進階搜尋


  查詢北醫館藏
系統識別號 U0007-1704200715050348
論文名稱(中文) 中文版五級急診檢傷分類電腦化系統之建構與臨床應用評估
論文名稱(英文) Development and Clinical Application Assessment of the Chinese Version of Five-Level Computer Triage System in the Emergency Department
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 陳麗琴
研究生(英文) Li-Chin Chen
學號 M406091010
學位類別 碩士
語文別 中文
口試日期
論文頁數 85頁
口試委員 指導教授-張文英
中文關鍵字 五級檢傷分類  電腦化系統  建構與臨床應用 
英文關鍵字 Five-Level Triage  Computer Triage System  Development and Clinical Application Assessment 
學科別分類
中文摘要 中文摘要 論文名稱:中文版五級急診檢傷分類電腦化系統之建構與臨床應用評估 研究所名稱:臺北醫學大學護理學研究所 研究生姓名:陳麗琴 畢業時間:九十四學年度第二學期 指導教授:張文英 臺北醫學大學護理學研究所副教授 檢傷分類(Triage)的功能是依分類級數決定病患看診優先順序,使有效分流及確保病患處置之時效性與安全性,因此本研究目的旨在建構中文版五級急診檢傷分類電腦化標準系統(Chinese version of CTAS)與其信效度,並比較檢傷護理人員使用四級與五級檢傷分類電腦化標準系統之一致性及其分級正確性之差異。本研究採描述性比較設計,以北、中部之三家醫學中心急診檢傷人員為研究對象,共30名,收集四級檢傷分類共收案749名個案,與五級檢傷分類共收案800名個案之資料。研究工具包括;中文版五級檢傷分類標準、急診檢傷模擬標準個案,資料收集後以SPSS 12.0 version for Windows 套裝統計軟體進行資料處理。以描述性統計、單因子變異數分析及薛費法事後多重比較、再測信度、一致性百分比、卡方檢定、敏感性及特異性進行資料分析。研究結果顯示中文版五級急診檢傷分類系統之評量者一致性及再測信度高,且專家內容效度皆在 .8~1.0之間,證明具良好信效度檢定。檢傷護理人員使用五級檢傷分類較四級檢傷分類判定級數之一致性高(percentage of agreement: 4L=55.7%; 5L=87.6%),於四級檢傷分級中一致性最高的為A醫院,而在五級檢傷分級一致性則以C醫院最高。檢傷分級結果與護理人員之檢傷工作年資無統計上顯著差異,經卡方檢定(Chi-square Test)後,顯示輕症個案之分級具統計上之顯著差異(χ2, p< .05)。比較臨床實際個案檢傷分級之正確性,結果顯示五級檢傷分類較四級之敏感性較高 (Sensitivity: 4L=50.23%; 5L=92.21%),且特異性亦較高(Specificity: 4L=79.46%; 5L=97.32%)。檢傷護理人員使用五級檢傷分類分級結果高估(over-Triage: 4L=52.7%; 5L=5.5%)或低估(under-Triage: 4L=0.3%; 5L=3.9%)之差異性亦明顯降低。本研究結果證實中文版五級檢傷分類電腦標準化系統,較四級檢傷分類系統檢傷人員檢傷分級之一致性、正確性皆明顯較高。本研究針對使用四級與五級檢傷分類之一致性與正確性,因此本研究結果可作為未來提升急診檢傷分類系統正確性之參考,及與國外以開發國家接軌的世界發展趨勢。
英文摘要 Abstract Title of thesis: Development and Clinical Application Assessment of the Chinese Version of Five-Level Triage Computer System in the Emergency Department Institution: Graduate Institute of Nursing, Taipei Medical University Author: Chen, Li-Chin Thesis director by: Chang, Wen-Yin, Associate Professor The principle of effective triage is to determine patient priority to be seen by a physician to ensure that those with the highest level of severity or risk are seen in a timely manner, optimizing overall patient safety. The purposes of this study were firstly to verify the validity and reliability of the five-level triage system, a computerized Chinese Version Canadian Triage Acuity Scale (CVCTAS), and secondly to identify if there were differences in percentage of agreement and accuracy between the Taiwan four-level triage and CVCTAS. The design was a descriptive and conducted in three medical centers (A, B & C hospitals) of ED in Northern and Middle Taiwan. To verify the validity and reliability of the CVCTAS, a total of 30 emergency department (ED) triage nurses participated in the study. To identify the differences in percentage of agreement and correction between Taiwan four-level triage and the Chinese Version of CTAS five-level triage, a total of 749 patients and 800 patients participated in the study, respectively. Two instruments were used in this study which were CVCTAS and standardized patient scenarios. The Statistical Package for the Social Sciences (SPSS-PC) version 12.0 was used for data analysis and a significant level was set at p value of < .05. Descriptive statistics, unvaried analysis by Chi-square test for nominal variables, and by ANOVA, Scheffe`s post hoc test for continuous variables, test-retest reliability, percentage of agreement, sensitivity and specificity were also performed in this study. In terms of the validity and reliability of the CVCTAS, the results showed that fairly well expert content validity (CVI = .8-1.0), perfect test-retest reliability (CCI=1) and high percentage of agreement (87.6%). In terms of the differences in percentage of agreement between the Taiwan four-level triage and the CVCTAS, the results showed that hospital A and hospital C had 55.7 percentage of agreement and 87.6 percentage of agreement, respectively. Regarding the accuracy, the results showed that the CVCTAS had fairly high sensitivity (92.21%) and specificity (97.32%) than Taiwan four-level triage whose sensitivity and specificity was 50.23% and 79.46%, respectively. Further analysis the triage accuracy, the author found the CVCTAS had lower “over-triage” (5.5%) than Taiwan four-level triage (52.7%), but had slightly higher “under-triage” (3.9%) versus (0.3%), respectively. In conclusion, the computerized CVCTAS had higher percentage of agreement and accuracy than the Taiwan four-level triage system; Therefore, the findings of this study can provide information to improve the future accuracy of triage system in Taiwan, and to connect the global trend with other developed countries.
論文目次 目 錄 頁數 致 謝…………………………………………………………Ⅰ 中文摘要…………………………………………………………Ⅲ 英文摘要…………………………………………………………Ⅴ 目 錄…………………………………………………………Ⅶ 圖表目次…………………………………………………………? 第一章 緒論 第一節 研究動機與重要……………………………………1 第二節 研究目的……………………………………………4 第三節 研究假設……………………………………………5 第四節 操作型名詞定義……………………………………6 第二章 文獻查證 第一節 檢傷分類意義與信效度相關研究………………9 第二節 國內、外急診檢傷分類方法及比較……… …….14 第三節 檢傷分類系統之成效評估………………………..21 第四節 電腦系統發展概念與標準化建構原則…………..23 第五節 概念架構…………………………………………..26 第三章 研究方法 第一節 研究設計………………………………28 第二節 研究對象……………………………. ……………29 第三節 研究工具…………………………………………..31 第四節 倫理考量…………………………………………. 35 第五節 研究步驟…………………………………………..36 第六節 資料的處理分析…………………………………..41 第四章 研究結果 第一節 檢傷護理人員基本屬性分佈.................43 第二節 五級急診檢傷分類電腦化標準系統之信效度…..46 第三節 檢傷護理人員使用四級與五級檢傷分類系統 之一致性差異分析………………………………..47 第四節 檢傷護理人員使用四級與五級檢傷分類系統 之正確性差異分析………………………………..55 第五章 討論 第一節 中文版五級檢傷分類電腦標準化系統之信效度………………………………………………….69 第二節 使用四級與五級檢傷分類之一致性……………..71 第三節 使用四級與五級檢傷分類之正確性…………......74 第六章 結論 第一節 結論………………………………………………..78 第二節 研究貢獻…………………………………………..80 第三節 研究限制與建議…………………………………..82 參考資料 中文文獻………………………………………………..………83 英文文獻………………………………………………………..84 附錄 附錄一 加拿大五級急診檢傷分類系統(CTAS)同意 授權書………………………………………..……….89 附錄二 中文版五級檢傷分類系統專家內容效度修正結果...90 附錄三 急診模擬標準個案……………………………………93 附錄四 參與研究同意書………………………………..……..95 圖表目次 圖一 中文版五級急診檢傷分類電腦化標準系統建構之 概念架構圖………………………………..……………27 圖二 中文版五級檢傷分類電腦化系統之研究流程圖……...40 圖三 檢傷護理人員與急診專家執行四級檢傷分類分 級之差異圖………………………………..………….…65 圖四 檢傷護理人員與急診專家執行五級檢傷分類分 級之差異圖………………………………..……….……67 表一 澳洲、美國、加拿大與台灣急診檢傷分類使用標 準之比較表……..……………………………………….20 表二 檢傷護理人員之基本屬性分佈……..………………….45 表三 檢傷護理人員執行四級檢傷模擬標準個案之一致性……..…………………………………………………51 表四 檢傷護理人員執行五級檢傷模擬標準個案之一致 性………………………………………………..………52 表五 檢傷護士執行四級檢傷模擬標準個案之檢傷一致 性分析……………………………………………..……53 表六 檢傷護士執行五級檢傷模擬標準個案之檢傷一致 性分析……………………………………………..……54 表七 檢傷專家及護理人員使用四級檢傷分類實際個案 之檢傷分級差異性分析…………………………..……57 表八 檢傷專家及護理人員使用五級檢傷分類實際個案 之檢傷分級差異性分析…………………………..……58 表九 檢傷護理人員使用四級檢傷分類之臨床實際個案 分級的敏感性與特異性分析……………..……………61 表十 檢傷護理人員使用五級檢傷分類之臨床實際個案 分級的敏感性與特異性分析……………..……………62 表十一 急診專家與檢傷護理人員執行四級檢傷分級差 異性分析………………………………………….….…66 表十二 急診專家與檢傷護理人員執行五級檢傷分級差 異性分析……………………………………………..…68
參考文獻 中文參考文獻 江錦玲、蔡云芳(1999)?急診檢傷護理人員與醫師在檢傷分類級數判斷上的一致性探討?慈濟醫學,11(3),255-261。 行政院衛生署(2004,10月30日)?台灣地區平均每日醫療服務量統計?取自1月05日,2006,http://www.doh.gov.tw/statistic/醫療服務量/93.html。 張博論、曾院美、吳肖琪、桑穎穎(2002)?急診檢傷分類輔助系統三層雪花式PDA界面設計原則?醫療資訊雜誌,15,17-32。 張顯洋(2001)?個人數位秘書PDA在臨床護理工作的應用-以慈濟醫學中心護囑資訊系統之整合研究為例?醫院,34(1),8-5。 陳明晃、黃英傑(2003)?民眾對急診檢傷分類與等候時間的認知?台灣急診醫學,5(3),128-130。 曾院美、陳世欣、張博論、陳玉枝、桑穎穎(2004)?急診檢傷護理評估專家輔助系統之評價?榮總護理,21(3),309-318。 英文參考文獻 American Hospital Association (2002). Emergency Department overload: A growing crisis. Medical Benefits, 19 (10), 8. Barton, A. J., Gilbert, L., Erickson, V., Baramee, J., Sowers, D., Robertson, K. J. (2003). A guide to Assist Nurse Practitioner With Standardized Nursing Language. Journal Emergency Medicine, 21 (3), 128-133. Beveridge, R., Ducharme, J., Janes, L., Baulieu, S., & Walter, S. (1999). Reliability of the Canadian Emergency Department Triage and Acuity Scale: inter-rater agreement. Annals of Emergency Medicine, 34(2), 155-159. Beveridge, R., Clarke, B., Janes, L., Savage, N., Thompson, J., Dodd G., et al. (1999). Canadian Emergency Triage and Acuity Scale: implementation guidelines. Canada Journal of Emergency Medicine, 1(3), 21-24. Brillman, J. C., Doezema, D., Tanberg, D. , Sklar, D. P., Davis, K. D., Simms, S., & Skipper, B. J. (1996). Triage Limitations in Predicting Need for Emergent Care and Hospital Admission. Annals of Emergency Medicine, 27 (4), 493-500. Bullard, M., Dong, S. L., Meurer, D. P., Blitz, S., Colman, I., & Rowe, B. H. (2004). Emergency Department Triage: evaluation the implementation of a computerized triage tool. Canada Journal of Emergency Medicine, 6(3), 188-193. Chang, P., Tzeng, Y. M., & Sang, Y. Y. (2003). The development of wireless PDA support systems for the comprehensive and intelligent triage of emergency nursing. The Journal of Nursing, 50(4), 151-162. Chi, C. H., Yen, Y. L., Tong, M. C. & Lee, M. F. (2005). A Regional Survey of Triage Criteria for Nursing Staff in the Emergency Department. Journal of Taiwan Emergency Medicine, 7(4), 198-208. Davis, F. D. (1993). User acceptance of information technology: system characteristics, user perception and behavioral impacts. International Journal of Man-Machine Studies, 38, 475-487. Derlet, R. W. (2002). Overcrowding in Emergency Department: Increase demand and decreased capacity. Annals of Emergency Medicine, 34(2), 155-159. Dillon, T. W., Mcdowell, D., Salimian, F., & Conklin, D. (1998). Perceived ease of use and usefulness of bedside-computer systems. Computers in Nursing, 16(3), 151-156. Dong, S. L., Bullard, M., Meurer, D. P., Colman, I., Blitz, S., & Holroyd, B. R., et al.,(2005). Emergency Triage: Comparing a Novel Computer Triage program with standard Triage. Academic Emergency Medicine, 12(6), 502-507. Eitel, D. R., Travers, D. A., Rosenau, A., Gilboy, N., & Wuerz, R. C. (2003). The Emergency Severity index triage algorithm version 2 is reliable and valid. Academic Emergency Medicine, 10 (10), 1070-1080. Gerven, R.V., Deloozh, H., & Sermeus, W. (2001). Systematic Triage in the Emergency Department using the Australian National Triage Scale: A pilot project. European journal of Emergency Medicine, 8, 3-7. Grafstein, E., Innes, G., Westman, J., Christenson, J., & Thorne, A. (2003). Inter-rater Reliability of Computerized Presenting Complaint-linked Triage System in an urban Emergency Department. Canada Journal of Emergency Medicine, 5(5), 323-329. Jimenez, J., Murray, R., Beveridge, R., Pons, J., Cortes, E., & Garrigos, F., et al., (2003). Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the principality of andorra: Can triage parameters serve as emergency department quality indicators. Canada Journal of Emergency Medicine, 5(5), 315-322. Murray, M., Bullard, M., & Grafstein, E. (2004). Revisions to the Canadian Emergency Department Triage and Acuity Scale Implementation guidelines. Canada Journal of Emergency Medicine, 6(6), 421-427. Murray, M., & Victoria, R. (2003). The Canadian Triage and Acuity Scale: A Canadian perspective on emergency department Triage. Emergency Medicine, 1(5), 6-10. Margaret, M. (2003). ED Triage: Is a five-level triage system best? American Journal of Nursing, 103(3), 61-63. Quimby, M. L., Vig, K.W., Rashid, R. G., & Firestone, A. R. ( 2004). The Accuracy and Reliability of Measurements Made on Computer-based Digital Models. Angle Orthodontist, 74(3), 298-303. Tanabe, P., Gimbel, R., Yamold, P., Kyriacou, D., & Adams, J. (2004). Reliably and Validly of scores on the Emergency Severity index version 3. Academic Emergency Medicine, 11(11), 59-65. Thurmond, V. A. (2003). Defining Interaction and Strategies to Enhance Interactions in Web-Based Courses. Nurse Educator, 28(5), 237-241. Travers, D. A., Waller, A. E., Bowling, J. M., Flowers, D., & Tintinalli, J. (2002). Five-Level Triage System More Effective than Three-Level in Tertiary Emergency Department. Journal of Emergency Nursing, 28(5), 395-400. Vance, J., & Sprivulis, P. (2005). Triage Nurse Validly and Reliably estimate Emergency Department Patient Complexity. Emergency Medicine Australia, 17(4), 382-386. Worster, A. Gilboy, N. Fertnandes, C. M. Eitel, D. Eva, K. Geister, R., & Tanabe, P. (2004). Assessment of inter-observer reliability of two five-level triage and acuity scales: A randomized controlled trial. Canada Journal of Emergency Medicine, 6(4), 240-245. Wuerz, R., Fernandes, C. M., & Alarcon, J. (1998). Inconsistency of emergency department triage. Annals of Emergency Medicine, 32 (4), 431-435. Wuerz, R., Milne, L. W., Eitel, D. R., Travers, D., & Gilboy, N. (2000). Reliability and Validly of a new five-level triage instrument. Academic Emergency Medicine, 7(3), 236-242. Wuerz, R., Travers, D., Gilboy, N., Eitel, D. R., Rosenau, A., & Yazhari, R. (2001). Implementation and refinement of the Emergency Severity Index. Academic Emergency Medicine, 8 (2), 170-176. Yi-Shun, W. (2001). Assessment of learner satisfaction with asynchronous electronic learning system. Information & Management, 41 (1), 75-79. Zimmermann, P. G. (2002). Guiding principles at triage: advice for new triage nurses. Journal of Emergency Nursing, 28(2), 24-33. Zimmermann, P. G. (2003). Orienting ED nurses to triage: Using scenario-based test-style questions to promote critical thinking. Journal of Emergency Nursing, 29(3), 256-258.
論文全文使用權限
  • 不同意授權瀏覽/列印電子全文服務。


  • 若您有任何疑問,請與我們聯絡!
    臺北醫學大學 圖書館 簡莉婷
    E-mail:etds@tmu.edu.tw
    Tel:(02) 2736-1661 ext.2519
    Fax:(02) 2737-5446