內科呼吸衰竭病人氣管內插管留置時間改善專案

Respiratory Failure Patients in a Medical Intensive Care Unit

本專案主要目的是透過制定明確呼吸器脫離流程及評估表，由醫護人員及呼吸治療科人員共同參與評估，使醫療團隊對呼吸器脫離方法有所共識及遵循，藉以縮短內科呼吸衰竭病人氣管內插管留置時間。本單位為綜合呼吸加護病房，專案前未有明確之呼吸器脫離計劃，醫護團隊欠缺一致的作法，決策由主治醫師決定，易形成個人偏見，延遲脫離時有所見。本專案醫護團隊依據國外文獻，參考Burns’weanassessment program(BWAP)來訂定本院的「內科呼吸衰竭病人呼吸器脫離評估表」及呼吸器脫離流程，經施行結果：氣管內插管留置時間由改善前的14.85天降至改善後11.53天縮短3.32天；住加護病房天數由改善前平均17.58天降至13.23天減少4.35天；健保醫療費由改善前每人105,480元降至改善後79,380元,每人可節省26,100元醫療費用支出。

The main purpose of this program is to develop a weaning protocol and an evaluation formthat are standard and clear enough for medical team members to follow. Use of the protocol canreduce the weaning time for patients receiving mechanical ventilation. Before the weaningassessment program, the doctor's decision of whether to perform extubation or not might delay thetiming of extubation. After the program, the extubation was decided by a team, which offered earlyextubation for the medical respiratory failure patients. The results were: First, the weaning timewas 3.32 days shorter than the average 14.85 days. Second, the day of staying in the MICU was4.35 days shorter than the average 17.58 days. Third, the cost was fromNT$105,480 toNT$79,380per person, saving NT$26,100/person at least.