系統模擬應用於醫院骨科部手足外科組門診之流程改善

在台灣競爭激烈且瞬息萬變的醫療產業下，醫院不僅注重醫療品質外也紛紛開始強調提供更優質的醫療服務品質，在國軍桃園總醫院服務品質問卷中病患最不滿意就是漫長的等待看診的時間，主要原因就是有現掛與預約的混合門診病患，所以本研究致力於改善過長的等候時間並提升醫療服務品質。透過分析兩個月資料庫資料並利用現場收集資料作驗證發現看診病患平均等候時間長達兩個小時，利用敏感度分析出現掛病患為主要影響過長等候時間的重要因素，應用四種模擬模型並設計十八個方案來調整病患比例與看診順序藉此改善病患的等候時間，經結果發現確實能有效平均降低現掛病患45%等候時間與預約病患55%的等候時間。

關鍵字

系統模擬；骨科；流程改善；病患等待；混合型病患

並列摘要

In Taiwan, National Health Insurance provides convenient and cheap medical service. Most hospitals emphasize on providing high quality service for patients. Long waiting time is a factor that affects clinical service level and patient’s satisfaction in many hospitals. From the service satisfaction questionnaire in TYAFGH, shows long waiting time is the biggest contributor to dissatisfaction of patients. Therefore, reducing waiting time will be an effective approach to increase patient’s satisfaction level. The long waiting time is mainly caused by mixed registration type which includes walk-in patients, schedule patients, and special patients. Analyzing two months data from databases and hospital visits find the current situation requires patients to wait nearly two hours to see a doctor in the hand and foot team clinic of orthopaedic surgery department. Simulation models were built and validated. Different scheduling approaches were applied to the simulation model for waiting time reduction. From the results it can be concluded that adjusting patient proportions and different sequence approaches can decrease waiting time of 45% for walk-in patients and 55% for scheduled patients respectively. Simulation results show how the approaches reduce waiting time for orthopedics patients.

並列關鍵字

Simulation system ； Orthopaedic Department ； Process improvement ； Patient waiting ； Mixed registration type

參考文獻

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[2] S. Su and C. L. Shih, "Managing a mixed-registration-type appointment system in outpatient clinics," International Journal of Medical Informatics, vol. 70, No. 1, 2003, pp. 31-40.

[3] C. S. Liu and L. White, "Key determinants of hospital pharmacy staff's job satisfaction," Research in Social and Administrative Pharmacy, vol. 7, No. 1, 2011, pp. 51-63.

[4] A. B. Tehrani, S. R. Feldman, F. T. Camacho and R. Balkrishnan, "Patient Satisfaction with Outpatient Medical Care in the United States," Health Outcomes Research in Medicine, vol. 2, No. 4, 2011, pp. e197-e202.

[5] G. M. Eilers, "Improving Patient Satisfaction With Waiting Time," Journal of American College Health, vol. 53, No. 1, 2004, pp. 41-48.

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系統模擬應用於醫院骨科部手足外科組門診之流程改善

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