| Summary: | 碩士 === 義守大學 === 管理科學研究所 === 90 === This research is to describe the approaches to establish in Kaohsiung City a information system for medical emergency as well as the appraisal norm of the modes of the said system. This includes observing the prompt and appropriate medical service an emergency case can get; reducing unnecessary transfer; indicating the nearest hospitals for ambulance corpses of fire bureaus; decreasing the overstaying time, giving the emergency cases prompt and appropriate medical treatment; equilibrating the medical resources in each first-aid responsibility hospital; developing fully the utmost functions of medical resources, enhancing the working efficiency and satisfaction of fire first-aid staff and medical personnel.
The information and measuring tools required in the research were “Kaohsiung City Emergency Medical Information Satisfaction Questionnaires”, “Analytic Table of the Reasons for Transfer in Kaohsiung City”, and “Kaohsiung City Emergency Cases Statistical Tables ”, which are employed to investigate the satisfaction of medical personnel and fire first-aid staff, the monthly number of emergency cases in each responsibility hospital, the ratio of injury examination category, the overstaying ratio, and the transfer ratio, and the analysis of the reasons for transfer, and the data assay is carried out in the manners of the average, mode, percentage, standard deviation in the descriptive statistics and the variation analysis and Pearson in inferential statistics.
The results indicate that in the medical staff satisfaction investigation (n=250), 6 among 25 items of the observed variates did not reach 3-point “Acceptable”, including 3 items in Dimension 1 “The Status Quo of Hospital Emergency Medical Treatment and Care”, 1 item in Dimension 2 “The Responsibility Hospitals’ Information Providing”, 0 item in Dimension 3 “The Information Providing and Integral Application of hospitals, fire stations, and command centers”, and 2 items in Dimension 4 “Overall communication”. The 6 items are inclined to the level of dissatisfaction. As to the statistical results about the satisfaction of the emergency medical staff in diverse categories toward the observed variates in respective questions, the 9 observed variates are the status quo of emergency medical manpower, the status quo of emergency handling capability, the status quo of emergency communication equipment, the status quo of emergency computer information equipment, the information about intensive care units, speed of first aid and hospitalization, selection of hospitalization, information about emergency cases, the communication among centers and hospitals. With the variation analysis based on the working categories of the staff, the P value is less than 0.05, indicating that the satisfactory cognition varies with the staff in different working categories. This investigation shows the basic level has diverse cognition with the high level. As to the communication for first aid and care of mass cases and current communicating system in “The Overall Communicating Condition of Emergency Medical Care”, the averages of the two observed variates are only 2.88 and 2.96 respectively without reaching 3-point “Acceptable”. Except the directors of fire bureaus and the chiefs of casualty departments, the rest staff is generally dissatisfied. As to the question if an emergency computer information system should be set up, the final average is 2.80 (the full marks is 3 point “Necessary”), and 7 categories of staff hold a positive attitude toward this question.
With regard to the Interhospital emergency transference ratio in the casualty departments (n=19), the investigation conducted in January to February 2002 shows the result is on an inverse proportion with the grades of medical centers, regional hospitals, district teaching hospitals, district hospitals, and the lower the grade of a hospital is in, the higher the transfer ratio is. Medical centers’ transfer ratio is 0.56%, also the lowest, then regional hospitals 7.24%, and then district teaching hospitals and district hospitals 12%. The investigation also implies the hospitals of higher grades have better emergency handling capability. As to the reasons of transfer, the requests of patients’ family is 36.97%, lack of intensive care units 24.93%, deficiency of other equipment and abilities 24.56%, the external factor of standing servicemen or veteran serviceman is about 5.81%, and the special factor of the unavailability of desired doctors 0.85%. Except the wards for burns and no vacant bed in operating rooms, in the variation analysis (P< 0.05) the ratio and reasons of transfer have remarkable difference in the hospitals of diverse grades. As to the overstaying conditions (n=19), in medical centers the 24-hour overstaying is 52.01%, 48-hour 1.05%; in regional hospitals 24-hour 0.25%, 48-hour close to 0; in district teaching hospitals and district hospitals the both items are 0. As we can see from the above, patients have to overstay for a bed due to fullness of intense care or ordinary beds in certain medical centers, but practically speaking the conditions of overstaying has been improved. After variation analysis, the factor of the hospital grades does not show statistically remarkable difference. With regard to the average number of emergency cases, medical centers are about 6000 persons per month, regional hospitals 3000, district teaching hospitals 2000, and district hospitals 400-500. As to the category of injury examination, in the ratios of Degree I and II, the medical centers is the highest, then regional hospitals, and then district teaching hospitals, and district hospitals is the lowest. But the Degree III of injury examination does not vary with the hospital grades, and all the ratios fall between 60% and 70%. Calculating with the sum of Jan. and Feb. 2001, Degree I is 3.14%, II 25.30%, and III 69.02%.
The result of this research shows the emergency medical treatment quality as well as the first aid and care quality have been improved, but we have to make more efforts on the emergency medical manpower, communication system, mass case care, disaster medical treatment, computer information system, mutual coordination and application of overall emergency medical resources. Beside, the gap of satisfactory cognition toward the status quo in each item between high level and basic level is enormous, and there are no integral planning about the communication system in mass cases care and disaster medical treatment. As a whole, the medical staff has a positive attitude toward the presence of a set of emergency medical information system.
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