急診室病患組合、人力排擠與醫療救治結果

以作者查詢圖書館館藏

、以作者查詢臺灣博碩士

、以作者查詢全國書目

、勘誤回報

、線上人數：147

、訪客IP：3.128.198.21

姓名

黃昭逸(Chao-Yi Huang) 查詢紙本館藏

畢業系所

產業經濟研究所

論文名稱

急診室病患組合、人力排擠與醫療救治結果

相關論文

★ 投資者之風險屬性與基金理財績效之實證研究	★ 企業經營績效的影響分析-以台灣醫療器材產業為例
★ 銀行財富管理業務手續費收入影響因素之實證研究	★ 母親的教育程度對兒童醫療利用行為之影響
★ 地區醫院的存亡與轉型	★ 教育對健康的影響—臺灣地區老人之實證研究
★ 醫院購置高科技醫療儀器與市場結構的關聯	★ 台灣地區醫院最適效率規模的估計-倖存者分析方法應用
★ 出口與生產力的關聯 —台灣電子業廠商之實證研究	★ 社會資本與家庭結構對健康及醫療資源利用之影響 —台灣地區老人之實證研究
★ 醫療利用可近性—台灣老人之實證研究	★ 父母健康知識與其子女健康狀況之關聯
★ 臺灣股市之效率檢定及多因素模型之探討—長期追蹤資料之計量分析	★ 醫療資源與國人健康的關聯
★ 青少年菸害的健康風險認知與吸菸行為的關聯─台灣地區的實證研究	★ 醫療資源可近性對個人醫療利用的影響 ――台灣地區的實證研究

檔案

[Endnote RIS 格式]

[Bibtex 格式]

[相關文章]

[文章引用]

[完整記錄]

[館藏目錄]

[檢視]

[下載]

本電子論文使用權限為同意立即開放。
已達開放權限電子全文僅授權使用者為學術研究之目的，進行個人非營利性質之檢索、閱讀、列印。
請遵守中華民國著作權法之相關規定，切勿任意重製、散佈、改作、轉貼、播送，以免觸法。

摘要(中)

急診壅塞的問題一直困擾著全世界的許多國家，它不僅造成病患的醫療救治
結果變差，更將低醫院急診室的醫療品質。在全民健保制度的落實之下不但降低
醫療費用支出，更調降人民的就醫門檻，這使輕、重症的病患都能選擇往急診室
求診，使整體的處置時間延長。
醫院急診室主要針對急重症患者在有限的時間下進行即時處置而設立。在醫
療人力資源有限下，過多非急重症患者前往急診室就醫，不僅容易影響急重症患
者的救治結果，更可能讓急診室的醫護人力過度負荷，導致人才流失。本研究使
用2000 年及2005 年全民健保資料庫百萬人次抽樣檔，以心肌梗塞、出血性中風
及阻塞性中風等重症患者作為研究對象，採用羅吉斯迴歸模型探討急診室輕症患
者的人流多寡是否會影響急重症患者的救治結果，特別是在醫學中心層級。另外
台灣經常遇上週末與夜間門診休診的狀況，使輕症患者只能選擇前往急診室求診，
我們加入時間要素，觀察在週末以及夜間時段下，是否急診輕症壅塞對於急重症
患者的醫療救治結果有顯著的影響存在。根據實證結果，整體來看急重症患者的
醫療結果受到輕症患者就診率影響並沒有達到統計上的顯著性，特定週末時段與
夜間時段中結果都未明顯對急重症患者的醫療結果有顯著的影響。

摘要(英)

Emergency department congestion can causes poor medical treatment outcomes for
patients worldwide. In addition, it reduces the quality of medical treatment in the
emergency room. The implementation of the National Health Insurance System in 1995
in Taiwan lowered medical expenses and the threshold for people to seek medical
treatment. It means that high number of patients with mild symptoms can be present in
the emergency department, which increases waiting times for all. The emergency room
is available for patients with acute and severe symptoms. It is designed to use the limited
time for treatment. However, too many non-emergency patients can delay the treatment
time of emergency patients and worsen their condition when medical resources are
limited. In addition, medical staff can be overworked, which leads to a shortage of
medical talent in the emergency department. This study used the National Health
Insurance Database from 2000–2005 to assess the effect of the number of patients with
mild symptoms on emergency patient outcomes in medical centers. We included patients
with myocardial infarction, hemorrhagic stroke, and obstructive stroke. Most patients
with mild symptoms choose to visit the emergency department during the weekend and
night periods; therefore, we evaluated whether treatment outcomes were affected by
emergency department congestion during these periods. Interestingly, we found no
significant effect of mild patient numbers on the treatment outcomes of patients with
severe disease, including during the weekend and night periods. In summary, there was
no effect the number of non-emergent patients on the treatment outcome of severe
patients.

關鍵字(中)

★ 急診壅塞
★ 輕症患者
★ 醫療人力

關鍵字(英)

★ ER crowding
★ mild patients
★ medical talent

論文目次

中文摘要 ...................................... i
Abstract ..................................... ii
致謝 ......................................... iii
目錄 ......................................... iv
圖目錄 ....................................... vi
表目錄 ........................................ vii
第一章前言 ..................................... 1
第一節研究背景 ................................. 1
第二節研究目的 ................................. 5
第二章文獻回顧 ................................. 7
第一節前言 .................................... 7
第二節急診壅塞與醫療結果的影響................... 7
第三節檢傷分類系統的重要性與輕重症患者對急診的影響...... 9
第五節小結 ....................................... 13
第三章資料來源與研究方法 .......................... 14
第一節資料來源 ................................... 14
第二節資料處理過程 ............................... 14
第三節實證模型 .................................. 17
第四節變數說明 .................................. 18
第五節敘述統計 .................................. 22
第四章實證結果 .................................. 27
第一節前言 ..................................... 27
第二節急診室急重症患者之醫療結果 .................. 27
第三節小結 ..................................... 32
第五章結論 ..................................... 34
第一節結論 ..................................... 34
第二節研究限制 .................................. 35
參考文獻........................................... 36

參考文獻

中文部分
1. 方震中(2016)，「急診壅塞解決之道」，健康世界月刊，472，12-17。
2. 江旺財、李衛華、廖之倩(2015)，「台灣急診壅塞的初探」，輔仁醫學期
刊，13(4)，223-231。
3. 吳士良(2007)，「急症病患週末假日入院與死亡風險及其住院天數的關
係」，國立陽明大學醫務管理研究所碩士論文。
4. 李淑芬、林宜靜、蔡偉德(2012)，「醫療救治品質存在週末效應？」，人
文及社會科學集刊，24(2)，233-275。
5. 林志豪(2018)，「日夜溫差大，小心腦中風」，林自豪醫師，民97 年12
月20 日，取自：https://drneurolin.com/。
6. 紀志賢(2011)，「臺灣急重症醫療挑戰與契機」，台灣醫學會專題討論24，
取自：http://www.fma.org.tw/2011/S-24-5.html。
7. 胡勝川(2015)，「如何因應急診壅塞」，財團法人台灣醫療改革基金會，
民104 年5 月18 日，取自：http://issue.thrf.org.tw/index.asp。
8. 張文瀚、黃謙瑄、蔡正河(2006)，「急診室之檢傷病患於尖離峰時刻就
醫之時間探討」，中華民國急救加護醫學會雜誌，18(1)，21-30。
9. 許錦田(2009)，「冬季腦中風」，高醫醫訊月刊，29(6)，4-6。
10. 黃柏諭(2013)，「運用系統模擬最佳化探討動態急診部資源規劃之研
究」，東海大學工業工程與經營資訊學系碩士論文。
11. 鄒永駿(2017)，「醫師人力與醫療結果之分析—以週末及夜間急診為
例」，國立中央大學產業經濟研究所碩士論文。
12. 蔡光超(2019)，「論醫院評鑑制度在解決急診壅塞現象時可扮演之角色」，國立台灣大學社會科學院政治學系政府與公共事務碩士在職專班
碩士論文研究計畫書。
13. 蔡哲福、蔡哲宏、李怡慶、謝良博、黃子齡(2013)，「急診檢傷分類等
候制度與病人知覺等候時間之相關性研究-以某區域教學醫院為例」，
澄清醫護管理雜誌，9(4)，20-28。

英文部分
1. Akhtar, N., Kamran, S., Singh, R., Cameron, P., Bourke, P., Khan, R., Joseph, S., Santos, M., Deleu, D., Own, A., Al-Yazeedi, W., Butt, A. A., Boulton, J., Shuaib, A. (2016). “Prolonged stay of stroke patients in the emergency department may lead to an increased risk of complications, poor recovery, and increased mortality.” Journal of Stroke and Cerebrovascular Diseases, 25(3), 672-678
2. Bell, C, M., & Redelmeier, D. A. (2001). “Mortality among Patients Admitted to Hospitals on Weekends as Compared with Weekdays. ” New England Journal of Medicine, 345(9), 663-668.
3. Boyle, P., Pineault, R., Roberge, D. (1992). “Assessing Quebec′s Multi- Component Program to Reduce Emergency Room Overcrowding. ” Canadian Public Policy, 18(2), 189-202.
4. Chalfin, D. B., Trzeciak, S., Likourezos, A., Baumann, B. M., Dellinger, R. P., (2007) “Impact of delayed transfer of critically ill patients from the
emergency department to the intensive care unit.” Critical Care Med, 35 (6), 1477-1483.
5. Cram, P., Hillis, S. L., Barnett, M., Rosenthal, G. E., (2004). “Effects of Weekend Admission and Hospital Teaching Status on In-hospital Mortality. ” The American Journal of Managed Care, 117(3), 151-157.
6. Diercks, B. D., Roe M. T., Chen, A. Y., Peacock, W. F., Kirk, J, D., Pollack, C. V. Jr., Gibler, W. B., Smith, S. C. Jr., Ohman, M., Peterson, E. D. (2007).
“Prolonged emergency department stays of non-STsegment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events.” Annals of Emergency Medicine, 50(5), 489-496.
7. Erenler, A. K., Akbuluta, S., Guzel, M., Cetinkaya, H., Karaca, A., Turkoz, B., Baydin, A. (2014). “Reasons for Overcrowding in the Emergency Department:Experiences and Suggestions of an Education and Research Hospital.” Turkish Journal of Emergency Medicine, 14(2), 59-63.
8. Esmaeili, R., Aghili, S. M., Sedaghat, M., Afzalimoghaddam, M. (2018). “Causes of Prolonged Emergency Department Stay; a Cross-sectional Action Research. ” Advanced Journal of Emergency Medicine, 2(2), e18.
9. Gill, J. M., & Riley, A. W. (1996). “Nonurgent Use of Hospital Emergency Departments: Urgency from the Patient’s Perspective.” The Journal of Family Practice, 42(5), 491-496.
10. Huang, Y. Q., Gou, R., Diao, Y. S., Yin, Q. H., Fan, W. X., Liang, Y. P., Chen, Y., Wu, M., Zang, L., Li, L., Zang, J., Cheng, L., Fu, P., Liu, F. (2014). “Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy.” Journal of Zhejiang University, 15(1), 58-66.
11. Maggs, F., & Mallet, M. (2010). “Mortality in out-of-hours emergency medical admissions – more than just a weekend effect. ” Journal of the Royal College of Physicians of Edlinburgh, 40(2), 115–118.
12. Martinez, D. A., Zhang, H., Bastias, M., Feijoo, F., Hinson, J., Martinez R., Dunstan, J., Levin, S., Prieto D. (2019). “Prolonged wait time is associated with increased mortality for Chilean waiting list patients with nonprioritized conditions. ” BioMed Central Public Health, 19(1), 233.
13. Miyazawa, A. Maeno, T., Shaku, F., Tsutsumi, M., Kurihara, H., Takayashiki, A., Suzuki, M., Maeno, T. (2019). “Inappropriate use of emergency department for nonurgent conditions: Patients characteristics and associated factors at a Japanese hospital.” Journal of General and Family Medicine, 20(4), 146-153
14. Moskop, J. C. (2010)“Nonurgent Care in the Emergency Department—Bane or Boon?” American Medical Association Journal of Ethics, 12(6), 476-482.
15. Reznek, M. A., Murray, E., Youngren, M. N., Durham, N. T., Michael, S. S. (2017). “Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding.” Stroke, 48(1), 49-54.
16. Salway, R. J., Valenzuela, R., Shoenberger, J. M., Mallon, W. K., Viccellio, A. (2017). “ Emergency Department (ED) Overcrowding: Evidence-based Answers to Frequently Asked Questions. ” Revista Médica Clínica Las
Condes, 28(2), 213-219.
17. Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., Mehrotra, A. (2013). “Emergency Department Visits for Nonurgent Conditions: Systematic Literature Review.” The American Journal of Managed Care, 19(1), 47-59.
18. Van den Heede, K., & Van de Voorde, C. (2016). “Intervention to reduce emergency department utilization : A review of reviews.” Health Policy, 120 (12), 1337–1349.
19. Wilcox, M. E., Chong, C. A., Niven, D. J., Rubenfeld, G. D., Rowan, K. M., Wunsch, H., Fan, E. (2013). “Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and metaanalyses.” Critical Care Med, 41(10), 2253-2274.
20. Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. Il, Lurie, N., Camargo, C. A. Jr. (2003). “Aconceptual model of Emergency Department crowding. ” Annals of Emergency Medicine, 42, 173-180.
21. Honeyford, K., Cecil, E., Lo, M., Bottle, A., Aylin, P. (2018). “The weekend effect : does hospital mortality differ by day of the week? A systematic review and meta-analysis.” BioMed Central Public Health 18, 870.
22. Becker, D. J. (2007). “Do Hosptials Provide Lower Quality Care on Weekends?” Health Service Research, 42(4), 1589-1612.
23. Lambe, S., Washington, D. L., Fink, A., Herbst, K., Liu, H., Fosse, J. S., Asch, S. M. (2002). “Trends in the use and capacity of California’s emergency departments, 1990-1999.” Annals of Emergency Medicine, 39(4),
389-396.
24. Funakoshi, H., Shiga, T., Homma, Y., Nakashima, Y., Takahashi, J., Kamura1, H., Ikusaka, M. (2016). “Validation of the modified Japanese Triage and Acuity Scale-based triage system emphasizing the physiologic variables or mechanism of injuries.” International Journal of Emergency Medicine, 9(1).

25. Otsuki, H., Murakami, Y., Fujino, K., Matsumura, K., Eguch, Y. (2016). “Analysis of seasonal differences in emergency department attendance in Shiga Prefecture, Japan between 2007and 2010.” Acute Medicine & Surgery,
3(2), 74-80.
26. Roberge,D., C.Sicotte, P. Boyle, and J. Turgeon, (1984). "Protocole prèliminaire pour l′ analyse de l′ engorgement des services d′urgence dans les centres hospitaliers de la région de Montréal, " Ministère de la Santé et des services sociaux, Service d′évaluation,Québec.
27. Weiss, S. J., Derlet R., Arndahl, J., Ernst, A. A., Richards, J., Fernández-Frackelton, M., Schwab, R., Stair, T. O., Vicellio, P., Levy, D., Brautigan,
M., Johnson, A., Nick, T. G. (2004). “Estimating the Degree of Emergency Department Overcrowding in Academic Medical Centers: Results of the National ED Overcrowding Study (NEDOCS).” Academic emergency medicine, 11(1),
38-50.

相關網站
1. 台灣急診醫學會 https://www.sem.org.tw/
2. 財團法人醫療改革基金會 https://www.thrf.org.tw/
3. 衛生福利部 https://www.mohw.gov.tw/mp-1.htm

指導教授

蔡偉德

審核日期

2020-7-28

推文