醫療品質雜誌Pub Date : 2023-07-01DOI: 10.53106/199457952023071704009
龔妍心 龔妍心, 紀鑫 紀鑫
{"title":"高危險族群肺炎鏈球菌感染之預防","authors":"龔妍心 龔妍心, 紀鑫 紀鑫","doi":"10.53106/199457952023071704009","DOIUrl":"https://doi.org/10.53106/199457952023071704009","url":null,"abstract":"\u0000 肺炎鏈球菌會潛伏在人類鼻咽部並引起疾病，常見的感染包括中耳炎、鼻竇炎和肺炎。肺炎鏈球菌有時會造成侵襲性肺炎鏈球菌感染症，尤其是在高危險族群的病人。肺炎鏈球菌疫苗被認為是預防感染最有效的方法，目前台灣臨床上可供使用的有1種多醣體疫苗PPV 23和2種結合型疫苗PCV13及PCV15。高危險族群可依照疾病管制署之肺炎鏈球菌疫苗接種建議，接受預防注射以保護自己不受肺炎鏈球菌感染。除此之外，流感感染後的繼發性細菌感染，最常見的菌種之一即為肺炎鏈球菌，因此每年接種流感疫苗亦是重要的預防方法。\u0000 Streptococcus pneumoniae bacteria are common inhabitants of the respiratory tract and can cause various diseases, including otitis media, sinusitis, and pneumonia. S. pneumoniae bacteria also cause invasive pneumococcal disease, especially in high-risk groups, and vaccines are regarded as the most effective method for preventing pneumococcal infection. The pneumococcal vaccines currently available in Taiwan are PPV 23, which is a pneumococcal polysaccharide vaccine, and PCV13 and PCV15, which are pneumococcal conjugate vaccines. High-risk groups should follow the vaccine recommendations of the Taiwan Centers for Disease Control to obtain protection from pneumococcal infections. S. pneumoniae is the most identified pathogen in patients with secondary bacterial infection following a primary influenza virus infection. Consequently, annual influenza vaccination is crucial for preventing pneumococcal infections.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117122984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
醫療品質雜誌Pub Date : 2023-07-01DOI: 10.53106/199457952023071704001
劉子弘 劉子弘, 吳燿光 Tzu-Hung Liu, 鄭敬楓 鄭敬楓
{"title":"國際趨勢─勝任能力導向醫學教育(CBME)應用與最新進展","authors":"劉子弘 劉子弘, 吳燿光 Tzu-Hung Liu, 鄭敬楓 鄭敬楓","doi":"10.53106/199457952023071704001","DOIUrl":"https://doi.org/10.53106/199457952023071704001","url":null,"abstract":"\u0000 當代勝任能力導向醫學教育(competency-based medical education, CBME)以可信賴專業活動(entrustable professional activities, EPAs)及里程碑(milestones)為兩項主要推動項目。描述專業工作的EPAs不僅能與描述個人能力的里程碑相輔相成，近年來因其可操作性高，成為國際CBME推動上的關鍵項目。Elaine Van Melle等人提出的CBME核心組成架構，包括成效能力、序列性進展、量身打造的學習經驗、聚焦於能力的指導、計畫性評估5項，可作為落實CBME的參考。在EPAs運用上，需有完整的八大描述項目，選定合適的信賴等級量尺，善用以信賴授權為導向的討論(entrustment-based discussion, EBD)等方式來評估，並參考A-RICH框架(Agency, Reliability, Integrity, Capability, Humility)來進行信賴授權決策。CBME可縱向延伸，自專科住院醫師訓練往醫學生及PGY階段發展，也能整合科技應用進行評估。在不久的將來，時間可變訓練計畫(time-variable training programs)極有可能成真，並會是CBME全面落實的指標。\u0000 The contemporary competency-based medical education (CBME) focuses on individuals’ entrustable professional activities (EPAs) and milestones. The EPAs that describe professional work complement the milestones that describe individual competencies. In recent years, EPAs have become a key component in international CBME due to their high operability. Elaine Van Melle et al. proposed five core components of CBME: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. This core components framework could facilitate the implementation of CBME. EPAs should be written using eight descriptive items, an appropriate entrustment scale, and assessment methods such as entrustment-based discussion; the A-RICH (Agency, Reliability, Integrity, Capability, Humility) framework should be employed to aid entrustment decision making. CBME may be extended vertically from resident doctor training to medical student training and postgraduate year training. Technologies may also be incorporated for assessment in CBME. In the near future, time-variable training programs are likely to be realized and will be an indicator for the full-scale implementation of CBME.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126538671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"勝任能力導向醫學教育中的群體決策-臨床能力委員會","authors":"黃子婕 黃子婕, 溫舒瑜 Tzu-Jie Huang, 劉政亨 Shu-Yu Wen, 呂曜廷 呂曜廷, 蔡巧琳 Yao-Ting Lu, 林煒柔 林煒柔, 黃國明 Wei-Jou Lin, 楊志偉 Kuo-Ming Huang","doi":"10.53106/199457952023071704002","DOIUrl":"https://doi.org/10.53106/199457952023071704002","url":null,"abstract":"\u0000 臨床能力委員會(Clinical Competency Committee, CCC)在勝任能力導向醫學教育的總結性評量中扮演重要的角色。委員會根據以評量藍圖執行的職場觀察評量結果，進行系統性的討論，對學員的能力進展做出公正可靠的判斷，回饋給相關利害關係人，並協助學員擬定個人化之補強訓練計畫。進行會議前應有共識會議、師資培育課程、及學員能力進展資料閱讀，事前的學員自我評量能夠促進學員與教師對學員能力進展的認知，並促進學員對於教師回饋的接納理解程度；會議中須建立結構化的決策過程，最終獲得客觀且可信的決策成果；會議後應向學員提供回饋，並協助制訂補強學習計畫或提供訓練協助規劃。藉由完善的CCC程序，可提升臨床醫事人員的訓練品質、教師教學水準、醫療服務品質及專業認同。\u0000 Clinical Competency Committee (CCC) plays a key role in the summative assessment of competency-based medical education (CBME). Specifically, CCC conducts systematic discussions according to the results of workplace observation and assessment derived from assessment blueprints to provide an accountable and reliable judgment on the progression of trainees’ competencies. CCC then informs assessment results to stakeholders and assists trainees in developing personalized remedial learning plans. CCC members should conduct a consensus meeting, complete faculty training courses, and review trainees’ competency development data before calling a CCC meeting . Student self-assessment should also be completed before the CCC meeting to improve trainees’ and CCC members’ understanding of the progress of their competency development and to ensure that trainees agree with and accept teachers’ feedback. During the CCC meeting, a structured decision-making procedure must be constructed for objective and credible decision-making. After the meeting, feedback should be provided to students to assist them in developing remedial learning plans or training assistance plans. A comprehensive group decision-making procedure should be carried out in CCC to improve the quality of clinical staff training, teaching, and medical services as well as the professional identity of clinical staff.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"274 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121253857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"臺灣醫事放射勝任能力導向醫學教育(CBME)推廣與可信賴專業活動(EPAs)建置經驗分享","authors":"陳嘉宏 陳嘉宏, 劉政亨 Chia-Hung Chen, 楊志偉 楊志偉, 黃子婕 Chih-Wei Yang, 吳銘哲 Tzu-Jie Huang, 陳惠萍 陳惠萍, 黃國明 Hui-Ping Chen, 杜俊元 Kuo-Ming Huang","doi":"10.53106/199457952023071704003","DOIUrl":"https://doi.org/10.53106/199457952023071704003","url":null,"abstract":"\u0000 勝任能力導向醫學教育(Competency-Based Medical Education, CBME)是近年來國際醫學教育趨勢，而可信賴專業活動(Entrustable Professional Activities, EPAs)是將CBME精神具體實行的方法之一。中華民國醫事放射師公會全國聯合會為落實醫事放射職類以勝任能力為導向的訓練，提供教師與時俱進的師資培育活動，遂擬定「醫事放射職類CBME訓練計畫三部曲」，透過三階段的方式推廣並落實能力導向醫學教育：「醫事放射學員的能力進展架構」-臺灣醫事放射職類可信賴專業活動的建置、「為勝任能力量身打造的教學與學習經驗」-CBME師資培訓推廣、「計畫性、系統性的評估設計與能力進展的行程」-醫事放射職類CBME訓練計畫全國執行。本會期望輔導各級教學醫院全面推廣台灣醫事放射職類CBME訓練與落實EPAs職場直接觀察教學，並建置執業模式下的能力進展架構與系統化評估，確保醫事放射師專業能力發展和教育品質提升。\u0000 Competency-based medical education (CBME) has become a trend in global medical education. Entrustable professional activities (EPAs) are one of the means to implement CBME. To provide up-to-date teacher training for implementing radiographers’ CBME, the Taiwan Association of Medical Radiation Technologists has organized a Three-Stage Radiographer CBME program. The three stages are as follows: (1) Competency development: establishing EPAs for radiographers. (2) Competency-oriented teaching and learning experience: promoting CBME teacher training. (3) Planned and systematic competency development and assessment: promoting and implementing the CBME teacher training program nationwide. Through the promotion of CBME, teaching based on direct EPA observations, as well as the establishment of a competency development framework and a systematic assessment model for in-service radiographers, the Association expects to improve the competency development of and education quality for radiographers in Taiwan.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131029097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
醫療品質雜誌Pub Date : 2023-07-01DOI: 10.53106/199457952023071704004
陳正文 陳正文, 許巍鐘 Jeng-Wen Chen, 王拔群 王拔群, 台灣耳鼻喉頭頸外科醫學會能力導向醫學教育核心小組 Pa-Chun Wang
{"title":"耳鼻喉頭頸外科運用Emyway平台推動EPAs系統性評量的經驗分享","authors":"陳正文 陳正文, 許巍鐘 Jeng-Wen Chen, 王拔群 王拔群, 台灣耳鼻喉頭頸外科醫學會能力導向醫學教育核心小組 Pa-Chun Wang","doi":"10.53106/199457952023071704004","DOIUrl":"https://doi.org/10.53106/199457952023071704004","url":null,"abstract":"\u0000 勝任能力導向的醫學教育(competency-based medical education, CBME)是以在地社會的期待與民眾需求為出發點，由各健康照護專業共識制訂循序漸進的核心能力架構，建置系統性的評量工具，落實聚焦於能力且個人化的學習體驗，在平衡病人安全、醫療品質與臨床學習效率的前提下，有計畫地培育健康照護專業人員，以確保所有完訓學員都能具備獨立執業的能力並達到預先訂定的精熟標準。推動CBME的關鍵步驟之一在於如何運用資訊平台，建構系統性「可信賴專業活動」(EPAs)的職場教學評量機制，持續分析、回饋、驗證並改善執行成效。台灣耳鼻喉頭頸外科醫學會於2021年加入醫策會「醫事專業人員能力進展資訊平台」(Emyway)開發計畫，成為國內第一個建置完成、測試並順利全面推動EPAs系統性評量的專科醫學會，本文將分享此推動的過程與初步成果，提供其他健康照護專業參考。\u0000 Competency-based medical education (CBME) is an approach that focuses on developing core competencies in healthcare professionals, considering the expectations of the local community and the needs of the population. It requires several processes, including the collaborative effort of the healthcare professions to construct a progressive framework of competencies, establish a programmatic assessment system, and implement an individualized learning experience that emphasizes competence. This approach balances patient safety, healthcare quality, and clinical learning efficiency to cultivate competent healthcare professionals systematically. The ultimate goal of this approach is to ensure that all graduates can practice independently and meet predetermined proficiency standards. One of the key steps in promoting CBME is using an information platform to construct an “Entrustable Professional Activities” (EPAs) assessment system for workplace-based teaching and learning. This platform facilitates ongoing analysis, feedback, validation, and improvement of the implementation process. In 2022, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery became the first specialty medical association in Taiwan to complete the development, testing, and full-scale implementation of EPAs through its participation in the “Emyway project” initiated by the Joint Commission of Taiwan. This article aims to share this initiative’s process and preliminary results, providing a reference for other healthcare professions.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126369388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"運用資訊自動化提升OSCE管理效率","authors":"施心筑 施心筑, 吳書能 Hsin-Chiu Shih, 尤琬筑 Shu-Neng Wu, 許郁笙 Wan-Chu Yu","doi":"10.53106/199457952023071704005","DOIUrl":"https://doi.org/10.53106/199457952023071704005","url":null,"abstract":"\u0000 客觀結構式臨床技能測驗（Objective Structured Clinical Examination, OSCE）需大量人力物力支持，本品質改善專案意在藉由資訊自動化、線上化，提升OSCE管理效率。活動中藉由建置OSCE網站、運用資訊自動化概念設定評分自動換算彙整模組、擬定並執行考官培訓計畫，大幅改善管理效率。品質改善活動後籌備時間自184小時減少至132小時，紙張耗費量從1224張紙減少至696張紙，考官成員數量自26位增加至31位。整體而言，品質改善專案的執行達成預定的目標，未來除持續執行之外，也將加強文件管理與備份，以專用帳號管理OSCE網站與雲端硬碟文件，定期下載備份資料以確保資料完整性。\u0000 Objective Structured Clinical Examinations (OSCEs) require substantial investments in terms of human and material resources. Thus, this Quality Enhancement Project aims to increase the efficiency of OSCE administration through the automation of online access to information.In this project, an OSCE website was established to substantially improve management efficiency, information automation was achieved by implementing a module for automatic score conversion and aggregation, and an examiner training plan was designed and implemented.Through various quality improvement activities, the preparation time for OSCE was reduced from 184 to 132 h, paper consumption was reduced from 1,224 sheets to 696 sheets, and the number of examiners was increased from 26 to 31. Thus, the overall objective of the Quality Enhancement Project was achieved.In the future, the project should be continued, file management and backup processes should be enhanced by managing the files on the OSCE website and cloud storage platforms through a dedicated account, and data should be regularly backed up to ensure data integrity.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125483950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
醫療品質雜誌Pub Date : 2023-07-01DOI: 10.53106/199457952023071704006
陳怡君 陳怡君, 周佳慧 Yi-Chun Chen
{"title":"運用選才、留任策略降低新進護理人員離職率","authors":"陳怡君 陳怡君, 周佳慧 Yi-Chun Chen","doi":"10.53106/199457952023071704006","DOIUrl":"https://doi.org/10.53106/199457952023071704006","url":null,"abstract":"\u0000 目的：探討新進護理人員離職率高，期望有效降低離職率，提升照護品質。材料與方法：實施對象為新進三個月的護理人員，本專案執行期間自2018年1月1日至2019年4月30日，統計2017年新進護理人員離職率高達23.5% (35/149)，歸納主要離職肇因：一、工作壓力及適應；二、離家遠/偏僻，予介入策略：一、創意〝搶人大作戰〞選才招募博覽會；二、新人關懷座談會；三、多元壓力調適措施（禪繞畫、心情卡）；以及四、互動式愛的傳承卡。結果：經專案實施後，新進人員離職率由23.5% (35/149)降至至11.3% (7/62)，目標達成率高達104.3%。結論：統計2020年至2021年效果維持期仍有10.3% (9/87)~17.9%（12/67），冀望此文章之分享，可作為護理人力資源管理之參考。\u0000 Purpose: This study investigated the effectiveness of a project for reducing the high turnover rate of new nursing staff. Because of the rural location of our hospital, talent recruitment and retention are challenging. The high turnover rate of nursing staff exacerbates the human resource shortage problem, which in turn increases training cost and affects quality of care. Materials and Methods: This project targeted the new nursing staff of the hospital and was implemented between January 1, 2018, and April 30, 2019. According to statistics, the turnover rate of new nursing staff was 23.5% (35/149) in 2017, and the main reasons for nurses leaving were (1) personal factors (e.g., work stress and adaptation difficulties) and (2) working environment–related factors (e.g., working far from home or in remote areas). Thus, a nurse retention strategy involving the following measures was formulated: a talent campaign implemented through a creative talent recruitment fair, new recruit care symposiums, and diverse work-pressure reduction measures (including the use of zentangles, mood cards, and interactive inheritance cards that are focused on love). Results: The turnover rate of new recruits decreased from 23.5% (35/149) to 11.3% (7/62), and the target retention rate reached 104.3%. Conclusion: This project is an ongoing project, and during the effective maintenance period from 2020 to 2021, the rate still increased from 10.3% (9/87) to 17.9% (12/67). The findings of this study can serve as a reference for the management of nursing staff.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126977713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"降低影像醫學科常規攝影檢查重照率","authors":"李宗憶 李宗憶, 丁詩偉 Zong-Yi Li, 陳善慈 Shih-Wei Ding, 林佳蓁 Shan-Tzu Chen, 李尉琦 李尉琦, 陳建成 Wei-Ci Li, 張瓊文 張瓊文, 朱惠珍 Chiung-Wen Chang","doi":"10.53106/199457952023071704007","DOIUrl":"https://doi.org/10.53106/199457952023071704007","url":null,"abstract":"\u0000 <p>統計2020年1~3月本科常規攝影平均重照率為6.41%。透過品管圈手法將主要重照原因分為「擺位不佳」、「體外異物」、「病人躁動」、「閉氣不佳」、「吸氣不足」及「項目條件錯誤」。經圈員們參考文獻與腦力激盪，根據三現原則、真因驗證，擬定6個對策群組共18項改善對策。包含對策群組1.神龍「擺位」、對策群組2.「異」不容辭、對策群組3.「靜」善「靜」美、對策群組4.不怕英雄氣短、對策群組5.告別雞同鴨講、對策群組6.望「成」莫「急」。對策實施後，X光影像重照率從改善前6.41%降低至3.43%。改善成果達到業界第一，並成為同儕標竿水準，未來將持續落實及精進對策的實施。</p>\u0000<p> </p><p>According to statistics, the average re-take rate of routine radiography from January to March 2020 is 6.41%. Using the method of quality control circle, the main reasons for re-take were divided into \"\"poor positioning\"\", \"\"foreign body\"\", \"\"patient agitation \"\", \"\"poor breath retention\"\", \"\"insufficient breathing\"\" and \"\"wrong item conditions\"\". After referring to the literature and brainstorming by the circle members, according to the principle of three occurrences and True Cause Verification, a total of 18 improvement countermeasures were drawn up in 6 countermeasure groups.The countermeasure groups content 1.\"\"well positioning\"\",2.\"\"without foreign body \"\",3.\"\"stand still\"\",4.\"\" well breath retention \"\",5.\"\" sufficient breathing\"\",6.\"\"right item conditions\"\". After the implementation of the countermeasures, the re-take rate of X-ray radiography decreased from 6.41% to 3.43%. The result is to reach No.1 and become the benchmark in the industry. In the future, we will continue to implement and improve the implementation of countermeasures.</p>\u0000<p> </p>\u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131203112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
醫療品質雜誌Pub Date : 2023-05-01DOI: 10.53106/199457952023051703009
譚家偉 譚家偉, 程毅君 Ka-Wai Tam
{"title":"明智選擇 ? 醫療狂飆後的反思運動","authors":"譚家偉 譚家偉, 程毅君 Ka-Wai Tam","doi":"10.53106/199457952023051703009","DOIUrl":"https://doi.org/10.53106/199457952023051703009","url":null,"abstract":"\u0000 近年來衛生福利部倡議明智選擇(Choosing Wisely)，各醫療院所亦開始思索如何投入此運動。明智選擇是為了壓制低效益醫療對病人安全的傷害及醫療成本的損耗，在2012年由美國內科醫學會基金會開始倡議的新觀念，之後國際間相繼響應成為一項全球性的運動。活動透過各學會提出其領域最常見的5到10項過度診斷或過度治療的項目，彙整後形成一個建議清單，讓醫療人員及民眾得知哪些處置為低效益醫療，以便揚棄或減少使用。要正確執行明智選擇可透過限制、減量、和溝通三種方法來達成。醫病共享決策(Shared Decision Making, SDM)很多時候是協助溝通來達成明智選擇的手段之一。本文除了闡述了明智選擇的內涵、源起及執行方式，也說明了它和SDM的差異，希望對讀者認識及實踐明智選擇有所幫助。\u0000 As the Ministry of Health and Welfare campaigns for the idea of “Choosing Wisely,” hospitals in Taiwan have been working to see how they could contribute to this campaign. An initiative proposed by the American Board of Internal Medicine (ABIM) Foundation in 2012, Choosing Wisely serves to reduce the harm of low-value care to patient safety and the cost due to such care. This initiative later became a global movement with the support it gained from countries worldwide. In an event held by ABIM, they asked the participating associations to list 5 to 10 most common types of overdiagnosis or overtreatment in their fields. Based on items they provided, a list was then compiled to inform health-care professionals and the public of the low-value care practices for them to decide whether to stop or reduce such practices. The implementation of Choosing Wisely can be achieved through the actions of “Limit, Lean, or Listen”. Shared decision making is one of strategies to achieve Choosing Wisely through “Listening”. This article discussed the meaning, history, and implementation of Choosing Wisely and how it differs from shared decision making, with the aim of improving readers’ understanding and practice of Choosing Wisely.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128213439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
醫療品質雜誌Pub Date : 2023-05-01DOI: 10.53106/199457952023051703003
邱柏惟 邱柏惟
{"title":"重大創傷跳島轉診以及5G智慧救護車","authors":"邱柏惟 邱柏惟","doi":"10.53106/199457952023051703003","DOIUrl":"https://doi.org/10.53106/199457952023051703003","url":null,"abstract":"\u0000 成大醫院急診部在2019年提出「特殊傷病患跳島策略」，縮短運送時間，透過連結院前救護和院後治療的方式，讓患者在短時間內得到初步評估和穩定生命跡象，並且安全轉送至醫學中心接受適切治療。自2020年起，已有55位生命徵象不穩定的重大傷病患透過此轉診模式由偏鄉地區轉診至成大，其中有43位存活離開急診並接受後續療。2022年成大急診部與遠傳電信合作，推出2.0版本的跳島策略，透過5G科技導入智慧救護，包括視訊通訊、遠程監控、智慧救護車和智慧穿戴等，提高到院前的醫療品質和效率。期待已此模式當成一個＂pilot study＂；讓5G通訊技術在未來的緊急醫療中扮演更重要的角色，造福更多的病人。\u0000 In 2019, the National Cheng Kung University (NCKU) Hospital Department of Emergency Medicine proposed an “island hopping” strategy for patients with special injuries to shorten patient transportation time. Specifically, through the coordination of prehospital care and posthospital treatment, patients can be assessed and stabilized t an early stage within a short time and transferred safely to a medical center for appropriate treatment. Since 2020, 55 critically injured patients with unstable vital signs have been referred to NCKU Hospital from remote areas through this transfer model, with 43 of them discharged from the emergency department alive and receiving follow-up treatment. In 2022, NCKU Hospital Department of Emergency Medicine collaborated with FarEastone Telecom in formulating Version 2.0 of the island hopping strategy, which incorporates smart emergency care through the use of 5G technology to facilitate the implementation of video communication, remote monitoring, smart ambulances, and smart wearable devices. The smart emergency care model improves the quality and efficiency of prehospital care. This model shall constitute a pilot study for incorporating 5G communication technology as a key instrument for emergency medicine to benefit more patients.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"706 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116122111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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