專責外傷制度成效之初探－－以台南市某醫學中心為例

Preliminary study of the effectiveness of trauma care system at a medical center in Tainan

目標：為了解專責外傷制度成立後，執行持續性品質改善計畫(Continuous quality improvement, CQI)對於外傷病人照護品質是否持續改善。方法：本研究以病歷回溯方式，利用外傷登錄資料庫分析個案醫院成立外傷科後所收治之病人共1,619人。將其分為成立初期（2011~2013，895人）及成立近期（2014~2015，724人），利用獨立樣本t檢定及卡方檢定檢視系統反應時間：包含接受緊急動脈栓塞(Transcatheter Arterial Embolism, TAE)與緊急胸腹手術病人在急診停留時間及緊急胸腹手術病人在鍵入刀序後至手術室時間，另對重大外傷(Injury Severity Score, ISS≧16)病人預後：包含住院天數及死亡率等變項進行差異性分析。結果：ISS在成立近期有顯著增加，由15.09增加到18.62；接受TAE病人於急診停留時間由143.52分鐘減少為117.94分鐘；另外在嚴重外傷(ISS=16~24)病人的住院天數由成立初期21.13天減少為成立近期16.27天，死亡率亦由5.34%降為1.03%，在統計上皆呈現顯著性差異。結論：專責外傷制度及持續性外傷品質改善計畫能有效提升急診處理病人的效率，且在嚴重外傷(ISS=16~24)族群可以減少住院天數及死亡率。

Objectives: To evaluate the quality of care for trauma patients following the implementation of continuous quality improvement (CQI) in a trauma care system. Methods: This was a retrospective chart review study using the trauma registry database of a medical center in Tainan from 2011 to 2015. The patients were classified into two groups: the years 2011~2013 (early period, N=895) and 2014~2015 (late period, N=724). Chi-square and t-test analyses were used to examine the indicators: duration of stay in the emergency room (ER) for emergency transcatheter arterial embolism (TAE)/torso surgeries, waiting time after scheduled for torso surgery, and length of stay (LOS)/mortality rate of patients with an Injury Severity Score (ISS) greater than 15. Results: The average ISS of the late period group was significantly higher (18.62 vs. 15.09) and the duration of stay in the ER for emergency TAE was significantly lower (117.94 vs. 143.52) than those of the earlier period group. In addition, the LOS declined significantly (16.27 vs. 21.13), and the mortality rate was significantly reduced (1.03% vs. 5.34%) among patients with an ISS of 16~24. Conclusions: CQI in a trauma care system was effective in the ER management of trauma with significant reductions in LOS and mortality rate in patients with an ISS of 16~24.