| 摘要: | 加護病房是重症病患治療最重要單位，也是一個整合專業醫療團隊合作與眾多醫療儀器集中之地。專業團隊須透過密集的溝通與資訊交換來進行醫療照護決策，由於醫療決策及處置大部份都具時效及緊急性，因此資訊的收集、傳遞及處理是照護關鍵。護理人員則是整體團隊中最重要的資訊管理者，如何即時有效的整合來自直接照護與醫療儀器所產出之相關資料與資訊，統整作為溝通與交班之依據，是相當艱鉅與困難的任務。然而傳統紙本及口頭交班模式欠缺交班結構性、資訊彙整困難耗時，且無法即時更新，易導致病患照護資料疏失或遺漏，對病人照護品質與安全有很大的影響，因此為落實交班資訊傳遞之完整性、正確性與及時性，須發展標準化且具結構性及系統性之交班規範，並能提供即時資訊獲得，以利追蹤與更新。而隨著電子病歷發展與醫院作業資訊化之廣泛，透過資訊科技之應用來整合臨床照護與醫療儀器等資訊所發展之交班資訊系統，被實務界與學者認為是可行之方案，然而資訊系統之發展與使用成效評估，能否為使用者所接受，為影響此系統發展成功之關鍵因素。本研究以Petter & McLean(2009) 之彙整性分析所提出之資訊系統成功模式於個人層級之所得之分析結果為依據，並參考護理人員使用醫療資訊系統之相關文獻，來發展研究架構，從使用者:加護病房護理人員之觀點探討影響交班資訊系統使用滿意度與系統成效。採問卷調查法，以南部某醫學中心之八個加護單位護理人員為調查對象，透過網路問卷，進行資料收集，共收集有效問卷201份，資料以AMOS統計軟體進行結構方程模式分析，並以整體模式配適度之契合度指標進行研究模式驗證，整體模式配適度指標均達可接受標準。研究結果發現：資訊品質(0.531***)與服務品質(0.421***)顯著影響使用者滿意度(R2=0.827)、使用者滿意度顯著影響系統成效(0.893***, R2=0.789)，系統品質(0.017)未達顯著性；而系統成效總平均數為2.25(SD=0.832)，以使用交班資訊系統可以改善我照護的決策品質(Mean=2.32)與使用交班資訊系統可以提升病人安全(Mean=2.29)最高。護理人員進行病患之臨床照護中，對交班資訊系統產生之資訊品質最為關注，因對醫療照護決策具有很大的影響。而系統整合不同資料來源的能力、產出的資訊正確性、即時性、完整性、以及資訊內容呈現方式與清晰度是否符合其專業需求，是相當重要的系統發展考量。又系統成效評估中以使用交班資訊系統可以改善照護的決策品質、提升病人安全、增加工作滿意度之成效較高，而可以提升單位整體的管理效能最低，此結果可以反應交班資訊系統之發展與現況使用者對系統成效之評價， 以提供未來在系統改善與維護之參考依據。而本研究結果可供系統發展者了解加護病房護理人員對影響交班資訊系統使用滿意度之關鍵因素，以作為系統發展與改善之參考；並提供管理者了解影響使用者對交班資訊系統使用成效評估，以作為在未來相關系統開發及維護之參考。
Intensive care units (ICUs) are the most essential departments in treating critical patients. At ICUs, professionals of multiple disciplines work together as a team in an environment that provides access to various pieces of medical equipment. Medical teams make medical decisions through frequent communication and information exchange. Medical treatments are typically urgent and decisions must be time-efficient; thus, information collection, delivery, and processing are critical in care provision. Nurses are the most crucial information managers on medical teams, and bear the difficult task of integrating information obtained from direct care and information produced by medical equipment in a timely and efficient manner, as well as compiling such information for subsequent communication and handoff. The conventional written and verbal handoff practices lack structure and makes summarizing information difficult and time-consuming. Such practice also hinders real-time update of information. This easily leads to information negligence or loss during handoffs, which greatly affects the quality and safety of patient care. Therefore, it is essential to develop standardized, structured, and systematic handoff guidelines to ensure the integrity, accuracy, and timeliness of information delivery in handoffs. The timely provision of information is also essential for follow-ups and updating. With the development of electronic medical records and healthcare information systems, a handoff system that applies information technology in integrating clinical care and information from medical equipment is theoretically and practically feasible. However, the success of this system largely depends on whether its development and the results of its effectiveness evaluation are acceptable by users. The research framework of this study was developed based the information systems success model at the individual level proposed by Petter and McLean (2009) and literature on the efficiency of medical information system application in nursing. This research aims to examine satisfaction with the handoff information system and system effectiveness from the perspective of users, specifically ICU nurses. An online questionnaire survey was used to collect information from nurses working in eight ICUs in a hospital in Southern Taiwan. A total of 201 valid questionnaires were collected. The AMOS statistics software was used to perform structural equation modeling on the data; the overall model fit indices all achieved the standard. The study framework included four research hypotheses, and three were supported. The results showed that information quality (0.531***) and service quality (0.421***) significantly affected user satisfaction (0.893***, R2 = 0.827), and that user satisfaction significantly affected system efficiency (R2 = 0.789). System quality and service quality accounted for 82.7% of the overall variability of user satisfaction. User satisfaction explained 78.9% of the overall variability of system efficiency. The results for system quality (0.017) failed to show statistical significance. Regarding the delivery of clinical care to patients, nurses are mostly concerned about the quality of the information generated by the handoff information system because of its substantial impact on medical decision-making. Whether the handoff information system has the capacity to integrate information from multiple sources, generate accurate, timely, and comprehensive information, and present information with a level of clarity that satisfies professional needs are vital aspects that must be considered during system development. Increased satisfaction with the handoff information system among ICU nurses and enhanced system efficiency can improve internal communication, work efficiency, and quality of care. The results of this study can assist system developers in understanding the key factors affecting the satisfaction of ICU nurses with handoff information systems, and can subsequently facilitate system development and improvement. Furthermore, the results can enable managers to identify the factors that influence user evaluations regarding the effectiveness of handoff information systems and serve as a reference for the development and maintenance of future systems. |
