫令的畫面上，若候診過久會自動變動所標記的顏色，提醒急診醫師在合理安全時間內看診。經過兩個月方案執行改善後的資料發現：檢傷二級病患候診時間大於十五分鐘者，從3.2%則降為1.0%，目標達成比率115%，候診時間超過十五分鐘者，從原本11.4%降至7.1%，目標達成比率為62.9%。特別是於較危急之檢傷二級病患的逾時等候情形獲得大幅度的改善，進而縮短急診病患候診時間。

We conducted a prospective study to determine if implementation of a dynamic color labeling of a patient’s waiting status can effectively decrease waiting time in the emergency department. We first developed a local triage system with a total of 5 levels of acuity (New triage categories 1 to 5, or N1-N5 respectively). For different time ranges of remaining time to acuity-specific due time, we assigned corresponding background colors of the patient list on the ED information system. As time elapsed in waiting to be seen by a physician, the background color would have a dynamic change progressing from white to red, which will alert the emergency physician to see the patient without delay. Those who waited longer than 15 minutes decreased from 11.4% to 7.1%, with target accomplish rate 62.9%. The number of N2 patient who waited longer than 15 minutes decreased from 3.2% to 1.0%, with target accomplish rate 115%. We conclude that this information technology was useful in facilitating provider communications, and improved the efficiency/efficacy of emergency medicine by shortening physician-waiting time, especially for those with more critical conditions.