長照機構住民急診就診原因及動向之初探-以中部某醫學中心急診部為例

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Title:	長照機構住民急診就診原因及動向之初探-以中部某醫學中心急診部為例 Reasons and Dispositions of Emergency Department Visits by Long-Term Care Residents : A Survey in a Medical Center Emergency Department of Central Taiwan
Authors:	廖彩鈺;Tsai-Yu Liao
Contributors:	醫務管理學系碩士在職專班
Keywords:	長期照護機構之住民;急診就診;動向;Long-term care residents;Emergency
Date:	2015-07-17
Issue Date:	2015-11-04 17:05:18 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	背景：由於人口老化所帶來的失能問題及家庭結構改變，造成許多失能的老年人難以居家受到完善照顧，因此長期照護需求快速增加，長期照護機構之照護品質，逐漸受到重視，維護長照機構住民之健康，了解其非必要急診就診已為首要任務。急診醫療在住民健康照顧上扮演著重要角色，由於住民皆以老年人居多且經常有多種合併症、複雜的醫療史，認知障礙、失智或重大疾病等造成生理功能受限，對於其無法預料的疾病或傷害，急診提供了緊急醫療及住院管道，但非必要的急診使用或誤用，是導致急診壅塞的原因之一，也造成需要緊急醫療病人無法即時得到適當照護，本研究將初步探討住民至醫學中心急診就診之原因及其動向。目的：探討長照機構住民急診就診原因及其動向。方法：以中部某醫學中心急診部2010年1月1日至2013年12月31日急診就診資料進行回溯分析，納入研究對象的條件為長照機構住民。使用SPSS統計套裝軟體進行分析，統計方法採用卡方檢定及多變數羅吉斯迴歸模組。結果：急診就診為1091人次，男性占53.4%，65歲以上占84.5%，收案期間3次以上重覆急診就診占31.6%，檢傷分級1級及2級(復甦急救與危急)共占82.9%，主訴以呼吸問題最多占44.4%，住院占70.3%、急診死亡占2.2%、病危離院占1.4%。使用多變數羅吉斯迴歸分析發現檢傷1級發生住院/急診死亡的風險是檢傷4級的5.9倍(95% 信賴區間 1.3-26.2)，意識狀態(GCS)9-12分發生住院/急診死亡的風險是13-15分的1.6倍(95%信賴區間1.0-2.6)，有3項非外傷主訴發生住院/急診死亡的風險是無非外傷主訴的4.7倍(95%信賴區間1.5-14.5)。結論：研究發現住民急診就診原因以呼吸問題最常見，就診後住院/急診死亡的比率高達73.9%。本研究顯示長照機構住民轉醫學中心急診就診是具有其需要性。 Objective: The purpose of this study is to explore the causes and adequacy of the long-term care institution residents who visit emergency department of the medical center. Background: The demands of long term care are increase rapidly due to dysfunction of aging population and changing family structure. To maintain the health of residents of long-term care institution (residents), learning unnecessary emergency department visit has been the primary task. Emergency department providing urgent medical treatment and hospitalized for those unpredictable illnesses and injuries of residents. However, unnecessary visits or misuses of emergency department may result in immediate need of emergency medical patients cannot get proper care. The purpose of this study is to explore the causes and adequacy of the residents who visit emergency department of the medical center. Methods: Utilizing the data of emergency department of a medical center in the middle Taiwan, from 1/1/2010 to 12/31/2013. Condition that included in the analysis object is being resident of long-term care institution. We analyze the data with SPSS statistics package software, our statistics methods are chi-square test and logical regression. Results: There are 1091 residents attended to emergency department, 53.4% of them were men, over 65 year-old accounted for 84.5%, more than three times to repeat emergency department visits accounted for 31.6%, triage grade 1 and grade 2 (resuscitation and critical) together accounting for 82.9%, the most complained of respiratory problems accounted for 44.4%, accounting for 70.3% of hospitalization, emergency department deaths accounted for 2.2%, 1.4% leave the hospital in critical condition. Using logistic regression analysis showed that the risk of hospitalization for triage occurs four 5.9 times (95% CI 1.3-26.2), consciousness (GCS) GCS score 9-12 occurs rick of hospitalization is 1.6 times than score 13-15 (95% CI 1.0-2.6), and patient who with three non-trauma complaints occurs the risk of hospitalization is 4.7 times (95% CI 1.5-14.5) than who have trauma complain. Conclusion: The study found a high rate of residents turn hospitalized after emergency treatment (including emergency death), the most common cause is respiratory problems. This study shows that resident who arrives the emergency department of medical center has ones appropriateness.
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