「最後一公里」的溫馨，縮短內科病房辦理出院等候時間之專案

背景：根據2019年6月1日～6月30日，統計本單位辦理出院等候時間平均每人為247分鐘，導致病人中午 12點後出院比率高達58.7%，高於全院平均值41.6%；新病人皆集中於下午3－ 4點才入住病房比率 高達61.2%，進而衍生諸多抱怨及醫護人員交接班壓力，故引發照護團隊執行專案之動機。 目的： 縮短辦理出院等候時間為96分鐘；提升辦理出院滿意度為4.0分。 解決方案： 分析問題主要導因包括：護理師未能在第一時間知悉出院醫囑及覆核當日出院相關照護耗時、書記因電子支付操作繁瑣，擔心刷卡錯誤、病人不瞭解辦理出院程序、各類文件申請方式宣導不足及繳費及領藥時間長。設立解決辦法為（一）提前告知出院時間及出院前一天完成出院醫囑開立、（二）提早覆核出院計畫、（三）擬定信用卡繳費操作說明、（四）修訂出院流程作業標準、（五）製作申請各類證明文件公告板、（ 六）規劃出院帶藥送至病房、（ 七）推動電子支付繳費。 結果評值：經專案執行後，辦理出院等侯時間247分鐘縮短96分鐘；辦理出院滿意度達由3.72分提升至4.0分，達本專案目的。 結論： 藉由跨單位溝通、協調及共同合作，簡化辦理出院流程，方可降低辦理出院等候時間，進而提升服務品質、病床周轉率及病人安全。  Background: According to the statistics data from June 1st to June 30th, 2019, the average waiting time of discharge from the unit was 247 minutes per person that led to a patient discharge rate of 58.7% after 12 noon, which was higher than the hospital’s average of 41.6%. The rate of new patients who were admitted to the ward at 3-4 pm was as high as 61.2%. This has resulted in many complaints, and generated pressure on the handover of medical staff, which motivated of the authors to implement this project. Purpose: The purpose of this project to reduce the waiting time of discharge to 96 minutes, and to improve the satisfaction level of discharge to 4.0 points. Strategies Procedure: Analyzing of the major causes of the problem, including the causal factors as follows: the nursing staff failed to notice the discharge order and conduct the time-consuming discharging care in the first time, the associate clerks worry about making mistakes when operating the complicated electronic payment procedures, the patient did not familiar with the discharge procedures, and insufficient introduction of various document and application procedures and long time waiting for payment and receiving medicine. The strategies to solve the problem includes (1)inform the nurse in charge about the discharge order in advance and issue doctor’s order of discharge a day before (2)review the discharge plan earlier, (3) prepare the operation instructions of credit card payment (4) revise the standard of operation of the discharge (5) make a bulletin board for demonstrating all related documents (6) directly deliver discharge medicines to the ward, and (7) promote the use of electronic payment. Outcome: The waiting time of discharge from the hospital was reduced to 96 minutes after the implementation of the project; the satisfaction degree of discharge increased from 3.72 points to 4.0 points, achieving the goal of this project. Conclusion: Through cross-unit communication, coordination and cooperation, discharge procedure was simplified to reduce the waiting time for discharge, thereby improving the quality of service, turnover rate of hospital beds, and patient’s safety.