|摘要: ||加護病房死亡率為台灣臨床成效指標(Taiwan Clinical Performance Indicator, TCPI)中綜合照護類別指標之一，係加護病房照護品質監控項目，是一項重要的結果面指標。透過該指標與其他照護監測指標間的分析與研究，可達到持續進行品質控制與監測及預防照護的疏失，進而提升重症加護單位病人照護品質與安全，持續作為醫院內部品質監測與管理成效之依據。
Intensive care unit mortality is one of the general care category indicators in the Taiwan Clinical Performance Indicator (TCPI). The intensive care quality monitoring project is an important outcome indicator. The analysis and study among those indicators could do continued quality control and monitoring and prevent carelessness then to improve the quality and safety of patient care in critical care units as the basis of internal quality monitoring and management effectiveness of hospital constantly.
We reviewed and collected 17 indicators of TCPI that were monitored for boht medical and surgical ICU from 2014 to 2016 by month. The mortality rate of both ICUs was also collected in this period. The association between these indicators and mortality rate was analyzed. The relationship among all indicators was examined. Furthermore, the comparison between medical (46 beds) and surgical (35 beds) ICU was performed. The main findings of our study are listed as below:
1. Significant difference in 7 performance indicators was noted between medical and surgical ICUs.
2. The use of ventilator, the incidence of central catheter-related bloodstream infection (CLABSI) and the incidence of catheter-related urinary tract infection (CAUTI) were higher in medical ICU than surgical ICU. The use of central venous catheters, the indwelling catheters and the incidence of ventilator-associated pneumonia (VAP) were higher in surgical ICU than medical ICU.
3. In medical ICU, except CAUTI, there was no significant difference among seasons in mortality and other indicators. It is only the incidence of pressure sore that revealed seasonal difference in all the indicators in surgical ICU.
4. Significant difference in the return to ICU unplanned within 24 to 48 hours, the use of central venous catheter, the use of ventilator and restraint was noted among the different length of stay (LOS).
5. The return to ICU unplanned within 24 hours, and the return to ICU unplanned more than 48 hours were lower but significant correlation with mortality rate in medical ICU.
6. Regression analysis indicated the return to ICU unplanned within 24 hours was the significantly independent factor associated with mortality rate in medical ICU. In surgical ICU, the indwelling catheter use and the use of ventilator use were two significantly independent factors related to mortality of surgical ICU.
Our results found the mortality rate and some indicators were significantly different between medical and surgical ICUs. With regards to the changes of season and the LOS, we noted some significant difference in terms of mortality rate and performance indicators. Several performance indicators: the return to ICU unplanned within 24 hours, the indwelling of catheter and the use of ventilator were significant factors of mortality rate of ICUs. In conclusion, due to the results of our study, it is suggested that the TCPI monitoring project adjustment and management mechanism be reformed based on the differences between medical and surgical ICUs. The continuous monitoring and review of those indicators of the return to ICU unplanned within 24 hours, the return to ICU unplanned within 24 to 48 hours, the use of central venous catheter, the use of ventilator, the indwelling catheter use, endotracheal tube removal unplanned and restraint could maintain and improve the quality and safety of patient care in critical care units.