護理荒頻減病床 誰來搶救醫院？

[oldlarge]

http://udn.com/NEWS/HEALTH/HEA1/8755341.shtml

【聯合晚報╱記者陳麗婷/台北報導】2014.06.21 02:58 pm

「急診擁擠到有時病床塞滿走道、大廳。」花蓮門諾醫院近來貼出公告，表示因護理人力不足，導致須採病床縮減，並坦言恐造成急診壅塞。台灣醫院協會表示，全台敢說人力充足的醫院不超10家，且關床現象持續出現，多數醫院都在「硬撐」。

有醫師就表示，年後急診擁擠理應稍緩解，但醫學中心仍壅塞，一進急診就可看到塞滿病床，原因除了民眾愛跑大醫院，醫院護理人力不足、減床都有影響。護理人力吃緊，加上醫院關床，連鎖效應恐引發急診壅塞。

花蓮門諾醫院急診主任鄧學儒表示，東部幾乎每家醫院均人力不足或縮床，也造成有時急診病床須移往大廳塞，院內同仁忙得焦頭爛額，遇上車禍患者急診送醫，病房沒床位、無法開刀，只好協調轉院，讓家屬更是心急。

減床、急診壅塞不僅東部嚴重，台灣急診醫學會發言人、台大醫院急診醫師顏瑞昇表示，台大醫院今年5、6月急診待床人數，比前幾年同期增加20%，急診塞滿病床。當私立醫院人力無法負荷或健保給付低、轉作醫美，就會減床，病患不信賴或沒地方去，自然往醫學中心急診擠，未來若擴大實施DRG(健保同病同酬)範圍，問題恐更嚴重。

花蓮門諾醫院人力資源部主任陳鳳仙表示，護理人力吃緊現象今年很明顯，主要是應屆畢業生會先往西部就業，若西部護理人力吃緊都無改善，東部召募更困難，為兼顧醫療品質，只好縮減內外婦兒科病床約30床，貼出公告是「希望誠實告知患者及家屬現況」。

一名常跑偏鄉支援的醫師表示，私立或偏鄉護理人力不足問題很嚴重，過去有些醫院會想辦法掩飾，但衛福部要求達到一定護病比，醫院只好縮床因應。據傳就有一家400床大醫院，縮50床以上。

台灣醫院協會理事長楊漢湶表示，各醫院用盡方法召募人員，衛福部祭出護理改革案後，或許人力稍回流，但整體工作環境壓力大、工作多，新人留任意願不高、流動率大，他也有聽說醫院關病房，減床效應會讓原本就擠爆的急診雪上加霜。「或許還沒有減到病人住不進去，所以衛福部還無感」。

[gary]

長官說
影響不大

[Einstein]

長官說對他自己
影響不大 (爽) (爽) (爽)

[min]

未爆開，當然影響不大。

[newshine]

通常只有第一線看到的人會急

或是會影響營運的老闆會緊張

唉

當官的人
通常都不太有感

[canonchun]

呼應了另一標題: 愛嫖，不付錢，就放給他爛!

[kwojohn]

.

[desktop]

通常只有第一線看到的人會急

或是會影響營運的老闆會緊張

唉

當官的人
通常都不太有感

反正總額 人不足 同減床 醫糾少 賺更多

[Funghy]

現在才知道護士比醫生重要

[JMW]

穿褲子的無膽不團結，反而要依靠穿裙子的帶頭發動抗爭革命，真正是女人撐起大片天

[newshine]

通常只有第一線看到的人會急

或是會影響營運的老闆會緊張

唉

當官的人
通常都不太有感

反正總額 人不足 同減床 醫糾少 賺更多

現在的醫療是戰國時代
我想應該不是這樣的看法

[gary]

市場機制會解決問題

[newshine]

市場機制會解決問題

最近在讀一本談經濟學史的書
正好在談國富論

大家應該都知道亞當斯密思主張的就是看不見的手會去調節一切

但是其實那時候就是用這個觀點來反對政府對於勞動條件的基本要求與限制的
以現在來看
當然會認為是放大推論了

此外市場機制要能夠調節
也必須要有幾個前提
包括資訊的透明化
一致的法規保障--沒有特許與特權
交易安全的保障
能夠自由流動的市場

但是
現在好像很多都不存在

最後
就算是可行
其實這個過程
放大去看
就是一個波動
也就是說會高高低低的
然後慢慢趨向所謂的平衡點

對於經濟學者來說
波動是必然的

對於政客來說
波動就會是一個困擾

對於人民來說
波動可能就無法生存了
(濕) (濕) (濕)

[月妃]

Re: 護理荒頻減病床 誰來搶救醫院？

長官說對他自己
影響不大 (爽) (爽) (爽)

[李誠民]

“市場機制會解決問題”……???2對極度專業的醫師行業,可能嗎?......

醫師過剩就去搞醫美!!(商業行為—廣告); 現在醫美逐漸倒閉(又回歸商業行為—醫師能敵得過嗎?!)…….

反而醫師行業成為四大皆空(五大,六大.....皆空); 然而台灣國民的健保負擔逐年增加!!!(因為政治不必負責!!!); 醫療水準極劇下降!!!......


“最近在讀一本談經濟學史的書
正好在談國富論

大家應該都知道亞當斯密思主張的就是看不見的手會去調節一切

但是其實那時候就是用這個觀點來反對政府對於勞動條件的基本要求與限制的
以現在來看
當然會認為是放大推論了”……………?!........

台灣健保制度只有回歸社會主義(公醫制度); 無解!!!

自經貿區設立,也只是浪費國家資源,更助長財團醫院的利潤而已!!!!

[李誠民]

“現在才知道護士比醫生重要”……..??---因為護士薪資比醫師少!!!

Doctors’ financial interests: what about a publicly available list held by the GMC?
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3646 (Published 11 June 2014)
Cite this as: BMJ 2014;348:g3646

The imbalance in the relationship between doctor and patient means that knowledge of a doctor’s financial interests will never be a panacea for resolving all biases and prejudices in medicine. However, a register like whopaysthisdoctor.org is not just for patients, but for doctors also.1
As doctors, we often rely on the views of key opinion leaders for the clinical knowledge we acquire and the decisions that we make. Whether information comes from journal articles, editorials, educational events, or published guidance, it is essential that we have a good understanding of whose lead we are following, and whether those involved have any affiliation with the treatment that they recommend.
Inconsistencies in declarations often make it difficult to ascertain a doctor’s interests, particularly at conferences and educational events, where the culture of declaration is not well embedded. A single, compulsory, publicly available list held by the General Medical Council would make such a process simple and reliable. It would also be convenient for doctors, who could make only one declaration each year, rather than every time they publish.

Who pays this doctor? It’s time patients knew
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3039 (Published 6 May 2014)
Cite this as: BMJ 2014;348:g3039

If my MP wanted to build a motorway, it would be reasonable for constituents to know whether he had shares in the construction company appointed, or indeed in the land that had now become valuable. And it’s easy to find out: all UK MPs have to make declarations on the publicly available register of members’ interests.1
But if I am a patient, I am unfairly ignorant. I don’t know whether my doctor is a chosen key opinion leader, paid by a drug company to increase prescribing of a drug. When my doctor recommends an intervention, I don’t know whether her education on my condition has come solely from a drug company representative—despite the associations between drug company education, higher prescribing costs, and lower quality.2 3 I have no idea whether my doctor’s travel to an international conference was paid for by the drug company making the product I am being recommended. Yet we know that even small gifts create changes in doctors’ behaviour……………………
………………………………..
Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey
Background: General practitioner (GP) prescribing accounts for about 10% of NHS expenditure. GPs at the top of the range have annual prescribing costs that are almost twice as much as those at the bottom of the range. This variation cannot be accounted for purely in terms of differences in underlying need for health care. ………………
Conclusions: While they cannot be held to have a causal relationship, the pattern of attitudes towards prescribing of GPs in the highest quintile of prescribing costs provide the basis for developing an educational intervention which may be an acceptable method of modifying the attitudes of GPs and consequently reducing their prescribing costs.

[cwhung]

據長期觀察鬼島賤寶的專家
羊痔涼先生表示:

醫院急診病人那麼多
一定是因為醫生太愛賺錢的緣故

[hjh]

市場機制會解決問題

+1

雖說這個市場不是很自由，但還是有市場機制在裡面。

如果說總額上升、點值上升、醫糾風險下降、醫護可剝削度上升等等，那麼自然就會增床，因為增床有利於醫院。相反的，比如現在，減床才有利於醫院，所以醫院就減床。 如果醫師納入勞基法，醫院會繼續減床，因為減床對醫院有利。 所以本文的問題根本不存在，醫院不需要被搶救。 沒道理市場的狀況永遠鼓勵增床，總有個平衡點，總有盤整的時候。

真正需要被搶救的，是病人，尤其是重症的，不是醫院，然而，台灣民眾支持的政府只會耍民粹，民智不足的情況下，輕症佔床，甚至DRG鼓勵治療輕症，又缺乏差額自費措施，怪誰？ 就怪就怪被蠢同胞投的蠢票給害到....

[李誠民]

“據長期觀察鬼島賤寶的專家
羊痔涼先生表示:

醫院急診病人那麼多
一定是因為醫生太愛賺錢的緣故”--鬼扯!!...公衛學者就會不愛錢?!

Cameron announces plan for seven day access to GPs
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5949 (Published 1 October 2013)
Cite this as: BMJ 2013;347:f594

英國首相--珂麥隆計畫將在明年四月實施GP每周上班七天,選擇在六個醫院,五十萬人做 先導試驗((piloted in six general practices in Manchester; cover half a million patients)花費五千萬歐元(?八千萬美金)…….

英國政府想擴大其它醫院服務壓力與減少二級醫療的壓力!!!.......

英國醫師協會開放討論,尋求新方法,增加病人利益(benefit),熱烈歡迎全國各界主要與GP的主管們的討論……

英國勞工黨馬上回應對GP工作需在夜晚與周末,而且新方案—初級醫療開放至早上八點至晚上八點,每周工作七天;許多稱為”Darzi clinics”(?--after their architect, the former Labour health minister Ara Darzi)被證明昂貴醫療:接著被正常工作外的外科減少,接著保守黨醫療首相秘書(衛生部長?!)--Andrew Lansley 停止觀察目標(Monitoring the target)……

開始政策後, 首相科麥隆說:"百萬人民可以在他工作中或家庭生活時,可以預約GP醫療時間.....每周七天,每日早上八點到晚上八點”….所以政治人物會誇大它的功勞,又沒足夠預算!!!....."沒錢怎麼辦?--個人觀點"
衛生部長(?Jeremy Hunt)說"我們活在二十四小時的七個小時社會中,我們需要GP找出新方法,可以提供預約時間適應工作艱苦的人民);就是專業人物, 當上官也就變了!!!

另外增加說: “這個需要另外資源與調查, 去支持GP每周工作全時數後, 需要增加的護理與社區照護的人力!!!!”…..???

這是英國去年醫護總罷工後,急診缺乏(臨時調軍醫支援後),實施私人保險多年後的事實(解決了富人(?...有能力的人),急需較好的醫療服務後:產生的問題---政治人物只會騙選票而已,挑起社會階級對立!!!解決眼前的問題,…..但是醫師有社會責任!!.....

這是社會主義下的公醫制度,健康保健與醫療的普遍現象:;所以所得稅都高達60-80%以上,就是政治人物要解決的經濟問題?!醫師並不是政治人物,如果政府不負責!!政策亂搞一通!!!不是傷害病人權益(?--WHA--Patient, social , colleague)

P.S.:台灣是規定超時工作(按勞基法,但又要求超時 ,才有合理健保給付?再以總額與點值控制醫師, 護士等超時工作!!)--不是獨裁法西斯政體嗎??

End top-down changes to NHS, says think tank
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3832 (Published 11 June 2014)
Cite this as: BMJ 2014;348:g3832

Politicians should loosen their grip on the day to day management of the NHS and allow organisations to initiate improvement from within, a new report from the health policy think tank the King’s Fund has urged. 極力主張; 強調; 強烈要求1
Chris Ham, the think tank’s chief executive and the author of the report, argued that intervening in management of the NHS and prescribing health service changes from the centre of government had hampered rather than nurtured reform.
The report said that the intentions in the Health and Social Act 2012 to distance ministers from the operational management of the NHS have failed to be realised.
“Regardless of which political party is in government, there appears to be an irresistible tendency for ministers to want to be seen to be leading the NHS, driven by intense media scrutiny and the Secretary of State’s ultimate accountability for the performance of the NHS,” said Ham in the report. ........
.....................

Reforming the NHS from within
Beyond hierarchy, inspection and markets
11th June 2014
Chris Ham

This paper reviews the impact of three approaches to NHS reform in England since the late 1990s: targets and performance management, inspection and regulation, and competition and choice. It argues for a fundamental shift in how the NHS is reformed, learning from what has worked (and what has not) in England and elsewhere.
Such a shift requires a much stronger focus than hitherto on bringing about improvement and change from within health organisations and networks of care. The paper argues that this is the best route to system-wide transformation, particularly given the limited impact of reforms that rely on external stimuli.
Key findings
• Transforming the NHS depends much less on bold strokes and big gestures by politicians than on engaging doctors, nurses and other staff in improvement programmes.
• A new settlement is needed in which the strategic role of politicians is clearly demarcated to avoid frequent shifts of direction that create barriers to transformational change.
• Improvement in NHS organisations needs to be based on commitment rather than compliance, supported by investment in staff to enable them to achieve continuous quality improvement in the long as well as the short term.
• The experience of high-performing health care organisations shows the value of leadership continuity, organisational stability, a clear vision and goals for improvement, and the use of an explicit improvement methodology.
• Leadership in NHS organisations needs to be collective and distributed, with skilled clinical leaders working alongside experienced managers.
• NHS organisations should prioritise leadership development and training (preferably in-house) in quality improvement methods.
Policy implications
• NHS leaders need to pursue complementary approaches to reform in which national leadership is combined with devolution, collaboration with competition, and innovation with standardisation. There should be much more emphasis on bringing about improvement and change locally from within, and less emphasis on the use of external stimuli.
• There needs to be much greater transparency, based on the collection and open reporting of data on performance.
• There needs to be a more realistic view of what inspection and regulation can contribute. Inspection can only be effective if frontline teams and NHS boards are fully engaged in delivering the best possible care.
• Competition and choice have a role to play, but should be viewed as just one means to improve care rather than a guiding principle.
• Integrated providers or systems are the most promising ways of promoting worthwhile innovations in care.
• Much greater leadership continuity will be needed in NHS organisations to support new styles of leadership, with a focus on developing leaders at all levels.

BMA annual meeting: BMA chairman attacks government for “bleeding every penny” out of NHS.
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g4215 (Published 23 June 2014)
Cite this as: BMJ 2014;348:g4215

The chairman of the BMA has called on the UK government to abandon the “bizarre market culture” that it has created in the NHS, saying that this wastes valuable resources.
In his keynote speech to the BMA’s Annual Representative Meeting in Harrogate哈羅蓋特, Mark Porter said that reforms enacted in the Health and Social Care Act 2012 were fragmenting care and were diverting energies and funding away from frontline services. He also attacked the Treasury for starving the NHS of resources and said that so called “efficiency savings” were merely a euphemism for cuts.
He went on to criticise MPs for continuing to impose pay freezes on NHS staff while awarding themselves an 11% pay rise.
Ahead of next year’s general election, Porter warned the government that failing to heed these warnings would compound “four years of waste and missed opportunities.” He said that the government’s reforms had created a system where commissioners felt compelled to tender services to the open market at some expense, in a climate where money was scarce……….
…………
P.S.:1.醫學是非常專業的行業,"醫病關係"是極不對等的,但又是每個國民都需要健康. 保健. 醫療;所以是政治人物最喜歡操作的政治話題(加稅, 選舉就是考驗政治人物是政客還是有道德觀的政治人); 台灣的醫師全聯會理事長都是政治熱衷者, 為甚麼?!...............利益而已!!!
2. "據長期觀察鬼島賤寶的專家
羊痔涼先生表示:

醫院急診病人那麼多
一定是因為醫生太愛賺錢的緣故"…….
他為甚麼從政?!賺錢而已,退休可以領更多退休金!!
3.台灣只剩走社會主義的公醫制度!!才能救台灣健保!!!,,,,,可悲!!!

[wangmaymay]

現在才知道護士比醫生重要

[wangmaymay]

穿褲子的無膽不團結，反而要依靠穿裙子的帶頭發動抗爭革命，真正是女人撐起大片天

(壓力) （窮） (我不依)

[cshwww]

通常只有第一線看到的人會急
或是會影響營運的老闆會緊張
唉
當官的人
通常都不太有感

放久了
就爛了
那更好
就說
歷史共業囉... (樂奔) (樂奔) (樂奔)

[Ben]

[/quote] 3.台灣只剩走社會主義的公醫制度!!才能救台灣健保!!!,,,,,可悲!!![/quote]
（阿飄） （阿飄） （阿飄）

[newshine]

護理師和醫師誰重要
在人力資源管理的角度來看

可以從市場面看
誰的比較稀少
就比較重要
稀少程度來自於
供應與需求的狀況
以及法令管制的問題

目前醫師大量製造
雖然護理師也製造不少
但是政府突然大幅調高護理人員/病床比
當然會造成供應短缺

政府在施政的時候
都沒有想清楚是否會產生重大影響
實在是
唉
...