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研究生:吳昌騰
研究生(外文):Chang-Teng Wu
論文名稱:運用跨團隊模式改善小兒急診72小時內非計畫性返診後之住院率
論文名稱(外文):The use of a cross-team model for children admitted to the hospital after an unscheduled return to the Pediatric Emergency Department with 72 hours
指導教授:杜裕康杜裕康引用關係
指導教授(外文):Yu-Kang Tu
口試委員:方啟泰邱政洵
口試委員(外文):Chi-Tai FangCheng-Hsun Chiu
口試日期:2014-07-10
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:公共衛生碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:77
中文關鍵詞:醫療品質指標小兒急診非計畫性急診返診衛教跨團隊模式
外文關鍵詞:Unscheduled Return VisitPediatric Emergency DepartmentEducation
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急診醫療品質的提升一直是急診工作同仁努力的目標,小兒科急診72 小時內非計畫性返診及返診後住院的問題,一直是關心急診醫療品質及費用的學者研究的議題。這些非計畫性返診急診的病童,有可能是一群未完成持續性治療,或是有潛在醫療糾紛,或是醫療資源浪費的高危險性病童,我們不可否認衛教對病人整體健康的重要性,但是病人家屬的出院衛教一直是急診醫療很脆弱的一環。本研究希望在小兒急診推行運用跨團隊衛教模式來改善小兒急診72小時內非計畫性返診率及返診後之住院率,並進行探討造成急診病患非計劃性返診的因素及臨床特性。
分析結果發現,研究三個月期間小兒急診72小時內非計畫性返診人數共459人,返診率分別3.8%、3.96%、4.98%,返診後之住院率分別為48%、53%、43.6%,跨團隊衛教模式對於改善小兒急診72小時內非計畫性返診後之住院率,實施前後住院率並無統計學上明顯差異;在「年齡」、「返診原因」、「性別因素」、「檢傷級數」、「就診時段」 這些影響急診返診主要因素中;「年齡」中,初次就診平均年齡,有逐漸下降之趨勢,有統計上的顯著差異。年齡小病童返診占多數,「返診原因」中發生返診機率「症狀未改善」較高;在「性別」中,男性病童返診占多數,在「看診班別」中,「白班」返診後之住院率明顯高於其他班別,但在統計學上並無明顯差異;在「檢傷級數」中,第三級與第四級發生返診機率明顯較高,有統計學上明顯差異。
結論: 跨團隊衛教模式對於改善小兒急診72小時內非計畫性返診後之住院率,實施前後住院率並無統計學上明顯差異


Background:
Return visits to the Pediatric Emergency Department (PED) that require admission are frequently reviewed for quality improvement purposes. Patient return could arise from a potential deficiency in the medical advice and/or education provided during the initial visit. Therefore, although the treating team typically educates the patient, it is unclear whether they accurately identify the reason for the patient’s return.
Objectives:
To assess the characteristics of pediatric return visits to the PED as well as the ability of a cross-team education model to lower the rate of return visit admissions.
Methods:
We used a cross-team educational model in children who visited the PED over a 3-month period. This study reviewed all returns that occurred within 72 h of the initial visit to a tertiary care PED. Clinical characteristics were collected and analyzed by reviewing patient charts in a computer. The cause of the return was identified, and the number of children admitted to the hospital during a return visit to the PED with 72 h of the initial visit was evaluated.
Results:
A total of 459 patients returned to the PED within 72 h of their initial admission. The revisit rates were 3.8, 3.96, and 4.98% in months 1, 2, and 3, respectively. The rates of admission during the return visit were 48, 53, and 43.6% respectively. The rate hospital admission after a return visits to the PED within 72 h was unaffected by the cross-team education model. The mean patient age during the initial visit was 4.82 years, and the mean age at return was 4.31 years. The prevalence of unscheduled revisits within 72 h was highest in male and younger patients. The most common reason for revisit was that the clinical symptoms remained. The most common diagnosis was fever. The occurrence of a first visit during the daytime shift increased the probability of a return visit. The admission rate after revisit was not related to gender, age, triage level, the time of the first visit, or diagnosis.
Conclusion:
The rate hospital admission after a return visits to the PED within 72 h was unaffected by the cross-team education model.


口試委員審定書 2
誌謝 3
中文摘要 4
Abstract 5
目錄 7
表目錄 9
圖目錄 10
第一章 1.導論 11
1.1 實習單位特色與簡介 11
1.2 研究背景 13
1.3 研究重要性 16
1.4 研究目的 17
1.5 研究範圍 17
第二章 2.文獻探討 19
2.1 急診定義 19
2.2 小兒急診 20
2.3 小兒檢傷分類 21
2.4 小兒急診醫學品質指標 23
2.4.1 醫療品質的定義 23
2.4.2 急診醫療品質指標 24
2.5 小兒急診再回診之相關因素 27
2.6 醫療建議及對病人的衛教 29
第三章 3.研究方法 31
3.1 研究設計 31
3.1.1 研究架構 31
3.1.2 研究工具 33
3.1.3 研究假設 35
3.2 研究樣本與資料期間 36
3.3 統計方法(Data Analysis) 37
3.3.1 資料之敘述統計 37
3.3.2 資料處理與分析方法 37
第四章 4.研究結果 38
4.1 敘述性統計量與檢定 38
4.2 返診個案基本資料 38
4.3 返診個案就診情形 42
第五章 討論 49
第六章 結論 55
參考文獻 56

圖目錄
圖1 62
圖2 63
圖3 64
圖4 65
圖5 66
圖6 67
圖7 68
圖10 69
表目錄
表1 71
表2 73
表3 74
表4 75
表5 76
表6 77




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