改善病人轉診流程以推動急診病人分流

Promoting Patient Diversion in Emergency Room through Improving Referral Procedure

急診病人多且暫留天數長，及疾病型態複雜化，導致病人無法充分的休息，及不良的治療環境，其對急診滿意度降低。調查本院急診病人對於整體負面評語有：住院病床難等，暫留區擁擠及環境吵雜無法休息等。因以上因素引發推廣分流轉診制度及流程，以改善病人滿意度。透過與市立聯合醫院合作，藉由醫病共享決策，減少暫留的時間，病人能直接入住病房，接受良好照護。決策矩陣分析後，擬定方案：（1）由專員協助轉診；（2）海報及影片製作宣導；（3）制定SDM決策輔助工具；（4）制定轉診流程並標準化；（5）跨院區合作；（6）制定輕症定義：（7）納入外包救護車廠商。轉診滿意度前測54分，解決方案介入後，2020年3-8月滿意度91.85分，且92.3%病人表示轉診對病人有幫助，92%病人認為可持續推行。透過跨院區合作，從宣導到標準流程建立，提升轉診成效以達成目標。建議以後持續此模式，拓展到雙北其他院際間之合作，提升病人照護品質。

Emergency room (ER) overcrowding and prolonged length of stay in ER have resulted in a noisy and less satisfactory environment for ER patients, and therefore a decline in patients' satisfaction. We have investigated the most frequent negative comments toward an emergency department of a tertiary medical care center in Taipei, Taiwan and are as the follows: prolonged ER stay before admission, crowdedness and noisiness in ER, etc. In order to reduce the waiting time in ER, we establish a program of patient diversion and referral to help improve patients' satisfaction. We aim to reduce the length of ER stay by a patient transfer program in cooperation with Taipei City Hospital. Patients are transferred directly towards Taipei City Hospital to receive well medical care if shared decisions are made. After the analysis of the selection matrix, we performed the following interventions:(1) a coordinator in charge of the referral and transfer process;(2) posters and videos to promote transfer;(3) tools to help with shared decision making (SDM);(4) establishing transfer protocol and standardization;(5) inter-hospital network and cooperation program;(6) definition of minor and less complex diseases that could be managed in local hospitals;(7) outsourcing for patient transportation. The intervention was conducted from March to August in 2020. The pre-test satisfaction score was 54 points and was raised to 91.85 points after the intervention. A total of 92.3% of patients were satisfied with and positive about the program and 92% of patients believed that the program is sustainable. The program has successfully and effectively simplified the transfer process and improved patients' satisfaction. To expand the hospital network in both Taipei and New Taipei City can be the next goal to promote quality of medical care.