運用團隊資源管理降低急診病人轉送病房逾時率

A Project to Improve the Time-Effectiveness of Emergency Patients Being Sent to Wards Using Team Resource Management

10.6540/NTJN.201909_21(2).0008

莊淑芬(Shu-Fen Chuang)；陳美江(Mei-Chiang Chen)；戴國斌(Kuo-Bin Tai)；施美娟(Mei-Chuan Shih)；陳麗貞(Li-Jin Chen)

團隊管理 ； 轉送 ； 逾時率 ； team resource management ； transfer ； time-effectiveness

新臺北護理期刊

21卷2期（2019 / 09 / 01）

89 - 101

繁體中文

等待照護時間長短是影響醫療服務品質與顧客滿意度的主要因素。相關數據顯示急診單位常因被延遲轉送病房時間，致使病人與家屬諸多抱怨及不滿意，導致醫療團隊士氣及人員情緒影響，更需花費額外時間處理其困境和糾紛。專案小組調查發現2014年10月1日至12月31日急診病人等候轉送病房逾60分鐘達52.8%，分析延遲轉送因素包括:護理師轉出至病房前準備完整性僅71.9%、助理員未整合轉送業務、病人與家屬接收訊息不足等。本專案目的旨為降低急診病人轉送病房逾時率，故運用文獻查證與標竿學習，進行決策矩陣分析，訂定解決方案:運用團隊資源管理之核心概念，修訂「急診助理員常規作業標準內容」及「觀察室病人及家屬等床須知」、制訂「急診病人轉送前準備內容」、落實助理員採組長整合轉送派工制作業流程，經縮短轉送逾時率由52.8%降為9.2%達專案之目的，並提升工作團隊士氣和急診病人之滿意度，維持急診醫療照護品質、減少病人與家屬的抱怨，並降低急診資源耗用及急診之壅塞問題，減少滯留急診等床，確保讓急診病床運用有效地運用。

As far as medical service quality and customer satisfaction are concerned, the time to wait for care is the essence. Relevant data shows that emergency units often cause complaints and dissatisfaction to patients and their family on account of delayed transfers to wards. This has an impact on the medical team's morale and the sentiment of team members. Moreover, extra time is required to tackle the difficulty and disputes. A survey by the project team has found up to 52.8% of emergency patients waiting to be transferred to wards for over 60 minutes in the period of October 1, 2014 to December 31, 2014. Factors of delayed transfers included completeness of preparations by nurses prior to transfer to ward (71.9%), not integrating transfer business by assistants, insufficient information received by patients and their family, and so on. This project aimed to improve the time effectiveness of emergency patients being sent to wards. To that end, we undertook a decision-matrix analysis through literature review and benchmarking learning to make solutions. Moreover, we utilized a core concept of team resource management to revise ＂emergency assistant SOP＂ and ＂guidelines on bed-waiting patients and their family in the observation room＂, and draft ＂preparations prior to emergency patient transfers＂. The purpose was to put in place consolidation of the transfer dispatch operating procedure by assistants/ team leaders. As a result of this, the overtime rate dropped from 52.8% to 9.2%. In addition, the morale of the team and the satisfaction of emergency patients increased. The quality of medical care was maintained. The complaints of patients and their family were reduced. Besides, use of emergency resources and crowding of the emergency room was improved, and bed waiting in the emergency room was lessened. All this made sure that emergency beds were effectively utilized.

1. 徐慧興,張世琦,潘靜怡,劉曉雲(2014)。運用團隊資源管理提升外科病房醫護團隊之訊息連結及值班滿意度。醫務管理期刊，15(4)，277-289。
   連結：
2. 劉寶玲,陳筱瑀,高淑美,楊青娥,謝嘉琪,戴辛翎(2011)。提昇急診病人轉送檢查護理交班之滿意度方案。醫務管理期刊，12(1)，60-72。
   連結：
3. Ajami, S.,Ketabi, S.,Yarmohammadian, M. H.,Bagherian, H.(2012).Wait time in emergency department (ED) processes.Medicinski Arthiv,66(1),53-57.
4. Almomani, I.,AlSarheed, A.(2016).Enhancing outpatient clinics management software by reducing patients' waiting time.Journal of Infection and Public Health,9(6),734-743.
5. Baker, D. P.,Day, R.,Salas, E.(2006).Teamwork as an essential component of high-reliability organizations.Health Research and Educational Trust,41(4, PART II.),1576-1598.
6. Richards, J. D.,Harris, T.(2011).Beam me up Scotty! Impact of personal wireless communication devices in the emergency department.Emergency Medicine Journal,28(1),29-32.
7. Zhu, Z.,Heng, B. H.,Teow, K. L.(2012).Analysis of factors causing long patient waiting time and clinic overtime in outpatient clinics.Journal of Medical Systems,36(2),707-713.
8. 朱鳳瑛,許淑純(2013)。運用團隊領導模式改善排床等候時間。醫學與健康期刊，2(1)，81-87。
9. 吳宛庭,康春梅,王拔群,黃啟宏,葉宜珍,黃鈺茹,洪錦墩(2013)。團隊資源管理工具提升成人加護病房病人安全風氣及照護品質。醫院雙月刊，46(2)，22-23。
10. 范姜玉珍,楊慧貞(2012)。共創同心圓探討護理同仁與醫療團隊的合作。志為護理-慈濟護理雜誌，11(2)，16-19。
11. 馬漢光,李培芬,鄒繼群,於淑娟,王又仙(2012)。品質提升措施對於門診顧客等候時間與滿意度之影響。醫療品質雜誌，6(6)，53-61。
12. 彭麗蓉,鄭宜芳,孫緒媛,劉富琴,陳瑩霞,呂旻芬(2010)。醫院舉辦員工通識課程之流程再造和成效探討。澄清醫護管理雜誌，6(2)，49-57。
13. 1&MmmID 衛生福利部（2018，1月29日）‧107-108年度醫院醫療品質及病人安全工作目標‧取自http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=777752343551741053 621273300317401756&MSID
14. 應純哲,藍宜亭,張景盛,翁慧卿,黃俊英(2013)。服務接觸與醫療照護品質之關係─等候時間知覺的調節效果。北市醫學雜誌，10(4)，337-346。
15. 嚴玉華,龔志銘(2014)。高齡病人對醫院品牌與高齡友善政策滿意之初探。臺灣老年醫學暨老年學雜誌，9(4)，184-197。

1. 陳美珠,金瑞萍,杜美瑤,江迎星(2022)。縮短病人入住VIP病房等候時間之專案。彰化護理，29(4)，87-97。