骨科病人出院準備服務模式之建立

Discharge Planning Service for Orthopedic Patients

本研究目的在建立骨科住院病人出院準備服務模式，以病房資深護理師兼任個案管理師及病人之照顧護理人員共同參與執行出院準備服務。在研究期間所有住院滿三天以上的病人進行出院準備服務需求評估，在篩選表得分³7分者由個管師收案，並於出院後二週進行追蹤。研究結果如下：1.共篩選517位，篩選得分³7分被界定為高危險群者，共57位，佔11.0%，£6分460人為非高危險群。2.高危險群病人中有17位(29.8%)，非高危險群中有16位(3.5%)轉慢性醫院或安養中心，兩者間出院安置有顯著差異(c2=58.912,p=.000)。3.出院護理指導需求，高危險群平均10.63項(SD=1.14)，非高危險群平均9.98項(SD=1.33)，兩組有顯著差異(t=–3.513，p=.000)。4.高危險群出院後二週追蹤結果，80%以上的病人能遵從醫囑按時服藥、做復健以及遵循肢體特殊擺位之要求，有2人(3.5%)再住院，沒有人使用急診。研究結果可作為建立出院準備服務模式之參考。

The purpose of this study was to investigate the need for and the effectiveness of dischargeplanning for hospitalized orthopedic patients. All hospitalized orthopedic patients were listed aspotential study subjects. Needs assessment were performed at patients admission and three daysafter surgery. All discharge instructions were complete before discharge, and high-risk cases andtelephone follow-up were taken by the case managers. Results showed: (1)Of the 517 cases, 57(11.0%) were scored more than or equal to seven points and defined as〝high-risk population〞.460 were scored less than or equal to six points and defined as 〝non-high-risk population〞. (2)17(29.8%) of the high-risk population and 16(3.5%) of the non-high-risk population were transferredto chronic care hospitals or nursing homes. There was a significant difference(x2= 58.912,p=.000). (3)The mean number of discharge instruction for high-risk population was 10.63(SD=1.14) and 9.98(SD=1.33) for non-high-risk population. There was a significant difference(t =-3.513, p =.000). (4)Two weeks after discharge, more than 80% of patients took their medicationregularly, with rehabilitation exercises and safety precautions according to the recommendations.Two (3.5%) patients of them were readmitted and none required emergency care. Comprehensivedischarge planning is needed for orthopedic patients to provide continued and high-quality healthcare.