4.5 Specialized Medical Care

In the rapidly evolving healthcare landscape, Tri-Service General Hospital Taichung upholds the core values of teamwork, professionalism, empathy, and innovation. It actively participates in the Tri-Service Southern Medical Alliance and, focusing on local medical needs, is fully committed to delivering top-tier medical quality at a quasi-medical center level.

The hospital has deeply developed specialized medical care through data-driven and interdisciplinary collaboration. In emergency cardiac catheterization and acute stroke care, the internal medicine and surgery teams coordinate seamlessly with case managers. In 2025, the volume and quality indicators for key procedures—such as complex coronary artery interventions, percutaneous transluminal angioplasty (PTA), and endovascular thrombectomy (EVT) for ischemic stroke—significantly exceeded expected thresholds. Additionally, the comprehensive orthopedic center, full surgical department, and colorectal surgery unit actively introduced advanced minimally invasive technologies, including hybrid operating rooms equipped with dual robotic arms, ROSA robots, precision anesthesia, and 3D endoscopic sinus navigation. Combined with interdisciplinary collaborations in rheumatology for gout and pediatric joint developmental assessments, these efforts exemplify precise, holistic care for high-risk groups. Furthermore, to address potential shortages in wartime medical support or transportation disruptions, the Military Medical Bureau has planned the establishment of a “Forward Resuscitative Surgical Detachment (FRSD),” integrating secondary-level medical support to perform damage control resuscitation and surgery. Each FRSD team consists of 10 members divided into four groups: triage, surgery, recovery, and administration, effectively enhancing medical capabilities for combat injuries.

Southern Medical Alliance Technical Exchange

The “Tri-Service Southern Medical Alliance,” overseen by the Military Medical Bureau of the Ministry of National Defense and centered at the Tri-Service Southern Regional Hospital, comprises six hospitals: Tri-Service Kaohsiung General Hospital and its Pingtung branch, Tri-Service Zuoying General Hospital and its Gangshan branch, as well as Tri-Service Taichung General Hospital and its Zhongqing branch. This integrated medical care network was established to implement national policies of “hierarchical medical care” and “two-way referral,” while balancing the dual missions of “wartime military medical rescue” and “peacetime local military-civilian care.” By sharing resources and vertically integrating hospitals at various levels with grassroots clinics within the alliance, the Tri-Service Southern Medical Alliance eliminates institutional and geographical barriers, providing seamless, uninterrupted, high-quality medical services to military personnel, veterans (and their families), and the general public in southern Taiwan.

Tri-Service Taichung General Hospital participates in the “Tri-Service Southern Medical Alliance,” focusing on addressing local medical needs. Through this alliance, it strengthens medical human resource management, develops key medical technologies, advances medical equipment, expands training facilities, and enhances hospital management and service capacity. These efforts gradually build medical quality and technical capabilities to a “quasi-medical center” level. Simultaneously, in accordance with the Military Medical Bureau’s PPF system and inter-hospital cooperation and deployment policies, the hospital reinforces medical support and personnel exchanges with its branches. This enables the branches to achieve independent operational capabilities early, ensuring regional medical accessibility and resilience. Moreover, the military medical system integrates resources through the “regional medical alliance strategy” and collaborates with the Tri-Service General Hospital to elevate medical technology and quality to a full medical center level, serving as a vital tool for sustainable healthcare.

The Southern Medical Alliance systematically enhances emergency and critical care, as well as key specialty capabilities, through a combination of “department management and key technology transfer.” It monitors and improves performance using quantitative thresholds and quality indicators, such as procedure volume, complication rates, and short-term mortality rates. On the personnel front, the deployment system clearly regulates the institutionalized dispatch of supplementary physicians to branch facilities to maintain service capacity and ensure continuity of care. In terms of training and wartime resilience, the alliance emphasizes combat injury rescue, emergency response capabilities, and talent development for military-civilian cooperation.

Using recent alliance execution results from Tri-Service Taichung General Hospital as an example, in 2025, multiple novel techniques were successfully completed, meeting or exceeding established thresholds, with quality indicators maintained within standards. These included 151 cases of complex coronary artery interventions (threshold: 30 cases) with a postoperative 48-hour mortality rate below 2.7%; 407 cases of percutaneous transluminal angioplasty (PTA) (threshold: 80 cases) with a surgical complication rate below 1.23%; 10 cases of acute ischemic stroke endovascular thrombectomy (EVT) (threshold: 1 case) with a symptomatic intracranial hemorrhage rate of 0%; and 139 cases of repetitive transcranial magnetic stimulation (r-TMS) (threshold: 30 cases) with a 0% adverse reaction rate post-treatment.

Additionally, director-level meetings proposed improvement strategies to enhance cancer diagnosis and treatment quality certification case growth. These include aligning with the new building and the installation of advanced medical equipment, strengthening hematology-oncology staffing, and targeting a 10% annual increase in cancer patient cases. These efforts aim to continuously advance the quality of cancer care and certification standards.

2025 Major Technical Execution Data:

Item No.	Technology Name	Q1	Q2	Q3	Q4	Total	Quarterly Threshold
1	Complex coronary artery intervention	39	32	43	37	151	30
2	Permanent transvenous cardiac pacemaker	3	4	7	8	22	3
3	Percutaneous transluminal angioplasty (PTA)	116	108	102	81	407	80
4	Cerebral angiography (DSA)	7	12	10	9	38	3
5	Acute ischemic stroke thrombectomy	2	2	3	3	10	1
6	Spinal surgery	52	58	58	54	222	50
7	Total knee arthroplasty	52	53	52	51	208	5
8	Repetitive transcranial magnetic stimulation (r-TMS)	15	34	47	43	139	30

Note: Unit (persons)

Emergency Cardiac Catheterization Treatment Center

Facing the challenges posed by rapid changes in the medical environment, Taichung Armed Forces General Hospital has consistently committed to enhancing the quality of emergency medical care, viewing this as central to sustainable medical development. Our hospital has demonstrated a high level of professional integration and outstanding performance in the management of acute coronary syndrome. This achievement reflects not only statistical data but also a concrete commitment by the surgical and internal medicine teams to collaborate closely and safeguard the lives of the regional population.

A Strong Foundation of Professional Teams and Interdisciplinary Collaboration

The key to sustainable medical care lies in the professionalism of the staff and the stability of the team. Currently, our hospital has established a comprehensive acute coronary syndrome care team, staffed by four full-time cardiology specialists, all certified interventional cardiologists, ensuring the high-quality performance of cardiac catheterization procedures. For surgical support, the hospital maintains a robust emergency consultation system, supported by three cardiac surgery specialists. This highly integrated scheduling and consultation system between internal medicine and surgery not only meets the national standards for a major emergency responsibility hospital but also provides acute myocardial infarction patients with seamless, around-the-clock medical care.

In 2025, our hospital achieved a 95% success rate in performing the first electrocardiogram (ECG) within 10 minutes of emergency STEMI patient arrival. Simultaneously, the accuracy of medication administration, including aspirin (ASA) and clopidogrel, remained exceptionally high at 95%, demonstrating the emergency team’s vigilance and adherence to standardized procedures in initial screening and treatment.

More critically, the “Door-to-Wire Time” (the interval from hospital arrival to guidewire placement) is a key indicator used to measure the efficiency of hospital interventional treatment. In 2025, the average proportion of cases with a Door-to-Wire Time under 90 minutes was 78.95%. Notably, during nighttime and holiday non-working hours, the team’s performance was even more impressive, with a success rate increasing to 85.71%.

Furthermore, for cases transferred within the system, our hospital demonstrated excellent transfer efficiency, achieving a 100% success rate for door-to-wire time under 60 minutes, ensuring that transferred patients receive timely treatment.

Continuous Growth and Future Outlook

The sustainability report serves not only as a review of the past but also as a blueprint for the future. In 2025, our hospital performed a total of 161 percutaneous coronary intervention (PCI) cases, including 14 emergency procedures. This stable case volume not only helps maintain the physicians’ technical proficiency but also underscores our hospital’s vital role in the regional emergency medical network.

In the future, we will continue to optimize the interventional treatment process during regular daytime working hours, aiming to elevate daytime efficiency to the same high level as nighttime. Through ongoing education and training, process reengineering, and enhanced collaboration between internal medicine and surgical teams, Taichung Armed Forces General Hospital will steadily progress on the path to medical excellence, fulfilling its social responsibility to protect life and maintain operations.

2025 Acute Coronary Syndrome Medical Indicator Data Table for Our Hospital

Evaluation Items / Indicators	Data Results	Remarks / Notes
Number of cardiology	specialists: 4	All possess qualifications as interventional cardiologists
Number of cardiothoracic	surgeons: 3	Form a solid support for the emergency consultation system
Emergency STEMI patients ECG completion rate within 10 minutes	95%	Completion of the first ECG within 10 minutes of hospital arrival
Accurate medication administration rate (ASA & Clopidogrel)	95%	Proportion meeting the criteria for administration of relevant medications
Annual average proportion of Door to wire time < 90 minutes	78.95%	A key indicator measuring the efficiency of hospital interventional treatment
Nighttime and holiday Door to wire time < 90 minutes achievement rate	85.71%	Performance during non-working hours is even more outstanding
In-system referral cases with door-to-wire time < 60 minutes achievement rate	100%	Demonstrating excellent transfer efficiency to ensure the most timely treatment
Total number of coronary intervention (PCI) cases performed hospital-wide	161 cases	Statistics for the entire year of 2025
Number of emergency coronary intervention cases	14 cases	Included in the above total of 161 cases

Acute Stroke Care

The Taichung Armed Forces General Hospital has long been dedicated to establishing a comprehensive emergency medical network, particularly in the field of acute stroke care. Through interdisciplinary team collaboration and efficient administrative processes, the hospital demonstrates a strong commitment to the health of the Greater Taichung community. The hospital’s core strength lies in its professional talent deployment. Currently, an elite acute stroke care team has been formed, integrating the expertise of the neurology and neurosurgery departments. Led by three neurologists, the neurology team ensures continuous medical coverage through a specialist on-call system and a reporting support mechanism. Meanwhile, three neurosurgeons provide a robust backup team responsible for complex surgical interventions.

To implement patient-centered case management, the hospital has designated specialized stroke case managers and employs physicians qualified to perform endovascular thrombectomy (EVT), ensuring patients receive the most appropriate treatment during critical moments. The hospital’s medical quality performance focuses primarily on timeliness and accuracy. In 2025, the hospital treated a total of 141 acute stroke patients who arrived at the emergency department through various means, including 82 transported via Emergency Medical Services (EMS), demonstrating the hospital’s strong collaboration with the local fire and rescue system. Clinically, among all acute ischemic stroke patients in the emergency department, the rate of receiving intravenous thrombolysis (IV-tPA) or EVT reached 15.05%. For all patients eligible for thrombolytic therapy, the hospital achieved a 100% administration rate of intravenous thrombolysis, reflecting the medical team’s strict adherence to clinical standards and zero tolerance for missed life-saving opportunities. In pursuit of sustainable operations, optimizing process efficiency remains a key indicator.

For acute ischemic stroke patients, the hospital’s door-to-needle time—the interval from arrival at the emergency department to the administration of intravenous thrombolysis—achieved a rate of 83.33% for treatment completion within 60 minutes during regular weekday working hours. Even during more challenging periods, such as nights and holidays, the overall compliance rate remained high at 71.43%. These results reflect seamless administrative coordination among the radiology, laboratory, emergency, and specialized wards, as well as the hospital’s consistent commitment to maintaining surgical capacity during nights and holidays. Looking ahead, Taichung Armed Forces General Hospital will continue to benchmark itself against the highest standards for hospital emergency medical capability grading. The hospital aims not only for technical excellence but also to implement sustainability principles in environmental, social, and governance aspects of its management. We deeply understand that behind every statistic lies the trust of a family; therefore, we will continuously review treatment processes and strengthen team operations to protect every stroke patient’s golden recovery period with the utmost efficiency and professionalism.

2025 Acute Stroke Medical Indicator Data Table

Evaluation Items / Indicators	Data Results	Remarks / Notes
Number of Neurology	Specialists: 3	Responsible for specialist on-call duty and reporting support mechanisms to ensure uninterrupted medical capacity.
神Number of Neurosurgery Specialists	Specialists: 3	Forming a strong support team, responsible for high-difficulty surgical interventions.
Total number of acute stroke admissions for the entire year	Specialists:  141	Includes the total number of patients arriving at the emergency department by various means
Among them: Number of people transported to the hospital via the EMS system	82 people	Indicates a close connection with the local fire and rescue system
Acute Ischemic Stroke Intervention Treatment Rate	15.05%	Proportion of cases receiving IV-tPA or EVT treatment
Proportion of patients meeting thrombolysis indications who received treatment	100%	Achieving strict adherence to clinical standards and the goal of zero omissions in life-saving interventions
Weekday Door-to-Needle ≤ 60 minutes achievement rate	83.33%	Time from emergency arrival to receiving intravenous thrombolytic therapy
Nighttime and holiday Door-to-Needle ≤ 60 minutes achievement rate	71.43%	Maintaining high-level interdisciplinary administrative efficiency even during off-hours

A Comprehensive Orthopedic Center Protecting the Mobility of Military Personnel and Civilians

The Orthopedic Department of Taichung Armed Forces General Hospital has long served not only as the guardian of the health of military personnel in central Taiwan but also as a beacon of hope for countless civilians regaining their mobility. Under the leadership of successive directors, the team has consistently upheld the core values of teamwork, professionalism, empathy, and innovation, closely integrating medical expertise with compassionate care. They have continuously advanced their efforts in critical care and precision medicine, earning repeated recognition in various teaching hospital evaluations and demonstrating a forward-looking medical approach that keeps pace with the times.

Opening the chapter on the Orthopedic Department’s medical achievements, the most impressive aspect is its comprehensive and meticulous development of subspecialties. The department goes beyond traditional orthopedic treatments; it encompasses spinal surgery addressing modern spinal disorders, joint reconstruction that helps patients regain mobility, and sports medicine established specifically for sports enthusiasts and professional athletes. Each subspecialty functions as a precise component, collectively forming a comprehensive mobility protection network. In response to the growing importance of osteoporosis and complex musculoskeletal infections, the department also includes a dedicated bone disease division. Alongside the fracture trauma division and expertise in shoulder and elbow joint medicine, these units provide patients with thorough care from head to toe, inside and out.

The Orthopedic Department is at the forefront of medical technology breakthroughs. To reduce postoperative pain and shorten recovery times, the team actively promotes various minimally invasive techniques. For example, in hip replacement surgery, the hospital was the first in Taiwan to perform the direct anterior approach. This muscle-sparing technique enables patients to return to normal life remarkably quickly after surgery. In spinal surgery, endoscopic and minimally invasive methods precisely address disc and canal stenosis issues. Particularly noteworthy is the team’s strong expertise in complex surgeries such as scoliosis and kyphosis correction, achieved through meticulous preoperative planning and execution to restore patients’ spinal health. Additionally, minimally invasive correction surgery for common bunion problems has become one of the department’s signature treatments, alleviating patients’ fears of surgery while enhancing both function and appearance.

Looking ahead, the Orthopedic Department is not resting on its current achievements but is actively planning for smart healthcare advancements. In the upcoming development blueprint, the ROSA robotic arm-assisted surgical system and precise spinal navigation technology will become indispensable tools for the medical team, elevating surgical accuracy to a new millimeter-level precision. Meanwhile, to address more complex bone defect reconstructions, the hospital is intensively preparing a high-standard human tissue bank. Through standardized bone bank operations, it aims to provide patients with more diverse and safer treatment options. This represents not only a technological upgrade but also a commitment to improving quality of life.

A Complete Surgical Department Team

In today’s rapidly evolving medical technology landscape, the Surgical Department of Taichung Armed Forces General Hospital consistently upholds the core values of empathy, professionalism, teamwork, and innovation. It strives to create a medical environment that meets the standards of a medical center. Through comprehensive upgrades in both hardware and software, the department not only pursues excellence in clinical skills but also integrates sustainable management principles into its medical services, ensuring that every patient receives the safest and most precise treatment possible.

To achieve the goal of one-stop treatment, the Surgical Department has actively introduced advanced medical equipment, most notably the hybrid operating room equipped with the dual robotic arm “icono” system. This sophisticated setup combines high-level imaging assistance with minimally invasive intervention techniques, enabling precise alignment for complex procedures in neurology, cardiovascular, and spinal surgeries. The multi-axis robotic arms offer exceptional flexibility, facilitating “one-scan-through” imaging and treatment from head to toe. Additionally, the integrated laser-guided positioning system significantly enhances surgical success rates and safety. This cutting-edge technology not only reduces operation times but also reflects a sustainable commitment to the precise utilization of medical resources.

In clinical practice, the department’s various specialties actively develop minimally invasive surgical techniques, significantly improving patient outcomes and quality of life. The Urology Department has introduced laser surgery and flexible ureteroscopic lithotripsy, while General Surgery has achieved breakthroughs in endoscopic breast surgery as well as minimally invasive liver and stomach procedures, all characterized by “small incisions and rapid recovery.” Utilizing 3D laparoscopy, the surgical team can perform complex procedures through very small incisions, effectively shortening hospital stays and reducing pain, enabling patients to return to their daily activities and society more quickly. This patient-centered treatment model is fundamental to sustainable medical development.

Between 2023 and 2025, the Surgical Department demonstrated steady growth in both surgical volume and service quality, highlighting the team’s professional expertise and reflecting the regional population’s trust in the hospital. Looking ahead, the department aims to reach a new milestone in “smart healthcare” by introducing the Da Vinci robotic arm system to enhance surgical precision. By integrating digital management with advanced equipment, the department will continue to optimize medical workflows and build an innovation-driven, professionally led, sustainable surgical system that protects the health of military personnel and civilians in central Taiwan.

Precision anesthesia ensures patient safety and accelerates recovery

With the rapid advancement of modern evidence-based medicine, anesthesia care has evolved from the passive maintenance of vital signs to active, precision, individualized anesthesia. In recent years, the hospital’s Anesthesiology Department has fully embraced this new concept by introducing multiple state-of-the-art smart medical devices. These innovations have not only enhanced patient safety during surgery but also significantly accelerated postoperative recovery.

In core orthopedic procedures such as total knee replacement (TKR), the Anesthesiology Department plays a vital and central role throughout the entire surgical process. This comprehensive care begins with preoperative optimization. When patients visit the anesthesia outpatient clinic, the team promptly conducts proactive interdisciplinary preliminary screening, coordinating with case managers to incorporate nutritionists’ high-calorie, high-protein supplementation plans and introducing physical therapists for preoperative rehabilitation. Simultaneously, the team dispels the traditional midnight fasting myth by guiding patients to consume ERAS-designated carbohydrate clear fluids two hours before surgery, thereby reducing insulin resistance and effectively alleviating preoperative anxiety.

On the day of surgery, the anesthesia team emphasizes “intraoperative precision” by implementing a multimodal analgesia protocol and utilizing precise instruments to monitor anesthesia depth and body temperature, ensuring optimal physiological parameters throughout the procedure. This accurate drug administration enables patients to be extubated immediately after surgery with the assistance of muscle relaxant reversal agents, significantly reducing reliance on ventilators. During the postoperative care phase, the absence of excessive fluid accumulation or residual drugs from surgery allows patients to experience a high-quality recovery characterized by “no pain, no dizziness.” Patients can begin consuming small amounts of food on the day of surgery and, with support from physical therapists and nursing staff, are encouraged to get out of bed within 24 hours, facilitating an earlier return to baseline physical function.

To achieve an exceptional level of safety, the Anesthesiology Department has established a comprehensive, three-dimensional monitoring network. Addressing the limitations of traditional anesthesia methods that rely on indirect physiological indicators such as heart rate and blood pressure to estimate anesthetic depth, the hospital is fully equipped with dual-brain anesthesia depth monitors and single-brain BIS (Bispectral Index) monitors. By incorporating EEG monitoring technology, clinicians can directly and in real time assess the suppression state of the cerebral cortex. This approach not only significantly reduces unnecessary anesthetic dosages but also effectively regulates “ideal EEG sedation,” thereby lowering the incidence of postoperative delirium and accelerating patient awakening. Furthermore, recognizing that unexpected intraoperative hypothermia substantially increases the risk of wound infection and cardiovascular complications, the department routinely employs forced-air warming blankets to actively maintain patients’ core body temperature above 36°C. For drug administration and fluid infusion, microcomputer-controlled target-controlled infusion pumps (TIVA/TCI) are utilized with total intravenous anesthesia, delivering precise dosages based on patient age, weight, and pharmacokinetic parameters to maintain stable blood drug concentrations and reduce postoperative nausea and vomiting. Additionally, advanced hemodynamic monitoring is implemented to enable goal-directed balanced fluid management (zero-balance), meticulously controlling every drop of infusion to prevent tissue edema and promote timely gastrointestinal recovery. Reason: The revision improves clarity and flow by restructuring sentences and enhancing vocabulary. Technical terms are clarified for precision, and punctuation is corrected for readability. Passive constructions are minimized to create a more direct and professional tone. The overall coherence is enhanced to better convey the advanced safety measures and technologies employed by the Anesthesiology Department.

This intelligent monitoring system has been widely implemented in clinical settings with excellent results. According to the 2025 annual statistics, the forced-air warming blanket has been used in 1,698 cases, the dual-brain anesthesia depth monitor has been flexibly applied in 694 cases, and the brainwave-guided sedation technique—crucial for ensuring high-quality patient awakening—has been successfully performed in 192 cases. The Anesthesiology Department’s integration of advanced technology and evidence-based data continues to establish a robust safety barrier for every surgical patient.