非計劃性再轉入冠狀動脈加護中心相關因素之探討

A Study of the Related Factors of Unplanned Readmission to the Coronary Care Unit

本研究主要目的是在探討冠狀動脈加護中心非計劃性再轉入率及其相關因素、再轉入相關因素與病患總住院天數及最後治療結果之關係。以立意取樣的方式，收集民國92年1月1日至92年10月31日非計劃性再轉入冠狀動脈加護中心之病患共38人，並以描述性分析、卡方檢定、t-檢定及線性迴歸來進行分析；結果顯示非計劃性再轉入率為2.4%，再轉入病患死亡率為57.9%，病患平均住院天數為59.8天；再轉入之診斷以心臟衰竭最多，非計劃性再轉入目的則以急救之後續照護最高；而病患自我照顧能力與病患治療結果及入院診斷在統計學上有顯著相關；住院醫師層級與再轉入診斷及再轉入間隔時間在統計學上有顯著相關；主治醫師親臨診治與再轉入間隔時間在統計學上亦有顯著相關；以再轉入之間隔時間亦可作為總住院天數之顯著預測因子。綜合以上之研究結果建議：一、醫護人員均應加強心臟衰竭病患臨床照護之專業知識與能力。二、假日轉出冠狀動脈加護中心(Coronary Care Unit,CCU)病患更應加強審慎評估其生理狀況與自我照顧能力。三、普通病房若有病房主任與亞急性觀察中心(Telemetric Unit)設立，則可延長再轉入間隔時間與縮短病患之總住院天數，同時亦可減少醫療資源耗費，降低病患再轉入加護中心之機率，使加護中心運用能發揮最大效益。

The purpose of this research was to study the related factors of unplanned readmission rate to the coronary care unit. The samples were the patients unplanned readmission rate to the coronary care unit from January 1st to October 31st in 2003. The methods of descriptive analysis ， χ2-test ， t-test, and linear regression were used to analyze all of the collected data. The results indicated that the unplanned readmission rate was 2.4 % , death rate 57.9%, and the average period of staying in hospital was 59.8 days. The major cause of unplanned readmission was heart exhaustion for the purpose of receiving post-emergency care. Patients' ability of self-care has a remarkable effect on the remedy result and admission diagnosis. The level of the visiting attendant had a c10se statistical relationship with the readmission diagnosis and the interval between readmissions. The in-person diagnosis of the doctors in charge also had a significant relationship with the interval between readmissions. The interval between readmissions was a notably predictable factor of the patients' total length of stay in the hospital. To sum up, is strongly suggested that the doctors and nurses working in CV general wards should enhance the knowledge of caring for the patients with congestive heart failure. Patients transferred out from the CCU during holidays should be more cautiously evaluated about their physiological status and self-care abilities. There should be a chief of the ward in the general cardiac unit, so as to prolong the duration of the patient readmitted to the CCU, total hospital days and decrease medical cost in order to lower the readmission rate at the coronary care unit. Consequently, the CCU of the medical resources can be used in the most efficient and economic way