應用模擬技術及參考國外門診流程於國內醫療院所門診流程改善之研究

An Application of Simulation Techniques to Enhance Taiwan's Outpatient Services with Reference to Those in America

葉進儀(Jinn-Yi Yeh) ； 陳民枝(Jeanne Chen)

《大葉學報》 10卷2期 (2001/12) Pp. 91-99

https://doi.org/10.7119/JDYU.200112.0091

摘要

最近幾年雖然國內醫療環境普及，醫院規模日益擴大，但對病患而言，還是有看診擁擠、等待遲延的狀況發生，因此要如何在提昇醫療照顧品質、進而節省醫療成本，縮減醫療資源浪費，實為重要的課題。本篇論文乃是應用模擬技術及參考國外門診流程來探討國內醫療院所門診流程的改善研究，所謂國內（台灣）的看診方式為指定醫生看診，即醫生診間及病患看診診間皆固定，而國外（美國）的門診流程是病患不指定醫生看診，其看診診間為隨機指定，醫生輪流至各診間看診。為了建構國內的門診流程模擬模組，資料蒐集自中部的某地區醫院，而國外的模組則修改自國內模組，經過電腦分析結果可知，國內的每位病患平均系統循環時間為81.2分，較國外的54.3分長，國內的病患門診等待的平均時間為42.08分，也較國外的18.5分長，國內系統內病患的平均數為29.727大於國外的21.726，而國內每位醫生的平均使用率最高達67.398%，最低為45.743%，比較國外醫生最高為60.697%，最低為60.146%，根據上述之資料分析可得結論為：將國內的門診流程採用國外的方式可縮短病患的看病等待的時間，而且可平均分配每位醫生的工作量。

關鍵字

醫療門診流程 ； 模擬 ； 醫療照顧品質

並列摘要

In recent years hospitals in Taiwan have increased in number and capacity. With these increases apparently there are still instances of overcrowding and long waiting lines for outpatient services, thereby creating a definite need to enhance healthcare quality, minimize cost and decrease abuses. This research applies simulation techniques to outpatient services in order to study ways to enhance healthcare services. Reference is made to American outpatient services. In Taiwan outpatients are assigned to a specific doctor in advance, while in America doctors are randomly assigned to patients. Random assignments refer to the fact that doctors alternate duties in examination rooms without being specifically assigned to one. Taiwan's simulation model is constructed on the basis of data collected from a hospital in central Taiwan; whereas, the American model is an adaptation of the one for Taiwan. Computer analysis shows that the average turnaround time (time going in through completion) for Taiwan's outpatient service is 81.2 minutes, longer than the 54.3 minutes for the American model. The average outpatient service waiting time in Taiwan is 42.08 minutes, also longer than the 18.5 minutes for the American model. The average number of patients in the Taiwanese simulation is 29.727, greater than the 21.726 in the American model. The average busy rate for doctors in Taiwan is as high as 67.398% and as low as 45.743%; whereas, for the American model, the upper bound is 60.697% and the lower bound 60.146%. We conclude from the simulation results that changing Taiwan’s outpatient service flow to one similar to that of America can reduce patients' average waiting time and evenly distribute a doctor's workload.

並列關鍵字

outpatient service ； simulation ； healthcare quality