急診急救室合理護理人力分配模式之建立

Establishing the Foundation of Attended Manpower for Emergency First Aid Rooms

急診急救室是處理檢傷分類一級的場所，因病患人數的不確定性及疾病嚴重程度之複雜度高，常造成管理者在護理人力分配上的困擾，故本研究目的在建立南部某醫學中心急救室合理護理人力分配之模式。資料收集自93年11月29日至94年06月20日止共18天，每天分48個時段(30分鐘為一時段)進行資料收集，由4位護理人員採立意選取對象觀察，訂定合理護理人力觀察項目有急救室病患人數、診斷、疾病嚴重程度，及三班護理人員在病患及家屬無抱怨下，能完成護理記錄、措施及醫囑的執行。結果顯示：合理可行之護理人員數以白班三人、小夜班三人及大夜班二人的人力安排；其適用範圍係在病患11人(含)以下、病情嚴重度於APACHEⅡ Score小於15分或TISS-76 Score評分在二級以下等情況，所謂合理可行之護理人力即在前述條件下，未觀察到病患及家屬的抱怨，且護理人員能完成各項護理措施及醫囑的執行；惟若病患人數12人以上，且疾病嚴重度APACHE Ⅱ Score其中有61.3%大於15分或有大於12.3％的病患TISS-76 score評分在三級以上時，每時段(30分鐘為一時段)應增派一位護理人員支援。根據該結果，建議樣本醫院未來可依照此研究結果作為人力的調派及運用。

The emergency room is where 1st categorized wounds are dealt and examined. Therefore,large numbers of doctor and nurses are required to save patient's lives. However, the uncertaintyof the number of patients and the complex severity of diseases often causes the administrator indistributing manpower. This research aimed to build up a model that can properly distribute theattended manpower in a hospital in Taiwan. A data was set with the gathering process duringNovember 29, 2004 to June 20, 2005, 18 days in total. With 4 nursing members observing in theemergency room gathering information 48 periods a day (each period was 30 minutes long) forconditions attended manpower were set as follows: the number of patients, the diagnose, diseaseseverity of first aid room patients, the completion of nursing records, procedures, and doctor'sorders all every circumstances of no complaints from patients relative's in three nursing shifts. Asa result, 86% the requirement have met with each shift 3 to 11 patients. However, if the number ofpatients reached above 12, with APACHEⅡScore degree above 15, greater than 61.3%, or TISS-76 Score measures Class 3rd to Class 4th more than 12.3%, the administrator may send one morenurse to help in the first aid room. Therefore, according to this conclusion, we advise the samplehospital to set the result of this research as an example in how to properly distribute and make useof attended manpower.