重症病人之共同照護體現

Demonstration of Combine Care for Patients in Critical

王國新、廖為博

羅東聖母醫院急重症科

Background         In the past few years, personal performance fee (PPF) was appraised and endeavored nearly all over the country. It really helped some hospitals to improve their management. However, a lot of medic-legal problem followed especially when complicated case was confronted. Combine care system was offered recently and its effect necessitated evaluation.

Method      Two old patients were transferred into ICU due to critical condition. Although their diagnosis was definite, the treatment decision was variable among doctors of each ward. As a coordinator of combine care, critical medicine physician performed his social technique to help each sub-specialist to do his job properly. Finally both of the patients received appropriate treatment including operation.

Case report 1: Gastric bleeding with hypovolemic shock

Case report 2: DKA with acute abdomen

Results       We applied two caases to show how to coordinate doctors of each ward for critical and complicated condition. There is certainly no absolutely perfect solution in treatment. With discussion and cooperation, we finally treat these patients with conclusion acceptable to doctors of each ward, including patients’ families of course.

Conclusion

1.         As a coordinator of combine care, critical medicine physician should be more flexible

2.         Never depend on one man show only, second opinion is appreciated

3.         If there is no sufficient human resource, even transfer may be a better choice

4.         Adhere to experience, evidence and guideline then choose the best

5.         Respect professional opinion of each

6.         Patient-centered

7.         The responsibility should be shared by all,includes families

8.         PPF necessitates further modification

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