運用ECRS縮短重難症病童跨院轉入急診的停留時間

Using ECRS to Shorten Emergency Room Stay Time for Critical Illness Children

10.6540/NTJN.202203_24(1).0006

蔡玟崚(Wen-Leng Tsai)；周果璇(Kuo-Hsuan Chou)；邱燕甘(Yen-Gan Chiou)；許雅芬(Ya-Fen Hsu)；徐美欣(Mei-Hsin Hsu)；郭玄章(Hsuan-Chang Kuo)；林盈瑞(Ying-Jui Lin)

重難症病童 ； ECRS ； 急診停留時間 ； critical illness children ； ECRS ； emergency room stay time

新臺北護理期刊

24卷1期（2022 / 03 / 01）

71 - 83

繁體中文

本專案旨在運用ECRS縮短重難症病童跨院轉診入兒科加護病房前於急診停留時間。專案小組以病歷回溯調查2016年1月至12月跨院轉入兒科加護病房共118人，於急診停留時間平均高達2小時13分鐘／人，經實地觀察後發現：跨院轉入需經急診部門處理耗時，急診停留期需經16個步驟；程序冗長，病童需等待醫師評估、護師建立靜脈管路與抽血及等待檢查檢驗報告時間，兒科加護病房床位聯絡作業繁瑣等問題。專案小組於2017年擬定可行之解決方案包括：建立跨院轉診專人、專線、轉診專用表單、運用ECRS簡化重難症跨院轉入兒科加護病房流程、制定急診至兒科加護病房快速通關流程，經實施後，跨院轉入流程步驟由改善前16個步驟減少至5個步驟，於急診停留平均時間由187分鐘／人下降至27分鐘／人，平均減少160分鐘／人，大幅減少病童於急診停留時間。家屬對跨院轉入於急診停留期間滿意度由改善前76.4%提升至92.6%。因專人專線方便轉診醫師聯繫，讓轉診醫師不再費心、轉診前也可快速掌握病童病情，使重難症病童及早介入高端醫療，爭取治療黃金搶救時間，讓家長安心，也免除家屬等候入住加護病房之辛苦，建議可推廣至其他醫療機構使用，提升醫療品質。

The purpose of the project is using ECRS to shorten the time at critical patients transferring from the emergency room (ER) to pediatric intensive care unit (PICU). From January to December at 2016, the number of transferring to PICU covered 118 cases in all, and the average time of lingering around ER reached up to 2 hours and 30 minutes. After analysis and field observation, referral need processed by ER had to undergo 16 steps, including waiting for evaluation and diagnosis, establishing the venous line and blood draw, waiting for the inspection outcome, and communicating operation of PICU bed information. After discussion, solutions included establishing referrals' commissioner, setting up line and form for special use, using ECRS to simplify procedures of crossing-hospital referral to PICU, and formulating rapid customs clearance process from PICU to ER. After the implementation, the average time at critical condition lingering around ER is reduced to 27 minutes, shortened about 160 minutes, and the family satisfaction of referral to PICU increased to 92.6%. As such, it simplified the procedure, facilitated doctors to contact, took an early intervention in high-end medical care, and prevented families waiting for beds. As pointed out in the introduction in this paper, using ECRS promotes medical institution to increase healthcare quality.

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