臺灣博碩士論文加值系統

研究背景：美國醫療保健改善研究所（Institute for healthcare improvement, IHI） 於2006年為改善住院病人照
護品質，提出醫院快速反應系統（Rapid Response System，RRS）。過去文獻對於醫院快速反應系統的介
入，對住院病人非計畫性入住加護病房比率、住院天數、及出院後再住院情形結果影響不一致。另外，研究指
出醫院快速反應系統的介入或許可增加病人簽立不施行心肺復甦術同意書及接受安寧緩和照護的比例，但仍缺
少相關實證數值佐證。
研究目的：本研究旨在探討醫院快速反應系統介入對於住院病人醫療處置與照護決策之影響。
研究方法：採觀察型研究法，以病歷回溯方式進行研究。於宜蘭某區域教學醫院，實施醫院快速反應系統之內科病房，進
行資料收集；收集期間為2012年1月1日至2017年2月9日。以2012年1月1日至2014年2月9日未實施醫院快速反
應系統前資料當作對照，分析2014年2月10日至2017年2月9日期間啟動醫院快速反應系統後，住院病人醫療處
置與照護決策之影響。以百分比、平均數及標準差之描述性統計分析基本屬性之分佈（年齡、性別、疾病嚴重
程度）；獨立樣本t 檢定、卡方檢定、以及曼-惠特尼U 檢驗(Mann–Whitney U test)檢定醫院快速反應系統
介入後對住院病人醫療處置及照護決策之影響。
研究結果：醫院快速反應系統相較於傳統醫院急救小組，能更早監測病人危急狀況，增進病人安全及提升醫療照護品質；
並且能夠提早預警住院病人惡化之情形，降低院內死亡率。對住院病人的醫療處置影響為，降低入住加護病房
比率、增加加護病房住院天數、降低加護病房內死亡比率、增加總住院天數、增加病人存活出院率以及病人出
院後14天再入院率為16.2%；對住院病人的照護決策影響為改善接受安寧緩和照護比率。此研究結果可作為臨
床照護與病人及家屬不同照護決策的選擇參考。

Abstract
Background: Institute for healthcare improvement (IHI) proposed the Rapid Response System (RRS)
in order to improve the quality of medical-treatment about inpatients in 2006. The
past studies about the intervention of RRS are inconsistent, including improving
inpatients transferring into ICU, lowering inpatient days, and reducing readmission.
Besides, the study showed that maybe the intervention of RRS can increase the rate of
signing the Do Not Resuscitate, accepting palliative care and hospice care. But it
still lacked for related empirical data analysis.
Purpose : The purpose of the study was to explore the effects on decision-making and medical-
treatment about inpatients with rapid-response system (RRS) intervention.
Methods : We explored the effects by using observation study by backtracking of medical history.
The samples were selected from the medical wards with rapid-response system. Data
were collected in a regional teaching hospital in Yi-lan from January 1st, 2012 to
February 9th, 2017. Patients without RRS from January 1st, 2012 to February 9th, 2014
were selected to be case study group, and the ones with RRS intervention from
February 10th, 2014 to February 9th, 2017 were participants of the contrast samples.
Percentage, mean, and standard deviation were used to analyze age, gender, and the
CCI index. T-test, Chi-square test, and Mann-Whitney U test were used to know the
effects on decision-making care and medical-treatment about inpatients with RRS
intervention.
Results: In contrast to traditional emergency group, the Rapid Response System (RRS) can monitor
patients’ endanger situation earlier, increase patients’ safety and improve medical
treatment quality. RRS can alarm inpatients’ worsen situation in advanced time, and
decrease the death rate in Intensive Care Unit (ICU). RRS effects of patients’
medical treatment are decreasing the hospitalizing rate in ICU, increasing inpatients
days in ICU, decreasing the death rate in ICU, and increasing total hospitalizing
days and survival to discharged rate. After intervention of RRS, the 14-day
readmission rate of patients is 16.2%. On the other side about inpatients’ care
decision-making, the effect of RRS is to improve the rate of accepting palliate care.
The result of this research can be the reference for the different care decision-
making among clinical care, patients and family members.

目 錄
碩士學位論文審定書
致 謝 I
中文摘要 II
ABSTRACT III
目 錄 V
圖目錄 VII
表目錄 VIII

第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 2
第三節 研究假設 3
第二章 文獻探討 4
第一節 醫院快速反應系統（RAPID RESPONSE SYSTEM, RRS）之介紹 4
第二節 醫院快速反應系統介入對住院病人醫療照護之影響 6
第三節 醫院快速反應系統介入對住院病人照護決策之影響 22
第四節 文獻總結 29
第三章 研究設計與方法 31
第一節 研究設計與架構 31
第二節 研究對象 33
第三節 資料來源與研究流程 35
第四節 研究變項與操作型定義 36
第五節 資料收集方法 40
第六節 統計分析方法 42
第七節 研究對象與權益的保護 43
第四章 研究結果 44
第一節 基本資料及特性之分佈與差異性 44
第二節 二組生理指標監測資料及比較 45
第三節 醫療處置之之分布情形與差異性 47
第四節 照護決策之分布情形與差異性 49
第五節 研究假設檢定 50
第五章 討論 57
第一節 住院病人的醫療處置，受醫院快速反應系統介入的變化 57
第二節 住院病人的照護決策，受醫院快速反應介入的變化 59
第六章 結論與建議 62
第一節 結論 62
第二節 對臨床護理之運用及建議 63
第三節 本研究限制與展望 64
參考文獻 66
中文文獻 66
英文文獻 68
附錄一 啟動院內快速反應系統通報單 72
附錄二 急救小組紀錄單 74
附錄三 國立陽明大學附設醫院研究倫理委員會證明 75
 

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