呼吸照護中心呼吸器管路更換策略之效性探討

蕭 秀鳳, 周 蘭娣, 黃 淑芬, Ying-Huang Tsai, 江 秉誠, Kuang-Hung Hsu

Research output: Contribution to journalJournal Article peer-review

Abstract

醫療服務品質往往與執行治療或照護過程有相當大的關係,如何控制此過程提升醫療品質是困難卻很重要的。大多數研究證實:呼吸器相關肺炎的發生與呼吸器管路的更換頻率沒有直接相關,本研究欲探討呼吸器管路不作例行性更換,對醫療品質之影響及醫療費用的相關性。 本研究於北部某醫學中心呼吸照護中心(24床)使用呼吸器病患,共收樣本數60人,採隨機分配方式,選取對照組與實驗組各30人,記錄下呼吸道感染率、住院日、及住院費用。在實驗組與對照組的性別、年齡、是否洗腎、是否氣切、預後狀況之比較,皆未達統計顯著差異。而呼吸器相關肺炎發生機率,實驗組與對照組分別?2.1/1,000與1.1/1,000、呼吸照護中心(RCC)停留天數實驗組與對照組分別?33.7(±29.18)天與33.87(±21.73)天、及呼吸照護中心花費實驗組與對照組分別?632,194.36(±465,062.12)元與635,702.33(±356,923.82)元亦未達統計顯著差異。不例行換管者,其醫療耗材及人工工時,皆比原始方案節省。 不例行更換呼吸器管路,並不會增加呼吸照護中心病人的呼吸器相關肺炎發生機率,在總額預算制度下,確實具有降低成本的效益。
The quality of medical service is closely related to the ways of treatments and care delivered to the patients. Procedure based research is vital for improving the quality of medical service. The frequency of replacing ventilator tubing is one of the most important factors related to the occurrence of ventilated associated pneumonia (VAP), however limited evidence was appeared in the previous documents. This study aims to investigate the effect of ventilating tubing replacement on the quality and cost of medical care. A total of 60 patients admitted to the respiratory care center of a medical center were evenly randomized to groups of experiment and control. The occurrence of lower respiratory tract infections, hospital stays, and medical consumptions were collected during the study period. The baseline information including age, sex, hemodialysis, and tracheostomy were not statistically significant between experimental groups. The comparison between experiment group and control group on ventilated associated pneumonia (2.1/1,000 vs 1.1/1,000), RCC stay (33.7 ± 29.18 days vs 33.87 ± 21.73days), and RCC medical consumptions (632,194.36 ± 465,062.12 NTD vs 635,702.33 ± 356,923.82 NTD) failed to show statistical significance. None routine replacement of ventilating tubing had shown to be lower in medical consumables and personnel works. The study has demonstrated that non-routine replacement of ventilating tubing can reduce medical cost, increase efficiency, and contain infections under global budget. Therefore, a recommendation of non-routine replacement of ventilating tubing in ventilating care center is made from this study.
Original languageChinese (Traditional)
Pages (from-to)43-54
Journal呼吸治療
Volume10
Issue number1
StatePublished - 2011

Cite this