東邦大学医療センター大森病院における平日救急輪番制導入後の眼科救急受け入れ状況

type:TOHO University Scholarly Publication

資料

東京都の眼科救急医療は大学病院が担っている部分が多く,医局員の負担増加や緊急手術に伴う1次救急医療の停止などが問題となっているため,当直医の負担軽減と1次救急医療継続を目的に平日救急診療の輪番制を導入した.輪番制は東邦大学医療センター大森病院,昭和大学病院附属東病院,公益財団法人東京都保健医療公社荏原病院とで行い,施行前後の救急患者の傾向を検討した.輪番制施行前の平成21年と施行後の平成22～24年の救急患者傾向を比較検討したところ,輪番制開始後は総受診者数は減少し,非輪番日の受診者数は激減した.前眼部疾患が60%前後を占め,2次救急症例数は不変だった.通常診療時間内患者は増加傾向を認めた.以上の,2次救急患者数は不変,総患者数の減少,通常診療初診患者数は増加という結果から,軽症の患者が受診を控えた可能性が考えられた.輪番制施行前は地域の眼科1次救急医療が完全に停止する場合もあったが,受診者の中には2次救急患者も含まれている可能性もあり,必ず受診できる1次救急医療の体制を構築し,地域の救急医療を守ることができたと考えた.In the Tokyo metropolitan area, university hospitals handle many ophthalmological emergencies. Several related issues have arisen, including the increased burden on physicians on duty and cessation of primary emergency care provision after emergency surgical procedures. To reduce the burden on physicians on duty and provide continued primary emergency care, three medical centers (Toho University Omori Medical Center, Showa University East Hospital, and Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital) participated in a weekday rotational system for emergency medical care, which was begun in 2010. Data on ophthalmological emergency patients before and after the introduction of this system were examined. The author conducted a comparative analysis of trends related to ophthalmological emergency patients at three medical centers in the year 2009 (before the rotational system) and during the period 2010-2012 (after the rotational system was begun). During 2010-2012, the total number of visits at the three ophthalmological medical centers decreased by 40%, as compared with the year 2009, and the mean number of medical center visits on non-rotational days greatly decreased, from 3.12 to 0.39 per day. Anterior ocular disease accounted for approximately 60% of cases, and the number of patients requiring secondary emergency care was similar after introduction of the rotational system. In addition, the number of after rotational system patients in the on-hour was higher than before the rotational system. The number of ophthalmological patients requiring secondary emergency care remained constant, while the total number of ophthalmological patients decreased. Thus, it is possible that patients with minor medical problems refrained from seeking medical assessment. Before enforcement of the rotational system, admission of ophthalmological primary emergency care patients sometimes completely stopped at regional hospitals. However, it is possible that those patients included secondary emergency patients. The present results indicate that the rotational system created a structure that assured admission of primary ophthalmological emergency patients and helped maintain availability of ophthalmological emergency care at regional centers.