| Summary: | 碩士 === 東海大學 === 工業工程與經營資訊學系 === 95 === Emergency care is one of the major part of health care. In emergency department (ED), patients who leaving without complete treatment (LWCT) is one of the important indicators for emergency care. In this study, we aimed to investigate the causes of LWCT according to clinical care, patients and medical system factors. There might be some factors related to improve the quality of emergency health care.
We design a cross-sectional study for patient who LWCT in emergency department in a medical center in middle Taiwan. There was two steps in this study. The first steps is the designation of a cause questionares for LWCT. The questionares is base on literal review and expert opinions of physician and nurses. All patients who LWCT were included during study period. According to the process, patients LWCT were divided into against advised discharge(AAD)、leave without being seen（LWBS）and leaving without complete seeing（LWCS）)。Patients of AAD or their family received the questionare at scene. The questionares for patiens of LWBS or LWCS could not be available at ED, so these questionares were completed by a follow-up telephone call. The statistic analysis was performed by SPSS for Window. Statistical analysis with the statistical Package for Social Science program (SPSS, Chicago, IL, U.S.A) was used for analysis. The continuous data of each group was expressed as Mean ± SD and compared with one way ANOVA. The discrete data were compared by c2 test. All statistical tests were two sided and a p-value less than 0.5 were defined as significant difference between groups.
Among Jul. 2006 to Oct. 2006, 20295 patients visit emergency department in this hospital. Four hundred and thirty eight patients (2.15% of all patients visiting ED) were included in patints of leaving without complete treatment. There were 401 patients met the criteria of AAD (91.6% in LWCT), 2 patients LWBS (0.4%) and 35 patients LWCS. There were 310 valid questionares. The major 3 causes of LWCT were personal factors in 259 (83%), medical systemic factors in 43 (13%), and medical care in 8 patients (3%). The medical systemic factors of AAD were related to patient’s economic status, nativity, and disease category. Patient’s ED staying time may be related to AAD. The staying time of AAD due to medical systemic factor was longer than that of personcal factor. The satisfying degree by scoring was also related to cause of AAD. Our result demonstrated that the satisfying score of personal factor, medical systemic factor and medical care were 4.08 ± 0.62, 3.51 ± 0.86, and 2.63 ± 1.19, respectively). The causes of AAD were also related to patient’s recommendation for others to this hospital, personal factor (95.8%), medical systemic factor (81.4%), and medical care factor (25%).
In this study, the most common causes of LWCT were personal factor and medical systemic factor. The medical care factors were related to patient economic, nativity and disease category. The medical systemic factor was related to patient staying time, satisfying score, and patient’s recommendation to visit. In this study, we demonstrated that LWCT is multiple factorials and related to quality of emergency care.
Our result could provide some notions that the leaders of government of health care, hospital or nursing care establish the policies for LWCT patients in emergency health care. We suggest that the health care providers could educat the patients or relatives, physicians could discuss the disease with patients in details, and nurses could give more informations to patients for health care. For the ED or hospital, we suggest that emergency physicians would give more detail studies according to clinical condition in ED, a patient-centered discharge plan for follow-up or referring, and continuous monitering emergency health care quality for LWCT patients.
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