泌尿部住院病人出院72小時內重返急診之改善成效
謝佳容12、陳安貞12、歐建慧1
國立成功大學醫學院附設醫院 泌尿部1、護理部2
The Effectiveness of Improvement Towards Inpatients Who Returned to Emergency Department Within 72 Hours After Discharge at Urology Department
Chia-Jung Hsieh1,2, An-Chen Chen1,2, Chien-Hui Ou1
Department of Urology and Department of Nursing, National Cheng Kung University Hospital
Purpose: Episodes of inpatients returning to the emergency department (ER) after discharge would not only enhance the consumption of medical resource, increase the rates of complications. It is also the indicator of monitoring the medical quality. In 2015, the total number of discharges in our medical center was 52,027 person-times, with 1,287 person-times (2.5%) of returning to ER within 72 hours after discharge. At urology department, the total number of discharges was 2,021 person-times, with 67 person-times (3.3%) of returning to ER within 72 hours after discharge. In order to decrease such incidence rate, and to furtherly enhance the quality of medical cares, we put on much discussion about associated factors towards those who returned to ER within 72 hours after discharge.
Materials and Methods: Our research included the patients returning to ER within 72 hours after discharge from urology ward at National Cheng Kung University Hospital during 2015-2019. We also investigated on their medical records and orders during admission and at ER, and listed the causes for analyzing the problem and establishing strategies for improving such condition with PDCA (Plan-Do-Check-Act). We then analyzed the data by the software SPSS.
Results: In 2015, acute urinary retention (28%) were the main causes for patients returning to ER, so we took steps to remove Foley tube in the early morning and measure the post-voiding residual urine volume (PVR) during the daytime. In 2016, episodes of bleeding (24%) were the main causes, while “others” predominated the main causes in 2017. Therefore, we conducted telephone interviews from 2017 within the 48 hours after discharge and offered self-care instructions for patients after discharge according to their urological diseases. We also offered sheets of algorithm for patients who returned to out-patient department earlier than it was scheduled. In 2018, pain predominated the main causes with incidence rate of 31% and we furtherly discovered that those episodes were mostly associated with the irritation of double-J stents. Since then, we adjusted pain killer in the post-operative order package. Acute urinary retention still played a big role (29%) so we introduced a device of portable bladder scan for measuring PVR since 2019. By doing these, The incidence rate of returning to ER decreased from 3.43% to 1.72%(p<0.05) at urology department in our center.
Conclusion: We analyzed the causes of inpatients who returned to ER within 72 hours after discharge and established strategies for such condition since 2015 with PDCA method. The incidence rates has been decreased and had reached the statistical significance in 2018. In 2019, the incidence rate was lower than that of the average value in our hospital. We will follow these incidence rates during the monthly conference of medical quality control.