北部某醫學中心執行急症中醫針灸會診經驗分享

An Experience of Consultation for Acupuncture in the Emergency Department of a Medical Center in Northern Taiwan

衛生福利部健保署自107年度起通過「中醫急症處置試辦計畫」；本項計畫在實證基礎、中醫界共識及急診專科醫學會的指導下主要針對九大項適應症；希望藉由中醫介入處置，減輕急診壅塞，減少病人反覆進出急診或滯留於急診觀察區。本院於2019年1月正式開始承辦中醫急症處置計畫，本文即是將目前收案狀況及作業流程做一介紹。從收案結果來看，以眩暈、急腹症和軟組織疼痛為前三主要的收案族群，而癌症疼痛、骨骼關節痛症、經痛三種適應症皆無收案患者。作業流程建議以中醫師主動搜尋有無合適之會診患者，再和急診醫師討論是否接受治療；以檢傷分級3-5級的患者為主要的收案對象；且中醫相關醫護人員完成所有輔助醫療行為（含針灸後起針及棄針），避免急診護理人員作業流程不熟悉造成中醫相關處置的醫療風險。此外，規劃住院醫師至急診單位接受專科受訓增強雙方交流，熟悉急診常見疾病或症狀的認識，從而提供相關有效的中醫輔助醫療，也讓急診單位更加了解和熟悉中醫。

The Health Insurance Department of the Ministry of Health and Welfare has passed the "Traditional Chinese Medicine Emergency Treatment Pilot Program" since 2018. This program is mainly targeted at nine major indications under the guidance of empirical foundation, consensus of the Chinese medical community, and the Emergency Specialist Medical Association. The purpose of this plan is reducing the congestion in the emergency department and readmission rate by using TCM strategy. Our hospital formally started a TCM emergency treatment plan in January 2019. This article is mainly focus on introducing the standard operating procedure and case collection situation. According to the result, dizziness, acute abdominal syndrome and soft tissue pain were the three mainly recruited types. Patients with cancer pain, skeletal and joint pain, and dysmenorrhea were not included in our study. Our operation procedure suggests that the Chinese physician should actively search for suitable patients for consultation, and then discuss with the emergency physician whether to receive acupuncture treatment; patients with triaged grades 3-5 are the main targets; the members of the TCM department complete the needle removal and needle abandonment actions to avoid the medical risks of acupuncture caused by unfamiliar operation procedures. In addition, arranging TCM residents to go to the emergency unit to receive ER specialist training to enhance communication between the two departments and improve the knowledge of emergency medicine. Moreover, facilitating the collaboration between ER and TCM department.