The medical quality and medical resource utilization analysis with doctor related patient admission to intensive care unit from unscheduled revisits emergency department within 72 hours

• Main Authors: Chao-Shen Chang, 張釗慎
• Other Authors: Ying-Ying Lo
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/jmdzdb

碩士 === 義守大學 === 醫務管理學系 === 107 === Aim: Primarily to examine physician judgment factors that result in patient’s readmission to the intensive care unit within 72 hours: 1. Whether or not emergency treatment procedures affected physician judgment. 2. Consumption of medical resources such as length of intensive care unit stay, national health insurance costs, etc. 3. Analysis and examination of medical quality. Methods: A retrospective study design was employed. Data for this study was obtained between January 2012 to December 2017 from patients with unplanned readmission to the intensive care unit within 72 hours in a medical center in southern Taiwan. Three emergency department quality experts were jointly responsible for reviewing and analyzing medical records. The focus for primary cause for readmission of patients was physician judgment factors, which were defined as incorrect diagnosis by the physician initially or incomplete treatment resulting in readmission to the intensive care unit. Specific criteria included: 1. the chief complaint and clinical symptoms of the initial consultation and re-consultation were similar. 2. The diagnosis for admission to the intensive care unit was associated with the chief complaint. 3. Analysis of the patient’s management process showed significant errors or room for improvement and descriptive statistics and inferential statistics were used for analysis. Results: Physician judgment factors were found to be associated with unplanned readmission to the intensive care unit within 72 hours. There were 35 cases associated with physician judgment factors (23.8%) and 112 cases associated with non-physician judgment factors (76.2%), and the incidence was around 1 out of 10,000. Physician judgment factors was associated with the emergency treatment procedure for patients who were readmitted to the intensive care unit within 72 hours. The risk of physician misjudgment was 4.837 times higher for patients who were retained for less than 2 hours for the initial diagnosis compared to those that were retained for more than 2 hours. Physician judgment factors was associated with resource consumption in patients who were readmitted to the intensive care unit within 72 hours, and less resources were consumed than those of non-physician factors. The reason for this was that the study population of physicians had different sensitivities towards different diseases. Respiratory and thoracic disease patients with severe disease and high resource consumption had a relatively lower misdiagnosis rate while the misdiagnosis rate for patients with neurological diseases was higher. Physician judgment factors were not associated with mortalities in patients that were readmitted to the intensive care unit within 72 hours. Physician judgment factors that led to unplanned readmission to the intensive care unit within 72 hours do exist. Medical staff was responsible for avoiding or reducing any opportunities for medical negligence. Therefore, it was recommended that emergency physicians and medical managers should not underestimate the potential risks.