滯留急診48小時之影響因素探討――以台北市某醫學中心為例

An Investigation of the Factors on Emergency Department Length of Stay - A Case Study of a Medical Center at Taipei

目的：國內多數醫學中心因急診病人滯留率過高，導致急診壅塞情形仍為外界、媒體及社群團體所關切。因此，本研究目的探討急診非外傷留觀病人滯留急診時間之影響因素。方法：利用台北市某醫學中心2013年度急診病人就醫資料，針對符合急診非外傷留觀病人達11,771人次，以Kruskal-Wallis檢定、Jonckheere-Terpstra檢定等統計方法探討滯留急診時間之影響因素，使用羅吉斯迴歸分析找出影響滯留急診超過超過48小時與否之顯著因素。結果：急診非外傷留觀病人以男性、年齡分層越大、檢傷分類為第一級、到院班別是白天班、搭民間或119救護車、星期六日／國定假日、及病人檢驗檢查處置有會診專科醫師、執行X光、血液細菌培養、超音波、辦理住院之留觀者較易滯留急診超過48小時。建議：衛生行政主管機關應持續政策推動，並落實轉診及醫院分級診療制度，醫院管理者應重視急診留觀情形，進一步分析滯留急診影響因素，由醫院管理從檢查處置、病房床位運作、安排下轉等改善策略及參考國內外作法，以降低留觀病人滯留急診過久及提升急診醫療照護品質。

Background: The emergency department (ED) length of stay (LOS) is long in most domestic medical centers and the problem of emergency overcrowding is still concerned by the media and community groups. The purpose of this study is to investigate the ED LOS influencing factors of emergency non-traumatic observation patients. Methods: The patients’ emergency medical records in a medical center were included in the year of 2013. There were 11,771 non-trauma observing patients. Related factors of the non-trauma observing patients in ED LOS were analyzed with the method of descriptive statistic, KruskalWallis test and Jonckheere-Terpstra test. Logistic Regression was also used to evaluate the effects of significance and the factors influencing among the observing patients of ED LOS over 48 hours. Results: The patients those are male, older age, triage category I, registered in the daytime, arrived with ambulance, arrived on weekend or holidays, had consultation of other specialist, arranged admission, and arranged examinations of X-ray, blood culture, also sonography usage had a higher odds for ED LOS over 48 hours. Conclusion: The health administrative authority should continuously promote policies and implement systems of hospital referral and grading. The Hospital managers should pay attention to ED LOS and analyze the factors of ED stasis. To decrease the ED LOS and improve emergency care quality, they should manage the time of examination, treatment, ward admission, referral and take the foreign and domestic policies for reference.