住院病人出院後三日內再急診之相關因素探討－－以東部某區域醫院為例

A study of patients' returning visits to emergency department within three days after hospitalization- a regional hospital in eastern Taiwan.

病人經住院診療病情穩定或康復，由醫療照護團隊與主治醫師認定後，可出院或轉介其他機構療養，但其中有部分的病人卻在短時間內，再回到醫療院所尋求治療，若是在病況不穩定下出院，很可能發生非計畫性重返急診或再住院。不僅會增加急診醫療資源耗用、醫療成本，以及醫療糾紛的產生與可能衍生的法律問題。方法：本研究利用個案醫院2010年至2015年病人就醫資料檔，並排除出院科別為精神科、護理之家以及資料欄位不完整後，選定出院後三日內再急診之病人次共計3,375筆為本研究對象，並以SPSS22.0統計軟體進行描述性統計及推論性統計。以期望了解三日內至急診就醫比率、病人特性、疾病別，以及影響病人再次急診之相關因素。結果與結論：在本研究對象出院後三日內再急診之3,375病人次，其中83.6%為不同診斷急診，性別以男性最多，有高達90%以上醫療團隊判定改門診追蹤治療即可。年齡「＞65歲以上」最多且平均住院天數也最高，出院科別以胸腔內科、外科占率最高。另根據研究資料分析，年齡「≧18~65歲」、具有重大傷病身份註記，出院後三日內因相同診斷再急診的風險較高。本研究結果推論：男性、具有重大傷病身分註記、年齡越高，其出院後三日內容易因相同診斷再急診。

Objective: A patient who has stabilized or recovered after inpatient treatment may be discharged from the hospital or transferred to another institution through referral as deemed by the medical care team and the attending physician. However, some patients may soon need to be returned to their medical institution for treatment. If patients in an unstable condition are discharged, unplanned return visits to emergency departments or re-hospitalization may likely take place, not only resulting in increased emergency medical resource consumption and medical costs, but also giving rise to medical disputes and possible legal issues. Methods: The patient hospital data files from 2010 to 2015 were adopted in this study. After excluding the Division of Psychiatry, nursing homes and incomplete data columns, the patients who made return visits to emergency departments within three days after discharge totaled 3,375 and were included as the research participants. SPSS 22.0 statistical software was used to carry out descriptive statistics and inferential statistics in order to gain an insight into the ratio of return visits to emergency departments within three days, patient characteristics, types of illness and related factors affecting patients' return visits to emergency departments within three days. Reaults and conclusion：Among the 3,375 patients (research participants) who made return visits to emergency departments within three days after discharge, 83.6% belonged to different diagnosis categories, and the males comprised the majority. More than 90% of the patients were deemed by the medical team to require only outpatient clinic tracking treatment. The patients aged above 65 comprised the majority, with the highest number of hospitalization days. Among the divisions from which the patients were discharged, the thoracic internal medicine and surgery comprised the highest percentage. In addition, according to the research data analysis, those aged ≧18~65 years old who were marked with catastrophic illness status were at a higher risk of making return visits to emergency departments within three days after discharge from the same diagnosis category. Results and Inferences: Male patients, patients with catastrophic illness status, and older patients were likely to make return visits to emergency departments within three days after discharge in the same diagnosis category.