| Abstract: | 隨著全民健保實施增加民眾就醫的可近性，72 小時內非計畫性返診的急診病患，是一群有潛在醫療風險和醫療糾紛的高危險性病患，亦會增加醫療費用支出，耗費人力及醫療資源。本研究將運用年齡、性別、第一次留觀期間、主診斷個數、次主診斷個數、兩次就醫主診斷一樣、檢傷級數、白班、小夜、出院指導不足等類別變項進行分析， 以中部某醫學中心急診室於2013年1月1日至2013年2月28日、2013年11月1日至2013年12月31日期間，非創傷性急診病人72小時重返急診個案為資料採描述性統計與對應分析方式討論二變數間相對關係,結果顯示:二次就醫主診斷不同者留觀期間較長、返診的個數白班多於小夜多於大夜、年齡越大的病人72小時返診時間較長、白班病人72小時返診時間較大夜長、前次住急診時間較久72小時返診時間較長、腸胃科、新陳代謝科、內科急診返診時間較短、腎臟病科返診時間較長、檢傷級數較低者72小時返診時間較長、病人有癌症、慢性病、重大傷病與返診時間無相關性、返診的年齡層以65歲以上為最多、重返原因最多前三項分別為:原以控制之急性症狀復發(46.4%)、新問題(35.8%)、個人因素(10.6%)，血液腫瘤科病人三班返診機率高，年資為1-6年、能力進階為N0、N1、N2之護理人員於病人返診出院時執行個別性衛教之相關性較高。
With the increasing accessibility of the public seeking for medical advices under the current National Health Insurance system, the unscheduled return patients visiting emergency department (ED) within 72 hours of discharge is a group of patients at high risks of potential medical risks and disputes that will increase medical expenses, consuming labor and medical resources as well.In this study, we used descriptive statistics and correspondence analysis to analyze the non-traumatic unscheduled return patients visiting ED within 72 hours of discharge in the ED of a medical center at middle Taiwan during January 1, 2013 to February 28, 2013 and November 1, 2013 to December 31, 2013 by some variables, such as age, sex, the duration of observation at ED on the previous visit, the numbers of primary diagnoses, the numbers of secondary diagnoses, same primary diagnoses between two visits, the grading at triage, day/night/graveyard shifts, insufficient instructions of discharge, etc. and to discuss the relation between each two variables. The results revealed longer duration of observation at ED with different primary diagnoses between two visits, the numbers of return visits: day shifts > night shifts > graveyard shifts; longer period of return within 72 hours of discharge in patients with (1) older age, (2) longer duration of observation at ED on the previous visit, (3) discharge during day shifts > night shifts > graveyard shifts, (4) lower grading at triage, and (5) primary diagnoses categorized as nephrology; shorter period of return within 72 hours of discharge in patients with primary diagnoses categorized as Gastrointestinology, Endocrinology, and Emergency medicine; no relation between the period of return within 72 hours of discharge and patients with chronic diseases, malignancies, or major injuries/diseases; and higher probability of unscheduled return during three shifts in hematologic patients. Most of the unscheduled return patients visiting ED within 72 hours were above 65 years old. The three major reasons of unscheduled return were: (1) acute relapsing exacerbations of previously alleviated symptoms (46.4%); (2) new problems (35.8%); and (3) personal factors (10.6%). Higher correlation was noted among the individualized health education by the nursing staff with seniority of 1-6 years or capability advancing grading of N0, N1, and N2 in the unscheduled return patients. |
