Following President Lai Ching-te's formal enactment of amendments to the Medical Action Act, which legally codifies mandated nurse-to-patient ratios across all three daily shifts, National Taiwan University Hospital (NTUH) has announced an operational restructuring strategy. The Ministry of Health and Welfare (MOHW) intends to enforce the ratios at major medical centers starting in 2027.

• The Overnight Staffing Bottleneck: NTUH Superintendent Dr. Yu Chung-jen voiced alignment with the law but noted that filling night and graveyard shift nursing slots remains an industry-wide challenge. To mitigate nurse burnout without compromising surgical volumes, NTUH is developing an "Inpatient-to-Same-Day Surgery" (一日手術) operational framework modeled after pilot runs at Taichung Veterans General Hospital.
• The Operational Shift: The strategy shifts pre-operative assessments entirely to outpatient clinics. Patients check in during the morning, undergo procedures, undergo post-op clinical observation, and are discharged by 7:00 PM to 8:00 PM the same day.
• Target Clinical Pathways:
• Cardiac Catheterization: Under traditional protocols, a catheterization requires a 3-day/2-night inpatient stay (Day 1: Admission/Assessment, Day 2: Procedure, Day 3: Discharge). The Same-Day model condenses simple diagnostics into a single 12-hour window, routing only complex intervention cases to dedicated inpatient beds.
• Other Specialty Adoptions: The hospital is extending this same-day model to micro-invasive urological surgeries (e.g., urinary tract calculi, cystoscopies) and advanced ophthalmic procedures.
• Systemic and Reimbursement Impacts: By turning multi-day admissions into single-shift operations, nursing coverage is restricted to day and evening shifts. This substantially reduces midnight bed occupancy, enabling the hospital to easily hit legislated nurse-to-patient ratios. NTUH noted that while these are handled as day surgeries, they currently bill under outpatient fee schedules; the hospital plans to petition the National Health Insurance Administration (NHIA) for modified reimbursement models once the program fully launches.

Resource:三班護病比醫學中心先行 台大醫院擬推「一日手術」減輕夜班負擔