改善心臟科門診病人跨院際轉診檢查之時效

Improving the Time Efficiency of Interdisciplinary Examination for the Referral Cardiologic Outpatients Across Hospitals

良好的轉診制度能合理運用資源提供病人適當醫療服務，應著重於病人就醫的可近性及醫療利用效率，評估病人等候時間做為判斷轉診服務流暢度與品質的簡易指標。本診所2009年1~4月共有118位心臟科門診病人須進行轉診檢查，其中107位接受跨院轉診服務，轉診檢查服務滿意度低僅2.23分(滿分4分)，而每位病人由取得轉診單至診所聽取報告平均等待長達25天，高於轉檢院區病人平均等待天數(14天)，另發現5位(4.7%)病人於等待檢查期間即發生不適症狀而住院檢查，故為顧及心臟科病人及時檢查、即早治療之時效性與重要性，本專案運用流程程序圖分析法，整合與簡化跨院轉診檢查流程，制定轉診作業規範、圖文版轉診說明單、實施教育訓練、落實作業監測措施，降低病人轉檢等候時間，結果顯示改善後轉檢等待時間由改善前25天降低為12天，轉診檢查服務滿意度也由2.23分提升至3.33分。本專案藉由跨團隊合作與簡化流程方式，有效降低病人轉診等待檢查時間並提升病人滿意度；透過簡化的轉診流程，將能達到便利與整合健康照護目標。本專案的結果，應可供衛生政策制定者及醫院經營管理者，研擬更完善轉診流程之參考。

The purpose of patient referral is to provide appropriate medical services to patients by integration of medical resources rationally. The efficiency of a referral system is depending on the convenience of medical departments and the utilization of medical facilities. The waiting period would be an indicator to assess the quality of services. There were 118 cardiologic outpatients who needed interdisciplinary examination in our clinic from January to April in 2009 and only 107 patients had received referral service. The satisfaction of our referral service was only 2.23 points (out of 4 points score). The average waiting period of interdisciplinary examination of the referral cardiologic outpatients is 25 days which is higher than the waiting period of referral hospital (14 days). Moreover, we also found that 5 patients (4.7%) had symptoms of heart disease and need hospitalization urgently during waiting periods. Take into account the cardiology examination in time and early treatment for patients, this project used Flow Procedure Chart to simplify and integrate the cross-hospital referral process and developed the standard referral procedures, demonstrated as guidance leaflets with graphic version, and reinforced the training programs and monitoring system to shorten the waiting period of interdisciplinary examination for the referral cardiologic outpatients. The results revealed the waiting period reduced to 12 days and patient's satisfaction of referral service increased to 3.33 points. This finding indicated that an integrated and simplified process could shorten the waiting time of referral examinations and increases the patient's satisfaction. Through simplifying referral examinations process, a convenience and integrated healthcare service can be established. The result of our project could serve as a reference for policy makers or hospital management teams to establish more appropriated referral systems.