非緊急急診病人特性及其相關因素探討

Non-urgent Emergency Department Use by Patients in a Regional Hospital

10.6288/TJPH2011-30-05-10

梁亞文(Yia-Wun Liang)；蔡哲宏(Jeffrey Che-Hung Tsai)；陳文意(Wen-Yi Chen)

急診 ； 非緊急急診 ； 病人特性 ； 加拿大檢傷分類系統 ； emergency department ； non-urgent emergency department visits ； patient characteristics ； Canadian Triage and Acuity Scale

台灣公共衛生雜誌

30卷5期（2011 / 10 / 15）

505 - 516

繁體中文

目標：本研究以加拿大檢傷分類系統(CTAS)探討非緊急急診比率並探討其影響因子。方法：本研究以中台灣某區域教學醫院急診病人為研究對象，共完成840位急診病人的訪視及病歷相關資料的檢視，最後完整收集758位急診病人資料，作為統計分析之用。本研究將CTAS第四級第五級病人定義為本研究之非緊急急診病人，再以邏輯斯複迴歸計算非緊急急診發生因子的危險對比值與95%信賴區間。結果：非緊急急診比率達51.97%，就診日、急診病人認為病情是否需要急診、檢傷人員判定病人疼痛程度及病人期望多快接受看診是非緊急急診發生的顯著因子。結論：衛生主管機關應持續加強民眾對急診的認識，積極宣導急診的正確使用時機，減少急診醫療資源的浪費；推動各項醫療服務改革政策時，必須跳脫單一醫療服務的思維，鼓勵不同層級醫療照護體系的合作，保障民眾的就醫可近性與醫療服務的適當性與品質。

This study determined the percentage of non-urgent emergency department (ED) patients and the factors influencing their visits by using the Canadian Triage and Acuity Scale (CTAS). Methods: During the study period, 840 patients presenting at a central Taiwan regional hospital ED were seen by the triage nurses and classified according to the CTAS. Data from 758 patients were analyzed. Non-urgent patients were defined as those who were classified CTAS IV and V. Multivariate logistic regression analysis was performed to identify factors associated with non-urgent ED visits. Results: Of these 758 visits, an estimated 51.97% were non-urgent. Significant factors associated with non-urgent ED patients were: visit days, patients perceptions about the emergency nature of the visit, pain level assigned by the triage nurses, and patient expected waiting time to be seen by a physician. Conclusions: Health administrators should persist in trying to educate people as to how to use ED services properly. In addition, policy makers need to understand that there is an inter-categorical relationship between ED use and other medical services; therefore, development of an integrated delivery system is encouraged along with implementation of policies to improve access to comprehensive, high quality health care services.

1. 梁亞文、陳芬如、鄭瑛琳(2008)。台灣的可避免住院及其病患社經狀態。台灣衛誌，27，16-23。
   連結：
2. 黃金安、賴其勛、胡哲生(2006)。急診醫療服務與其它醫療服務之類別間關係。台灣衛誌，25，384-93。
   連結：
3. 行政院衛生署：全民健康保險統計動向。台北：行政院衛生署，2007。Department of Health, Executive Yuan, R.O.C. (Taiwan). National Health Insurance Annual Statistical Trend Report. Taipei: Department of Health, Executive Yuan, R.O.C. (Taiwan), 2007. [In Chinese]
4. Australian Institute of Health and Welfare (AIHW). Australian Hospital Statistics 2003-04. AIHW Catalogue No. HSE37. Canberra: AIHW, 2005.
5. Bernstein E, Bernstein J, Lowe RA, et al. Timely access to health care: the critical role of EM, 1997. Available at: http://www.saem.org/inform/access.htm. Accessed December 6, 2008
6. 行政院衛生署：民國九十六年衛生統計動向。台北：行政院衛生署，2007。 Department of Health, Executive Yuan, R.O.C. (Taiwan). 2007 Health Statistical Trend Report. Taipei: Department of Health, Executive Yuan, R.O.C. (Taiwan), 2007. [In Chinese]
7. Page L. Patient bypassing primary doctors for emergency care. Available at: http://www.ama-assn.org/amednews/2001/02/12/bil10212.htm. Accessed May 2, 2009.
8. American College of Emergency Physicians (ACEP)(2000).Preserving America's Health Care Safety Net: An Imperative for US All.Washington, DC:National Press Club.
9. Asplin, B. R.,Magid, D. J.,Rhodes, K. V.,Solberg, L. I.,Lurie, N.,Camargo, C. A., Jr.(2003).A conceptual model of emergency department crowding.Ann Emerg Med,42,173-80.
10. Baker, L. C.,Baker, L. S.(1994).Excess cost of emergency department visits for nonurgent care.Health Aff,13,162-71.
11. Billings, J.,Anderson, G. M.,Newman, L. S.(1996).Recent findings on preventable hospitalizations.Health Aff,15,239-49.
12. Billings, J.,Parikh, N.(2000).Mijanovich T. Emergency department use: the New York Story.Issue Brief (Commonw Fund),434,1-12.
13. Brillman, J.,Doezema, D.,Tandberg, D.(1996).Triage: limitations in predicting need for emergency care and hospital admission.Ann Emerg Med,27,493-500.
14. Bullard, M. J.,Liaw, S. J.,Chen, J. C.(1996).Emergency medicine development in Taiwan.Ann Emerg Med,28,542-8.
15. Campbell, P. A.,Pai, R. K.,Derksen, D. J.,Skipper, B.(1998).Emergency department use by family practice patients in an academic health center.Fam Med,30,272-5.
16. Cunningham, P. J.,Clancy, C. M.,Cohen, J. W.,Wilets, M.(1995).The use of hospital emergency departments for nonurgent health problems: a national perspective.Med Care Res Rev,52,453-74.
17. Emergency Nurses Association(2001).Position Statement: Hospital and Emergency Department Overcrowding.Des Plaines, IL:Emergency Nurses Association.
18. Gordon, J. A.,Billings, J.,Asplin, B. R.,Rhodes, K. V.(2001).Safety net research in emergency medicine: proceedings of the Academic Emergency Medicine Consensus Conference on "The Unraveling Safety Net".Acad Emerg Med,8,1024-9.
19. Gordon, J. A.,Chudnofsky, C. R.,Hayward, R. A.(2001).Where health and welfare meet: social deprivation among patients in the emergency department.J Urban Health,78,104-11.
20. Han, A.,Ospina, M. O.,Blitz, S. B.,Strome, T.,Rowe, B. H.(2007).Patients presenting to the emergency department: the use of other health care services and reasons for presentation.CJEM,9,428-34.
21. Lamont, S. S.(2004).The Spread of See and Treat. Research into Practice.London:NHS Modernisation Agency.
22. McCaig, L. F.,Burt, C. W.(2004).National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary.Adv Data,340,1-34.
23. McCaig, L. F.,Burt, C. W.(2001).National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary.Adv Data,320,1-34.
24. National Audit Office(2004).Report by the Comptroller and Auditor General. HC 1075 Session 2003-2004.Report by the Comptroller and Auditor General. HC 1075 Session 2003-2004.,London:The Stationery Office.
25. Nourjah, P.(1999).National Hospital Ambulatory Medical Care Survey: 1997 emergency department summary.Adv Data,304,1-24.
26. Oster, A.,Bindman, A. B.(2003).Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations.Med Care,41,198-207.
27. Pitts, S. R.,Niska, R. W.,Xu, J.,Burt, C. W.(2008).National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary.Natl Health Stat Report,7,1-38.
28. Sarver, J. H.,Cydulka, R. K.,Baker, D. W.(2002).Usual source of care and nonurgent emergency department use.Acad Emerg Med,9,916-23.
29. Selby, J. V.,Fireman, B. H.,Swain, B. E.(1996).Effect of a copayment on use of the emergency department in a health maintenance organization.N Engl J Med,334,635-41.
30. Shocker, A. D.,Bayus, B. L.,Kim, N.(2004).Product complements and substitutes in the real world: the relevance of 'other products'.J Market,68,28-40.
31. Steinbrook, R.(1996).The role of the emergency department..New Engl J Med,334,657-8.
32. Tsai, J. C. H.,Chen, W. Y.,Liang, Y. W.(2001).Nonemergent emergency department visits under the National Health Insurance in Taiwan.Health Policy,100,189-95.
33. Vertesi L.(2004).Does the Canadian emergency department triage and acuity scale identify non-urgent patients who can be triaged away from the emergency department?.CJEM,6,337-42.
34. Weinick, R. M.,Krauss, N. A.(2000).Racial/ethnic differences in children's access to care.Am J Public Health,90,1771-4.
35. Williams, R. M.(1996).The costs of visits to emergency departments.N Engl J Med,334,642-6.
36. 台灣急診醫學會(2005)。行政院衛生署委託研究計畫行政院衛生署委託研究計畫,台北=Taipei:行政院衛生署=Department of Health, Executive Yuan。
37. 邱曉彥、陳麗琴、林琇珠、桑潁潁、康巧娟、邱艷芬(2008)。台灣急診檢傷新趨勢—五級檢傷分類系統。護理雜誌，55，87-91。
38. 莊逸洲、黃崇哲(2005)。醫院功能與管理—門診、急診、住院。台北=Taipei:華杏=Farseeing Publishing Group。
39. 詹靜媛(2003)。Taipei，國立台北護理學院護理研究所=School of Nursing, National Taipei University of Nursing。

1. 蔡金玲,郭年真(2020)。週日門診開診狀況與忠誠病人急診利用之相關性探討。台灣公共衛生雜誌，39(6)，656-668。
2. 陳文意、梁亞文、張曉鳳(2016)。照護連續性對高齡者急診與非緊急急診之影響探討。臺灣公共衛生雜誌，35(2)，152-163。
3. 賴甫誌、趙從賢、童恒新、苗迺芳、吳春滿(2016)。急診醫護人員疼痛處理知識與影響因素之探討。護理雜誌，63(1)，99-109。
4. 溫在弘、陳威全、郭年真、林民浩(2016)。剖析台灣民眾的就醫流動：利用引力模式評估就醫距離與醫療資源分布的影響。臺灣公共衛生雜誌，35(2)，136-151。
5. 謝春蘭,陳麗貞,陳瑋錡,許惠如,邱嘉玲,石惠美(2023)。探討某醫學中心急診病患就診滿意度及其相關因素。長庚護理，34(2)，15-28。
6. 楊其璇,陳文意,林晏如(2021)。人口結構變動對醫學中心急診部分負擔政策有效性之影響。台灣公共衛生雜誌，40(5)，525-544。