一中規模市中病院の腹部救急患者の受入の取り組みについて

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 31; no. 5; pp. 751 - 757
• Main Authors: 山下 巌, 斎藤 文良, 日野 浩司, 小島 淳夫, 木内 清歌, 桐山 誠一, 野村 直樹, 安齋 明雅, 堀 亮太, 山口 哲司, 渋谷 和人, 塚田 一博
• Format: Journal Article
• Language: Japanese
• Published: 日本腹部救急医学会 2011; Japanese Society for Abdominal Emergency Medicine
• Subjects: チーム医療; 救急医療; 救急搬送; 消化器外科医
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.31.751

Although there is concern regarding the breakdown of community healthcare, we believe that emergency patients must be treated safely and promptly at a high medical level. Before our efforts were implemented, emergency patients were examined in our crowded general outpatient setting. Lack of cooperation among doctors or between doctors and other healthcare professionals sometimes resulted in our inability to provide smooth, prompt diagnosis and treatment. Moreover, we sometimes refused to accept emergency patients because of the unavailability of doctors due to surgery, examinations, or lack of appropriate expertise, and our emergency care was unsatisfactory. Therefore, we established a gastrointestinal surgeon-oriented practice by separating general and emergency outpatient departments. More specifically, outpatients were diagnosed and treated at the affiliated clinic and emergency patients at the emergency outpatient department of our hospital, regardless of consultation hours. Our efforts for approximately 10 years has allowed the construction of team-based medicine because of the close cooperation between doctors and other healthcare professionals and a barrier-free relationship among doctors, especially for the treatment of patients with abdominal emergencies. We can now provide prompt, smooth, safe, and high-quality emergency care. 近年，地域医療の崩壊が危惧されている中で，当院は救急患者を安全に，迅速に，高い医療水準で治療したいと考えている。しかし，以前は救急搬送患者の診察は，混雑する一般外来と同じ場所で，診療の合間に行っていた。その際，医師間または医師とコメディカル間の連携不足もあり，結果的に，円滑で迅速な診断治療は行えないことがあった。また，救急搬送を依頼された時点で，手術，検査中や専門外という理由で，受け入れ不能とすることがあり，満足できる救急医療ではなかった。改善するための取り組みとして，消化器外科指導医が主導し，一般外来を救急外来と分離し，一般外来患者は附属クリニックで，救急搬送患者は，診療時間内外を問わず，病院の救急外来（救急部）で診断治療を行った。約10年間の取り組みにより，特に腹部救急患者に対して，医師とコメディカルとの親密なチーム医療や医師間の垣根のない関係が構築でき，迅速，円滑，安全な質の高い救急医療が可能になったと考える。