中文摘要
急診是醫療體系中的重要一環，但近年來許多大型醫學中心面臨「過度壅塞」的困境。當急診就醫人數過度增加，超過配置人力及設備，極易導致急診過度負荷，此種窘境排擠真正急重症病患所需要的資源，會嚴重影響急診的服務品質，危及病人安全，降低醫護人員工作士氣。
急診病患壅塞問題複雜，根源絕非單一因素，往往源自多面向，解決方法亦是多方向多層次考量，需醫院各科彼此建立共識，集思廣益齊心處理，整體醫療團隊合作使能竟其全功。
本研究利用輸入-處理效能-輸出（Input-Throughput-Output model）三階段的概念模型。把急診過度壅塞分成三個流程階段討論，找出各階段可能的原因，擬定其相對應可能解決的方案，再觀察進行改善所獲得的成效。本文我們選定某醫學中心急診就診病患進行改善研究，研究時間由西元2008年一月至2009年十二月，以急診病人進行前瞻性分析研究。
本研究在「輸入」面透過緊急醫療網通報滿床次數，算出每天各時刻滿床次數，當作人力調度參考；在「處理效能」方面、首度以層析分析法算出醫師不同情況的工作負荷權重來做不規則彈性排班調整醫師人力的參考；在「輸出流程」方面，讓急診簽床透明，讓住院病患入出院手續加速。另外宣導民眾改變就醫觀念，轉介適當的病患到策略聯盟區域醫院亦值得做。
降低醫學中心急診壅塞狀況，使就醫病患生命安全更有保障，讓醫學中心醫護同仁維持良好士氣免於過多不當負荷，提供真正重度急症病患緊急醫療，達到醫學中心照顧急重症病人的全人照護的使命。

Abstract
Background: Emergency department (ED) overcrowding has become a significant problem throughout the large medical centers, leading to possible threatened medical quality, causing raised stress levels among staff and patients in EDs, and most importantly, adversely affecting patient outcomes. Due to its complexity, a large concerted group effort will be needed to increase awareness, implement proposed solutions, and make a change. ED overcrowding is a multifaceted problem that will require a multifaceted solution.
Methods: We set up the "Input-Throughput-Output" model provides a structure for examining the factors that affect ED access, quality and outcomes. Using this model, we clarify the issues of ED overcrowding into three stages, propose ways to obtain needed information in each stage, test the strategies and then evaluate their outcomes. We utilized the analytic hierarchy process (APH) method to measure the weights of the physician’s stress and arrange more efficacious and flexible duties accordingly.
Results: This is a prospective study investigating ED overcrowding at this medical center from January 2008 through December 2009. Hospitals developed and implemented a number of best practices revolved around patient flow initiatives, specifically looking to improve input, throughput, and output.
Conclusion: This study suggests that a decrease in ED overcrowding can be achieved through ongoing collaboration of the indicators and the implementation of best practices via the Input-Throughput-Output model.

目錄
中文摘要•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••I
英文摘要••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••II
致謝詞••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••IV
前言••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••1
第一章 緒論
第一節 背景與重要性 ••••••••••••••••••••••••••••••••••••••••3
第二節 研究目的、研究問題與研究假設 •••••••••••••••••••••4
第二章 文獻回顧與理論
第一節 急診過度壅塞的文獻••••••••••••••••••••••••••••••••••6
第二節 國內急診過度壅塞的狀況•••••••••••••••••••••••••••••7
第三節 急診過度壅塞的定義•••••••••••••••••••••••••••••••••13
第四節 急診過度壅塞的相關研究•••••••••••••••••••••••••••••14
第三章 研究方法
第一節 研究目標及設計 •••••••••••••••••••••••••••••••••••••18
第二節 研究樣本 ••••••••••••••••••••••••••••••••••••••••••••19
第三節 輸入-處理效能-輸出模型 ••••••••••••••••••••••••••••19
第四章 研究結果
第一節 急診病人的背景分析••••••••••••••••••••••••••••••••••21
第二節 建立輸入量的原因、相關指標及解決措施•••••••••••••26
第三節 建立處理效能的原因、相關指標及解決措施•••••••••••29
第四節 建立輸出流程的原因、相關指標及解決措施•••••••••••32
第五章 討論
第一節 減少病人輸入量的因應方案••••••••••••••••••••••••••35
第二節 透過通報滿床機制之數值設計評估改善措施••••••••••37
第三節 健保每季末病患轉院潮對急診輸入量之影響••••••••••39
第四節 增進處理效能及改善急診流程••••••••••••••••••••••••40
第五節 利用層次分析法(AHP)調查醫師工作負荷壓力•••••••••43
第六節 輸出流程的改善措施與檢討••••••••••••••••••••••••••49
第七節 實施改善措施獲致之成效•••••••••••••••••••••••••••••59
第六章 研究結果於急診實務的應用••••••••••••••••••••••••••••••••62
第七章 結論與建議
第一節 結論•••••••••••••••••••••••••••••••••••••••••••••••64
第二節 研究限制與建議•••••••••••••••••••••••••••••••••••64
參考資料
中文學術期刊•••••••••••••••••••••••••••••••••••••••••••••••••66
報紙媒體••••••••••••••••••••••••••••••••••••••••••••••••••••••67
英文學術期刊••••••••••••••••••••••••••••••••••••••••••••••••

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報紙媒體

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