| Abstract: | 目的：本研究目的旨在瞭解中部某大學附設醫院內科加護病房非計畫性重返加護病房發生率、重返結果及其相關因素，以期找出非計畫性重返加護病房之相關危險因子。方法：本研究為病例對照研究，研究對象為中部某醫學大學附設醫院自2006年1月至2008年8月內科加護病房所有轉出病人，以轉出後48小時內非計畫性重返加護病房共40位病人為研究組，再以年齡配對選出無重返加護病房80位病人為對照組，以經文獻查證及專家效度檢定後之非計畫性重返加護病房相關因素調查表為研究工具，登錄研究所需相關資料，以Spss pc (+)12.0 for windows套裝軟體進行分析。結果：研究發現48小時內非計畫性重返加護病房發生率為1.1%，重返後死亡率為75%。重返原因以呼吸道問題居多，佔20位(50%)，重返班別以小夜班最多，佔26位(65%)。重返加護病房者死亡率風險分析顯示，年齡≧65歲、住加護病房期間細菌培養陽性者、住院時曾接受手術者及相同問題重返加護病房者，重返後死亡率較高（odds ratio 分別為3.0, 2.67, 1.39, 2.33）。在重返與未重返兩組間，總住院天數及住院期間曾接受手術比率重返組明顯高於未重返組(P<0.05)，病人轉出加護病房時，血糖數值高於正常範圍比率則未重返組高於重返組(P<0.05)。結論：內科加護病房在病人轉出時，對於入住加護病房時為呼吸道問題、年齡≧65歲、住加護期間細菌培養陽性及曾經接受手術病人，轉出時應審慎評估並特別交班加強觀察及照護。未重返組病人轉出時血糖值平均高於重返組之發現，可於未來研究再進一步探討其相關程度，而重返加護病房事件明顯延長總住院天數，增加病人及其家庭經濟負擔，更造成醫療資源浪費。
Purpose: The purpose of this study was to explore the incidence, results, and factors related to unplanned readmission to the Medical Intensive Care Unit (MICU) of a university hospital in central Taiwan. Method: In this case control study. We recruited patients discharged from the MICU between January 2006 and August 2008. A total of 40 patients who had the "unplanned readmission within 48 hours of discharge" were assigned to the experiment group. Eighty patients who were not readmitted were assigned to the control group. The two groups were matched by age. A self-developed questionnaire was used to collect data from review medical record. Results: About one percent (1.1%) of all discharged patients had unplanned readmissions within 48 hours. This group had a mortality rate of 75%. Patients with respiratory disorders had highest readmission rate (n=20, 50%). The incidence of readmission was more likely to occur during the evening shift (n=26, 65%). Risk analysis showed that the mortality rate of the unplanned readmitted patients was higher for those ≧65 years old (odds ratio: 3.0), with a positive blood culture (odds ratio: 2.67), who had received surgery during their first MICU hospitalization (odds ratio: 1.39), or those who were readmitted with a related diagnosis (odds ratio: 2.33). Patients who experienced unplanned readmission to the MICU had a significantly longer hospital stay and were more likely to receive surgical intervention than those who did not (P<0.05). In addition, Patients who did not readmission to MICU have higher rate of blood sugar level than those who did (P<0.05). Conclusion: MICU patient who are admitted for respiratory disorders, who are more than 65 years old, have a positive blood culture, or who have received surgery during their MICU hospitalization, should be carefully evaluated before being transferred out of the MICU, and be carefully monitored after being transferred to a regular ward. Future study, a greater proportion of non-readmitted patient blood sugar levels, is able to investigate the correlation between these two factors. The occurrence of readmission to the MICU clearly prolongs the length of hospital stay, increases the patients and their families' economic burden and results in a waste of medical resources. |
