To Analyse the Factors in Relationship to a 72 Hours Unscheduled Revisit to the ED for Patients with Non-Tramatic

• Main Authors: LIAO,HSUEN-MIN, 廖學敏
• Other Authors: WENG,SHAO-JEN
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/35715252345667254746

碩士 === 東海大學 === 工業工程與經營資訊學系 === 104 === With the increasing accessibility of the public seeking for medical advices under the current National Health Insurance system, the unscheduled return patients visiting emergency department (ED) within 72 hours of discharge is a group of patients at high risks of potential medical risks and disputes that will increase medical expenses, consuming labor and medical resources as well. In this study, we used descriptive statistics and correspondence analysis to analyze the non-traumatic unscheduled return patients visiting ED within 72 hours of discharge in the ED of a medical center at middle Taiwan during January 1, 2013 to February 28, 2013 and November 1, 2013 to December 31, 2013 by some variables, such as age, sex, the duration of observation at ED on the previous visit, the numbers of primary diagnoses, the numbers of secondary diagnoses, same primary diagnoses between two visits, the grading at triage, day/night/graveyard shifts, insufficient instructions of discharge, etc. and to discuss the relation between each two variables. The results revealed longer duration of observation at ED with different primary diagnoses between two visits, the numbers of return visits: day shifts > night shifts > graveyard shifts; longer period of return within 72 hours of discharge in patients with (1) older age, (2) longer duration of observation at ED on the previous visit, (3) discharge during day shifts > night shifts > graveyard shifts, (4) lower grading at triage, and (5) primary diagnoses categorized as nephrology; shorter period of return within 72 hours of discharge in patients with primary diagnoses categorized as Gastrointestinology, Endocrinology, and Emergency medicine; no relation between the period of return within 72 hours of discharge and patients with chronic diseases, malignancies, or major injuries/diseases; and higher probability of unscheduled return during three shifts in hematologic patients. Most of the unscheduled return patients visiting ED within 72 hours were above 65 years old. The three major reasons of unscheduled return were: (1) acute relapsing exacerbations of previously alleviated symptoms (46.4%); (2) new problems (35.8%); and (3) personal factors (10.6%). Higher correlation was noted among the individualized health education by the nursing staff with seniority of 1-6 years or capability advancing grading of N0, N1, and N2 in the unscheduled return patients.