重大外傷病人照護品質及醫療資源耗用在醫院專責外傷制度下之探討

Does Hospital Trauma System Improve Quality of Care and Medical Resource Utilization for Patients with Major Trauma

目的：衛生福利部2009年將外傷列入「醫院緊急醫療能力分級」的評鑑項目。個案醫院成立外傷科後，在專責外傷制度下制定臨床照護規範及標準作業流程，故本研究目的為了解重大外傷病人在醫院專責外傷制度下的照護品質及醫療資源耗用是否獲得改善。方法：本研究以病歷回溯方式，以台灣南部某醫學中心外傷資料庫為基礎，將其分為外傷科成立初期 （2011~2013年）及外傷科成立近期（2014~2015年），運用SPSS統計軟體，以卡方及t檢定分析重大外傷 (Injury Severity Score, ISS≧16) 病人在專責外傷制度下死亡率、住院天數及醫療資源耗用是否有顯著性差異。結果：外傷科成立近期ISS增加，重大外傷族群由23分提高為25分；死亡率在外傷科成立初期及近期沒有差異；嚴重外傷 (ISS=16~24) 病人族群住院天數由16天減少為13天，在統計上達到顯著性差異 (p<0.05)；醫療資源耗用部份，僅嚴重外傷族群有顯著性的減少，極嚴重外傷 (ISS≧25) 族群在統計上未達到顯著性的差異。結論：醫院專責外傷制度下可以減少嚴重外傷 (ISS=16~24) 病人的住院天數及醫療資源耗用。本研究結果可以提供個案醫院對於成立外傷科之效益做為評估的依據，也證實外傷科可以減少嚴重外傷病人醫療資源耗用。

Objectives: The purposes of the study were to explore the quality of care and medical resource utilization for patients with major trauma treated under hospital trauma system. Material & 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 divided into two groups: early period (2011~2013) and late period (2014~2015). Chi-square and t-test analyses were used to examine the following indicators: mortality rate, length of stay (LOS), and medical resource utilization of patients with an Injury Severity Score (ISS) greater than 15. Results: No significant difference in mortality rate was found. In the group of ISS 16~24, the LOS of late period was significantly shorter than its counterpart (16 vs. 13 days). In addition, medical resource utilization was significantly reduced. Conclusions: Hospital trauma system was able to reduce LOS and medical resource utilization among severe trauma patients (ISS=16~24). It can be used as a reference for evaluating the effectiveness of hospital trauma system.