Hu S C, Tsai J, Kao W F, Yen D, Wang L M
Department of Emergency Medicine, Tzu-Chi Buddhist General Hospital, Tzu-Chi College of Medicine, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Aug;61(8):470-8.
It is a worldwide trend to serve emergency patients at emergency department (EDs) staffed by board-certified emergency physicians (EPs). The question arises as to how many EPs are cost effective? This cannot be answered until utilization of emergency resources in the community is explored, so that appropriate plans for efficient ED use, staffing and training of EPs can be made.
A prospective randomized chart-review study was conducted from August 1, 1995, until May 31, 1996, in the EDs of eight large hospitals in Taipei City. These included Chung-Hsin Municipal Hospital (CHH), Chung-Shiaw Municipal Hospital (CSH), Ho-Ping Municipal Hospital (HPH), Jen-Ai Municipal (JAH), Mackay Memorial Hospital (MMH), Tri-Service General Hospital (TSGH), Veterans General Hospital-Taipei (VGH-T) and the Yang-Ming Municipal Hospital (YMH).
Of 37,889 cases reviewed, the average daily ED census at each hospital was: VGH-T 198; TSGH 148; MMH 224; HPH 62; YMH 84; CHH 41; JAH 102; and CSH 139. At MMH, pediatric patients comprised 38.8% of emergency patients and the elderly comprised 49% of patients of VGH-T. The average age of patients was 56 years in VGH-T and 40 years in other hospitals. There were 71 (11.1%) pediatric patients and 3,087 (1.8%) adult patients taken to hospital by an emergency medical services (EMS) ambulance. A total of 176 pediatric and 2,230 (8.1%) adult patients belonged to triage categories 1 and 2. VGH-T had a much higher percentage of triage 1 and 2 patients (769, 13%) than the other hospitals. A total of 30.7% of pediatric and 17.4% of adult patients were classified as triage 4 (pseudoemergency). Patients requiring advanced life support, referral cases and patients requiring an intensive care unit (ICU) bed accounted for 1.1%, 0.9% and 0.6% of pediatric patients, and 6.8%, 3.4% and 1.8% of adult patients, respectively. These figures increased to 11.1%, 7.7% and 3.5%, respectively, in VGH-T. Among patients requiring ICU admission, 30% of pediatric and 53% of adult patients were not admitted on presentation to the ED. Of 10,099 children and 27,555 adults who were evaluated for case disposition, 651 (6.5%) and 4,061 (14.7%), respectively, were considered for admission. Among these 542 (83.3%) and 2,894 (71.3%), respectively, were admitted.
VGH-T is a favorable training ground for EPs due to its high volume of adult and elderly, advanced life support eligible, ICU and high acuity patients. MMH is an ideal place for training in pediatric emergency medicine. Utilization of the 119 emergency response system is low. The number of patients with high acuity triage in Taipei City is low. However, Taipei City faces a shortage of acute care beds, especially ICU beds.
由具备专科医师资格认证的急诊医师（EPs）在急诊科（EDs）为急诊患者提供服务是一种全球趋势。问题在于多少名急诊医师具有成本效益？在探索社区急诊资源的利用情况之前，这个问题无法得到解答，以便制定关于急诊科高效使用、人员配备和急诊医师培训的适当计划。
1995年8月1日至1996年5月31日，在台北市八家大型医院的急诊科进行了一项前瞻性随机图表回顾研究。这些医院包括中兴市立医院（CHH）、中坜市立医院（CSH）、和平市立医院（HPH）、仁爱市立医院（JAH）、马偕纪念医院（MMH）、三军总医院（TSGH）、台北荣民总医院（VGH-T）和阳明市立医院（YMH）。
在审查的37889例病例中，每家医院急诊科的日均普查人数为：VGH-T 198人；TSGH 148人；MMH 224人；HPH 62人；YMH 84人；CHH 41人；JAH 102人；CSH 139人。在MMH，儿科患者占急诊患者的比例为38.8%，而在VGH-T老年患者占患者总数的49%。VGH-T患者的平均年龄为56岁，其他医院为40岁。有71名（11.1%）儿科患者和3087名（1.8%）成年患者由紧急医疗服务（EMS）救护车送往医院。共有176名儿科患者和2230名（8.
