| Summary: | 碩士 === 輔仁大學 === 公共衛生學系碩士班 === 100 === Motivation :The increases in the number of emergency room visits and in the complexity of illnesses have become common worldwide problems. The general practice is to determine the level of medical emergency or priority through triage in order to provide timely and appropriate diagnosis and treatment. However, past studies found that in Taiwan, the four-level triage system still needed improvements in terms of identifying the level of urgency and the forecast of subsequent consumption of medical resources. Furthermore, foreign studies indicated that the five-level triage system was more effective. Taiwan has been using the five-level triage system since 2010.
Method：This study will investigate the impact on the quality of care for patients and the consumption of medical resources following the implementation of the five-level triage system.
The subject of this study involves the analysis of retrospective data collected from patients of an emergency department of a hospital in Northern Taiwan. The data was collected in two periods: from January to November of 2009 for four-level triage and from January to November of 2011 for five-level. The purpose is to compare the effectiveness of indicators between four-level and five-level triage systems. The study also uses logistic regression to analyze the impact on the quality of medical care due to the switch of triage systems. In addition, linear regression is used to examine the amount of wait time for medical care and the utilization of resources from the two triage systems.
Results : The study finds that the five-level triage system and the four-level triage system both use quality and medical indicators, (such as wait time in emergency room, revisit within three days, the final results and medical costs), to review their differences. The study results show significant differences between the two systems and influence over each other. The implementation of the five-level triage system appears to be more effective in identifying patients who need to be hospitalized, but faces an upward trend in key indicators such as wait time, medical costs and the rate of revisit within three days. Thus, it can be inferred from the study results that timely review, appropriate intervention and administration of a good system are necessary in the age of complex medical structure and diseases.
Conclusions : In general, there is an increase in the probability of emergency patients admitted for hospitalization in the five-level triage system. The rate of revisit within three days is slightly higher. The overall wait time also increases, but in this system, the wait time before treatment remains short for patients with high risk medical emergency. Lastly, the five-level triage system indeed results in the overall increase of medical costs.
Suggestion：The study recommends that hospitals allocate medical resources more effectively. Also, they need to improve the accuracy of system data input and create standard operating procedures (SOP) for diagnosis and treatment. Lastly, hospitals are advised to strengthen medical education for both staff and patients. With the implementation of such enhancements, the efficiency of emergency triage and the overall quality of the medical system can further be improved.
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