團隊合作提昇大腸癌篩檢率──以高雄市某沿海漁港之地區醫院為例

Rising the rate of colorectal cancer screening through TRM in a coastal fishing port regional hospital in Kaohsiung

高雄市某漁港地區因地理位置與習俗的關係，居民較無篩檢觀念。希冀藉由提高大腸癌篩檢量，達到早期發現早期治療。個案醫院自104年1月開始為期一年，執行國民健康署大腸癌篩檢計劃，初期每月篩檢率＜40件。運用團隊資源管理手法跨科室合作，提高大腸癌篩檢率與陽性追蹤完成率。本院採取方法：（1）利用要因分析圖，找出篩檢率偏低的原因為：民眾認知不足、繳交檢體不便利、確認符合篩檢資格時間過長。（2）改善對策：1.設置癌篩小站並提供文宣與專人說明。2.提供郵票信封袋，提高外部篩檢之檢體回收率。3.增加民眾可隨時領採檢管的地點。4.制訂醫院員工推薦獎勵制度。（3）利用大腸癌篩檢陽性病人回診前，電話詢問病人做大腸鏡意願，並協助掛號。最後執行結果：（1）改善前（104年1月～3月）大腸癌篩檢數共115件；改善後（104年4月～12月）大腸癌篩檢數共1050件，其中護理科推薦有314件，醫事人員推薦有183件，獎勵金共發出5280元，成長率達325％，達成率為105％。（2）改善後榮獲大腸癌疑癌追緝王地區醫院第一組第一名。 Ci-Jin District, which is subordinated to Kaohsiung City, Taiwan, is a small island with only 29,010 populations. Because of its solitarily geographic location, resources the local residents obtain is relativity inadequate. There is only a community hospital on the island, and the residents are not quite interested in participating health issues. We have undertaken the cancer screening program from Ministry of Health and Welfare since 2015. However, the rate of colorectal cancer screening got low in the early month of year. Therefore, we adapted team resource management (TRM), cause and effect analysis chart and Pareto Chart to find the reasons as well as increase the rate and amount of colorectal cancer screening. After analysis, we found the several reasons as follow: 1.The weak of health issue, 2. Inconvenience for returning specimen. 3. Long time to check the qualification. Moreover, our improvement as follow: 1.Setting up the cancer screening desk. 2. Offering the envelope with stamp.3.Extending the points for returning specimen. 4. Formulating the reward rule for staff. Finally, the results as follow: 1. The growth rate of colorectal cancer screening is up to 325%. 2. The achievement rate of colorectal cancer screening growth is up to 105%. 3. Be honor to win the award.