作者: 劉敏玲
班別: 碩士班
畢業系所:醫療機構管理研究所
畢業年度: 2001
指導老師: 陳維昭
論文題目: 急診病患對就醫之感受等候時間、實際等候時間與滿意度之相關研究─以某醫學中心為例


摘要:
本研究目的是要瞭解病患在急診就醫流程各階段中,『實際』與『感受』的等候時間分佈情形及差異,並探討其對病患滿意度的影響。希望以病患的觀點與需求,提供急診就醫流程各階段中,管理上之重點優先次序,改進急診醫療服務品質的方向。
文中是以某醫學中心急診部之來診病患做為隨機取樣之對象。以“時間研究” 測量病患在急診就醫各步驟中『實際』的等候時間,並以問卷調查病患『感受』的等候時間與『滿意度』,輔以介入方式探討影響情形。研究自89年1月8日~89年1月28日進行訪問,樣本數共196位,問卷回收率為92.8%。重要結果摘述如下:
1. 病患之檢傷分類以III級最多佔二分之一以上,其次是II級。看診科別以內科最多,看診後的動向以當天離院佔多數。病患「感受」與「實際」的等候時間有顯著差異,且等候時間越長差距越大。感受的時間影響病人滿意度比實際的時間強。
2. 病患在急診就醫以等候「檢驗報告」時間最長,其次是等候「x光報告」,第三是等候「照會醫師」時間,而等候時間越長,病患不滿意比例越高,醫療管理者首先須改善急診醫療服務的方向有病患「等候檢驗報告」、「等候x光報告」及「等候照會醫師」等時間流程。
3. 病患特性以「來診時段」、「來診方式」及「科別」為影響各流程步驟的等候時間因子;影響等候時間的滿意度有「性別」、「年齡」、「教育程度」、「科別」、「來診時段」、「來診方式」因子。
4. 檢體分析前的『介入』,僅能縮短檢體收集後到檢體執行登錄時間,並不能減少病患等候檢驗報告時間,所以病患滿意度沒有顯著的改變。但在等候x光報告的時間方面,『介入』能明顯縮短病患的等候時間,且滿意度也有顯著的改善。
本研究建議:1.急診環境設備須因輕症病患的就診需要,區分重症與輕症診療區,提供病患就醫各流程步驟之等候時間訊息,減少病患對醫療服務的不滿意。 2.建立「急診之檢查/檢驗報告通報系統」,協助醫師及時掌握檢查/檢驗報告,減少病患診斷處置與停留急診時間。
Abstract─
The objective of this study was to explore perceived waiting time, actual waiting time and their relations to satisfaction of patients of the emergency department (ED). We hope to provide management priority of ED patient care to improve the quality of the ED service according to patients’ opinions and demands.
We used “time motion study” to measure ED patient’s actual waiting time and gathered both perceived waiting time and satisfaction toward ED services from the questionnaires. In addition, we adopted an “intervention” to explore its effects on satisfaction. In this study, a simple random sampling was used for the emergency patients at a medical center. For our investigation we analyzed 196 samples gathered from 2000/01/08 to 2000/01/28. The result of this study are shown as follow:
1. Over one half of the triage patients were category III (55.6%), followed by category II (40.3%). Most of them are internal medicine patients and discharged in one day. There were significantly differences between perceived and actual waiting time. The longer the waiting time was, the larger the difference between actual and perceived time. Patient satisfaction caused by perceived waiting time was significantly higher than that caused by actual waiting time.
2. ED patients spent most time on waiting laboratory test results, followed by waiting x-ray test reports and on waiting to see the consulting doctor. The longer the waiting times were, the lower the satisfactions. Therefore, these three kinds of waiting times should be our first priority to improve the ED services.
3. Three of the patient characteristics (time of arrival, mode of arrival and disease pattern) were significantly associated with the waiting time of the ED. The characteristics of patients, such as sex, age, education, disease pattern, time of arrival and mode of arrival, were significantly associated with satisfaction.
4. The intervention during waiting laboratory test results could only reduce the time from specimen collection to login it, but it couldn’t speed up the laboratory testing time. Their satisfactions were the same as without intervention. However, the intervention shortened the waiting time for x-ray test results and significantly improved satisfactions.
This study suggest that
(1) It’s necessary to treat major and minor disease in separate rooms to meet the demand of minor disease patients, and to provide the information of waiting times for all patients to decrease dissatisfaction.
(2) The ED information system should be established. They will help doctors to deal with the patient’s reports in time and save the patient’s waiting time.