南臺灣某醫學中心急診COVID-19疫情前後之醫品指標分析

Analysis of the medical care quality of COVID-19 Pandemic in the Emergency Department of a Medical Center in Southern Taiwan

目的：透過急診病人流與醫品指標結合，探討本院急診COVID-19疫情前後醫品指標分析。
方法：本研究為回溯性研究，藉由急診檢傷資料庫及臺灣醫療品質指標系統，利用描述性統計、獨立樣本及卡方檢定統計分析探討急診病人醫品指標的變化。
結果：急診檢傷人次及入院方式是由親人帶來就診人次的比較，疫情中較疫情前分別降低16.2%及4.9%，檢傷5級就診人次增加，但受到COVID-19傳播途徑影響，2020年與2019年相比，小兒科（8537人次vs 14495人次）及牙科（861人次vs 1139人次）看診人次明顯減少。就診後住院、自動出院及急診滯留小於24小時較疫情前提高，且都達顯著差異，疫中會診超過30分鐘率則低於疫前。在疫情期間急診重大疾病病人照護指標之變化，只有急性腦中風病人於60分鐘內施打血栓溶解劑且完成取栓個案之完成率53.8%低於疫前62.5%。
結論：本文分享南台灣某醫學中心急診在因應COVID-19之感染管制與防疫管理之下，透過病人流分析在疫情期間急診重大疾病病人照護指標只有急性腦中風病人小於60分鐘內施打血栓溶解劑且完成取栓個案之完成率降低，疫情期間會診時間反而縮短且未出現急診壅塞現象，顯示未受到疫情影響，期望能提供他院醫療品質管理及其他新興傳染病防治之參考。

Purpose：An analysis of the medical quality indicators before and after COVID-19 pandemic using the combined data of Medical Quality Indicators with the number of emergency patients.
Methods：A retrospective study, using descriptive statistics, independent samples and Chi Square Statistics to analyze the effect on the medical quality indicators for emergency patients. The study is based on the emergency department triage database and the Medical Quality Management System of Taiwan.
Results：Comparing the number of patients who were admitted to the inpatient wards before and during the pandemic, the patients admitted through emergency triage decreased by 16.2% and the patients admitted through outpatient department accompanied by their relatives dropped by 4.9%. There is an increased number of triage level 5 patients. Due to the COVID-19 transmission passage, comparing 2019 and 2020, the number of outpatient appointments in Pediatric and Dental departments have significantly decreased from 14,495 to 8,537 (Pediatric) and 1,139 to 861 (Dental). The numbers on inpatient admission self-discharge and over 24 hours remaining in the emergency room increased significantly compared with pre-pandemic period. The time spent on each outpatient appointment also decreased to less than 30 minutes.
During the pandemic, the only change in critical emergency care indicator was the percentage of patients with acute stroke receiving treatments (Thrombolytic injection and thrombus removal) within 60 minutes dropped from 62.5% to 53.8%.
Conclusion：This article aims to share the COVID-19 pandemic control experience in a medical center in southern Taiwan. After analyzing the combined data of critical emergency medical quality indicators with the number of emergency patients. The result indicates that the COVID-19 pandemic has not affected the medical care quality. The negative effect is only on the acute stroke patients receiving treatment within 60 minutes. In fact, there is a positive effect on shortened outpatient appointment time with a good flow of emergency patients seen by the medical team.