建構實證醫學為基準之醫院明智就醫運動──以外科手術為例

Evidence-Based Medicine as the Benchmark for the Choosing Wisely Campaign—Examples from the Field of Surgery

目的：明智就醫(Choosing Wisely)運動源自2012年由美國內科醫學基金會所發起，其精神為實證醫學導向、不重複的治療或檢查、避免傷害的以及對病人而言是真正需要的，個案醫院朝此方向努力邁進。
方法：針對2018-2020年DRG手術中之甲狀腺切除術和疝氣手術，透過組成跨領域團隊進行文獻探討與分析後，耳鼻喉頭頸部對於甲狀腺切除術後不放置引流管，一般外科則導入PERIO專案，設定指標，定期開會並檢視成果。
結果：耳鼻喉頭頸部接受甲狀腺切除術的病人，其平均住院天數下降1.7天(p =0.004)、總費用下降3,686元(p =0.019)；一般外科接受疝氣手術的病人，其檢查費下降689元(p =0.002)，已達統計上顯著差異。
結論：經各科討論後能發現各自之優缺點及可精進之處，可促進單位間橫向溝通平台，共同為病人接受最適照護持續努力。

Purpose：The Choosing Wisely (CW) campaign was initiated by the American Board of Internal Medicine (ABIM) Foundation in 2012. The spirit of CW involves the use of evidence-based medicine, non-repetitive treatments/tests, free-from-harm treatment, and truly necessary care. In the present study, the authors’hospital is dedicated to the implementation of the Choosing Wisely campaign.
Methods：We selected patients who underwent thyroidectomy and hernioplasty from 2018 and 2020. An interprofessional team was established to practice evidence-based medicine. Otolaryngologists (ENT) did not apply a drainage tube after thyroidectomy, and general surgeons (GS) applied the Perioperative Management Center (PERIO) protocol. The departments set goals and held regular meetings to discuss relevant metrics and review the outcomes.
Results：The length of stay decreased by 0.7 days (p =0.004) with a decrease in total cost of 3,686 New Taiwan Dollars (NTD) (p =0.019) for ENT thyroidectomy patients. The examination fee dropped by 689 NTD (p =0.002) in GS hernioplasty patients. There were significant differences in the relevant metrics, comparing before and after implementation of the new policy.
Conclusion：Following multidisciplinary discussions, physicians were able to benchmark their colleagues' performances and improve the healthcare process. We recommend this communication platform for healthcare providers to facilitate cooperation and enhance the quality of healthcare for surgical patients.