降低剖腹探查手術病人平均住院天數之策略

Strategies to Reduce the Duration of Hospitalization of Laparotomy Patients

及早進行出院準備可讓病人順利返家或到照護機構，減少不必要醫療支出，本單位2018年剖腹探查手術病人平均住院天數較2017年增加三天，分析原因為病人或照顧者居家照護正確性僅75.5%、手術後三天內首次下床僅13.3%、每日進食熱量未能符合病人基本所需、醫師臨時告知可出院但家屬未準備好要求延遲出院、可出院時家屬決定至照護機構需照會轉介。改善措施包含建立出院標準及系統提示出院預告、修訂出院準備評估作業、製作居家照護衛教影音檔及QR Code、建立活動計畫表、增設起身輔助工具、建立剖腹探查手術病人食譜。經改善後平均住院天數由13.5天降低至10.3天，足見方案有效，期望本專案成效能提供同儕醫院參考。

Early preparations for discharge can allow patients to return home or go to care institutions smoothly, reducing unnecessary medical expenses. In 2018, the average duration of hospitalization for patients undergoing laparotomy was three days longer than that of 2017. The reasons were as the follows: the patient or caregiver was only 75.5% correct in home care, only 13.3% got out of bed for the first time in three days after surgery, and the daily calorie intake failed to meet the patients’ need, the family members were not ready to an unplanned discharge, and preparation to discharged to the care institution. Improvements includes the establishment of discharge standards and system prompts for discharge notice, revision of discharge preparation procedure, production of home care and education video files and QR Code, establishment of activity plan, addition tools for getting out of bed, establishment of laparotomy surgery patient recipes. The average duration of hospitalization was reduced from 13.5 days to 10.3 days. The effectiveness of this project can provide hospitals for reference.