台灣於2018年進入高齡社會，國人醫療需求逐年增加，但相關的分級醫療制度並未獲得落實，以至於醫學中心及區域醫院的壅塞情況時有所聞。急診壅塞問題導致患者等待時間延長，醫療服務效率降低，並增加醫療錯誤和患者不滿的風險。多數現有研究傾向從解決急診結案速度去疏導壅塞，也就是將患者分流至門診或住院，但對急診留置期間，個別醫院內部的醫療品質較少有直接的評估。
本研究使用新竹區域醫院急診部門的就診資料，對急診科處置患者的效能進行量化分析，特別關注不同醫師在急診壅塞狀況下對看診速度的影響。資料來源為2024年1月該院急診部門的自動記錄時間資料，經過資料清理與處理後，共計4,921人次及20,020筆醫令記錄進行分析。
研究結果顯示，急診壅塞對患者等待時間和醫療品質有顯著影響。急診工作負荷指數越高，患者等候時間越長。不同醫師的能力和背景對患者等候時間的影響也存在顯著差異，特別是年齡較大的醫師和部分年輕醫師表現有差異，延長患者留在醫療系統的時間。此外，研究還發現，壅塞狀況下，某些夜間時段的負荷特別高，建議在這些時段增加支援人力以應對壅塞。
透過這些分析，本研究針對區域醫院的急診壅塞提供具體建議，包括改進醫師排班和提升醫療品質，期望能為醫療機構提供參考，進一步提升急診醫療服務質量，減輕壅塞帶來的負面影響，促進整體急診醫療體系的長遠發展。

As Taiwan entered an aging society, demand for healthcare services increased. However, the ineffective implementation of a tiered healthcare system has led to overcrowding at medical centers and regional hospitals. Emergency department (ED) overcrowding results in prolonged patient waiting times, decreased efficiency, and increased risks of medical errors and patient dissatisfaction. Most studies focus on alleviating overcrowding by speeding up discharge processes, but there is a lack of direct evaluation of care quality within individual hospitals during ED stays.
This study uses patient visit data from Hsinchu Regional Hospital's ED to analyze the efficiency of emergency physicians, focusing on consultation speed under overcrowded conditions. The data, from January 2024, was cleaned and processed, resulting in 4,921 patient visits and 20,020 medical orders.
Results show that ED overcrowding significantly affects waiting times and care quality. Higher workload indices correlate with longer waiting times. Physicians' abilities and backgrounds impact waiting times, with variability among older and some younger physicians leading to extended patient stays. Certain nighttime periods experience high loads, suggesting increased support during these times could help alleviate overcrowding.
This study provides recommendations for addressing ED overcrowding in regional hospitals, including improving physician scheduling and enhancing care quality, aiming to improve emergency medical services and mitigate overcrowding impacts.

中文部分:
胡勝川 (2015): “如何因應急診壅塞,” 醫療改革基金會深度論壇。
黃豐締·林政翰 (2021): “以急診工作負荷指數即時監測系統進行急診壅塞管理決策,” 《醫療品質》, 10(1), 85-95。
趙從賢 (2016): “以事件存活分析, 儲列模型及多階段模型探討急診病患滯留時間, 處理流程, 及影響因子分析,” 國立臺灣大學流行病學與預防醫學研究所學位論文。
衛生福利部 (2023): 112年度醫院緊急醫療能力分級評定基準及評分說明與評量方法。
蔡光超 (2019): “解決急診壅塞之政府角色,” 國立臺灣大學政治學系學位論文。

英文部分：
American College of Emergency Physicians, Emergency Medicine Practice Committee. (2016): “ED crowding: High impact solutions.”
Asplin, B. R., D. J. Magid, K. V. Rhodes, L. I. Solberg, N. Lurie, & C. A. Camargo Jr (2003): “A conceptual model of emergency department crowding,” Annals of emergency medicine, 42(2), 173-180.
Bernstein, S. L., V. Verghese, W. Leung, A. T. Lunney, & I. Perez (2003): “Development and validation of a new index to measure emergency department crowding,” Academic Emergency Medicine, 10(9), 938-942.
Hocagil, A. C., H. Hocagil, & T. Akkaya, (2014): “The knowledge levels of emergency physicians: whom to care about? Physicians or patients?” Eurasian Journal of Emergency Medicine, 13(4), 187.
Marco, C. A., R. P. Wahl, H. R. House, D. G. Goyal, S. M. Keim, O. J. Ma, ... & A. L. Harvey (2018): “Physician age and performance on the American Board of emergency medicine concert examination,” Academic Emergency Medicine, 25(8), 891-900.
McCarthy, M. L., D. Aronsky, I. D. Jones, J. R. Miner, R. A. Band, J. M. Baren, ... & R. Shesser (2008): “The emergency department occupancy rate: a simple measure of emergency department crowding?” Annals of emergency medicine, 51(1), 15-24.
Miyawaki, A., A. B. Jena, L. G. Burke, J. F. Figueroa, & Y. Tsugawa (2023): “Association between emergency physician’s age and mortality of medicare patients aged 65 to 89 years after emergency department visit,” Annals of Emergency Medicine, 82(3), 301-312.
Rowe, B. H., P. Channan, M. Bullard, S. Blitz, L. D. Saunders, R. J. Rosychuk, ... & B. R. Holroyd (2006): “Characteristics of patients who leave emergency departments without being seen,” Academic Emergency Medicine, 13(8), 848-852.
Tsugawa, Y., J. P. Newhouse, A. M. Zaslavsky, D. M. Blumenthal, & A. B. Jena (2017): “Physician age and outcomes in elderly patients in hospital in the US: observational study,” BMJ, 357.