急性精神病患重覆住院改善方案

An Improvement Project to Reduce Re-admission of Acute Psychiatric Patients

本專案旨在降低出院精神病患重覆住院率，經統計本病房自89年11月至90年4月出院病患半年內重覆住院率為27.6%，分析再入院原因依序為未持續門診追蹤治療、私自停藥或未按時服藥、生活作息不規則、家屬支持等問題，在未持續門診追蹤治療方面，經調查90年4月至7月出院病患門診返診狀況，發現有20%未返診，其中有38.9%的病患於半年內再住院，故成立專案小組，針對高雄縣、市出院精神病患進行電話訪談服務，目的為提昇門診返診率，降低重覆住院率，進而減少醫療資源浪費。90年10月20日開始執行電話訪談服務，實施半年後成效評值結果顯示：出院病患重覆住院率由執行前的27.6%降至10.3%，共節省54人(86－32人)的醫療費用3,312,414元(63%)。返診率亦由80.2%提昇至94.4%。從上述結果顯示本專案的推行確實能改善出院病患重覆住院問題，也能減少醫療資源浪費，故本方案值得繼續推展，並期望未來能針對全部出院病患進行電話訪談服務，以服務及造福更多病患。

This project was implemented to reduce the hospital readmissions of the psychiatric patients. During November 2000 to April 2001, the readmission rate of our psychiatric ward was 27.6%. The major causes were loss of follow-up at the outpatient department (OPD), self-discontinuation or non-compliance to the medications, irregular living habit and lack of family support etc. After we examined all the psychiatric outpatient records among April to July 2001, twenty percent of them did not come back to visit. Moreover, a total of 38.9% of them needed rehospitalization. Thus, we developed a project team to improve the OPD follow-ups, reduce the rehospitalizations and optimize the medical resources through telephone interviews to the psychotics living in the Kaohsiung city and Kaohsiung county. Beginning from 20th of September 2001, our result showed the rehospitalization rates was reduced from 27.6% to 10.3% within half a year. The hospital expenditures also decreased from NT$ 3,312,414 dollars of 54 patients resulted from a 63% reductions. The patient visits increased from 80.2% to 94.4% at the psychotic outpatient department. In conclusion, our result obviously demonstrated an improvement to the readmission rate and optimization of the medical resources. It is worthy to provide a routine telephone interviews for the benefits of all the discharged psychiatric patient in the future.