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題名：專責外傷制度成效之初探--以臺南市某醫學中心為例
書刊名：臺灣公共衛生雜誌
作者：王志榮／顏淑婷／黃詩芳／沈延盛／應純哲 引用關係
作者(外文)：Wang, Chih-jung／Yen, Shu-ting／Huang, Shih-fang／Shan, Yan-shen／Ying, Jeremy C.
出版日期：2016
卷期：35:6
頁次：頁587-594
主題關鍵詞：專責外傷制度；重大外傷；持續性品質改善；Trauma care system；Major trauma；Continuous quality improvement
原始連結：連回原系統網址new window
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目標：為了解專責外傷制度成立後，執行持續性品質改善計畫(Continuous quality improvement, CQI)對於外傷病人照護品質是否持續改善。方法：本研究以病歷回溯方式，利用外傷登錄資料庫分析個案醫院成立外傷科後所收治之病人共1,619人。將其分為成立初期(2011~2013，895人)及成立近期(2014~2015，724人)，利用獨立樣本t檢定及卡方檢定檢視系統反應時間：包含接受緊急動脈栓塞(Transcatheter Arterial Embolism, TAE)與緊急胸腹手術病人在急診停留時間及緊急胸腹手術病人在鍵入刀序後至手術室時間，另對重大外傷(Injury Severity Score, ISS≧16)病人預後：包含住院天數及死亡率等變項進行差異性分析。結果：ISS在成立近期有顯著增加，由15.09增加到18.62；接受TAE病人於急診停留時間由143.52分鐘減少為117.94分鐘；另外在嚴重外傷(ISS=16~24)病人的住院天數由成立初期21.13天減少為成立近期16.27天，死亡率亦由5.34%降為1.03%，在統計上皆呈現顯著性差異。結論：專責外傷制度及持續性外傷品質改善計畫能有效提升急診處理病人的效率，且在嚴重外傷(ISS=16~24)族群可以減少住院天數及死亡率。
Objectives: To evaluate the quality of care for trauma patients following the implementation of continuous quality improvement (CQI) in a trauma care system. Methods: This was a retrospective chart review study using the trauma registry database of a medical center in Tainan from 2011 to 2015. The patients were classified into two groups: the years 2011~2013 (early period, N=895) and 2014~2015 (late period, N=724). Chi-square and t-test analyses were used to examine the indicators: duration of stay in the emergency room (ER) for emergency transcatheter arterial embolism (TAE)/torso surgeries, waiting time after scheduled for torso surgery, and length of stay (LOS)/mortality rate of patients with an Injury Severity Score (ISS) greater than 15. Results: The average ISS of the late period group was significantly higher (18.62 vs. 15.09) and the duration of stay in the ER for emergency TAE was significantly lower (117.94 vs. 143.52) than those of the earlier period group. In addition, the LOS declined significantly (16.27 vs. 21.13), and the mortality rate was significantly reduced (1.03% vs. 5.34%) among patients with an ISS of 16~24. Conclusions: CQI in a trauma care system was effective in the ER management of trauma with significant reductions in LOS and mortality rate in patients with an ISS of 16~24.
期刊論文
1.Capella, J.、Smith, S.、Philp, A.(2010)。Teamwork training improves the clinical care of trauma patients。J Surg Educ，67，439-443。  new window
2.Nathens, A. B.、Jurkovich, G. J.、Cummings, P.、Rivara, F. P.、Maier, R. V.(2000)。The effect of organized systems of trauma care on motor vehicle crash mortality。JAMA，283，1990-1994。  new window
3.MacKenzie, E. J.、Rivara, F. P.、Jurkovich, G. J.(2006)。A national evaluation of the effect of trauma-center care on mortality。New England J Med，354，366-378。  new window
4.Celso, B.、Tepas, J.、Langland-Orban, B.(2006)。A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems。J Trauma，60，371-378。  new window
5.Liberman, M.、Mulder, D. S.、Jurkovich, G. J.、Sampalis, J. S.(2005)。The association between trauma system and trauma center components and outcome in a mature regionalized trauma system。Surgery，137，647-658。  new window
6.Davenport, R. A.、Tai, N.、West, A.(2010)。A major trauma centre is a specialty hospital not a hospital of specialties。Br J Surg，97，109-117。  new window
7.Rainer, T. H.、Cheung, N. K.、Yeung, J. H.、Graham, C. A.(2007)。Do trauma teams make a difference? A single centre registry study。Resuscitation，73，374-381。  new window
8.Wang, C. H.、Hsiao, K. Y.、Shih, H. M.、Tsai, Y. H.、Chen, I. C.(2014)。The role of trauma team activation by emergency physicians on outcomes in severe trauma patients。JACME，4，1-5。  new window
9.Offner, P. J.、Hawkes, A.、Madayag, R.、Seale, F.、Maines, C.(2003)。General surgery residents improve efficiency but not outcome of trauma care。J Trauma，55，14-19。  new window
10.Nathens, A. B.、Jurkovich, G. J.、Maier, R. V.(2001)。Relationship between trauma center volume and outcomes。JAMA，285，1164-1171。  new window
11.Mann, N. C.、Cahn, R. M.、Mullins, R. J.、Brand, D. M.、Jurkovich, G. J.(2001)。Survival among injured geriatric patients during construction of a statewide trauma system。J Trauma，50，1111-1116。  new window
12.Rozycki, G. S.(2014)。The strength that it takes: ten lessons learned from 28 years on the front lines。J Trauma Acute Care Surg，77，9-13。  new window
13.Mitchell, F. L.、Thal, E. R.、Wolferth, C. C.(1995)。Analysis of American College of Surgeons trauma consultation program。Arch Surg，130，578-584。  new window
14.Demetriades, D.、Martin, M.、Salim, A.、Rhee, P.、Brown, C.、Chan, L.(2005)。The effect of trauma center designation and trauma volume on outcome in specific severe injuries。Ann Surg，242，512-519。  new window
15.Cudnik, M. T.、Newgard, C. D.、Sayre, M. R.、Steinberg, S. M.(2009)。Level I versus Level II trauma centers: an outcomesbased assessment。J Trauma，66，1321-1326。  new window
16.Sanddal, T. L.、Esposito, T. J.、Whitney, J. R.(2011)。Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah。J Trauma，70，970-977。  new window
17.Mullins, R. J.、Mann, N. C.(1999)。Population-based research assessing the effectiveness of trauma systems。J Trauma，47(3Suppl)，S59-S66。  new window
18.Peitzman, A. B.、Courcoulas, A. P.、Stinson, C.、Udekwu, A. O.、Billiar, T. R.、Harbrecht, B. G.(1999)。Trauma center maturation: quantification of process and outcome。Ann Surg，230，87-94。  new window
19.Fulda, G. J.、Tinkoff, G. H.、Giberson, F.、Rhodes, M.(2002)。In-house trauma surgeons do not decrease mortality in a level I trauma center。J Trauma，53，494-502。  new window
20.Helling, T. S.、Nelson, P. W.、Shook, J. W.、Lainhart, K.、Kintigh, D.(2003)。The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients。J Trauma，55，20-25。  new window
21.Markovchick, V. J.、Moore, E. E.(2007)。Optimal trauma outcome: trauma system design and the trauma team。Emerg Med Clin North Am，25，643-654。  new window
22.Chiara, O.、Cimbanassi, S.(2003)。Organized trauma care: does volume matter and do trauma centers save lives?。Curr Opin Crit Care，9，510-514。  new window
其他
1.衛生福利部醫事司。醫院緊急醫療能力分級評定，http://www.mohw.gov.tw/CHT/DOMA/DM1.aspx?f_list_no=608&fod_list_no=773。  延伸查詢new window
2.衛生福利部(20160805)。104年國人死因統計結果，https://www.mohw.gov.tw/cp-2630-18831-1.html。  延伸查詢new window
 
 
 
 
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