建立以個體為基礎模型(ABMs)模擬急診室壅塞

Using Agent Based Modeling for the Simulation of Emergency Department Overcrowding

鍾濟宇(Chi-Yu Chung)

指導教授 ： 詹前隆

元智大學/資訊學院/資訊管理學系/碩士(2013年)

https://doi.org/10.6838/YZU.2013.00219

摘要

急診室壅塞造成了急診救護之障礙與醫療品質的低落，已是一個被全球醫療機構視為重要且極需解決的問題。急診醫療照護的政策制定與資源的配置，對其病患的健康與生命安全有直接的關聯與影響，需要清楚掌握造成壅塞的因子並對症下藥，才能有效緩解急診壅塞。本研究的目的是利用個體為基礎模型建構一個可調控之急診室環境。模擬高病患流量配置所形成的急診室情境下，使用兩項指標，工作分數(Work Score)與病患未完成診療即離開率(LWBS Rate)，即時監控模型壅塞程度和急診醫療品質；並運行「離院準備服務」與「調整住院病床分配比重」兩項紓緩策略，探討壅塞介入措施之成效以及病患就醫與急診系統的運作模式。從這樣的動態模擬程序中，得以觀察藉由模型中代理人彼此間互動之細節，瞭解或發現造成急診壅塞環節與其因果關係，進而輔助決策者提出緩解壅塞策略規劃與制定。

關鍵字

個體為基礎模型 ； 模擬 ； 急診室 ； 急診壅塞

並列摘要

Emergency Department (ED) overcrowding is a major problem of hospitals across the globe that may affect the quality and access of health care. This study presents an Agent Based Modeling to create an Emergency Department environment, to simulate ED system process using the scenarios and resources allocated based on the level of hospital of the high ED patient flow. This model consists of physician, nurse, patient, registration staff, examination staff, and those agents interact with each other. The model used two indexes (the Work score and LWBS rate) to evaluate and monitor ED crowding in the real-time. In an ED crowding situation, hospitals can use strategies such as, non-urgent patients discharge and the percentage allocation of inpatient beds to alleviate the ED crowding. Policy makers can observe in detail the patient’s behavior, understand the causes of crowding and the effects generated by the interaction between the agents and environment, thereby assisting in setting up strategies to handle the ED overcrowding.

並列關鍵字

agent based modeling ； simulation ； emergency department ； overcrowding

參考文獻

3. Asplin, B. R. (2001). Tying a knot in the unraveling health care safety net. Academic Emergency Medicine, 8(11), 1075-1079.

4. Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. I., Lurie, N., & Camargo Jr, C. A. (2003). A conceptual model of emergency department crowding. Annals of emergency medicine, 42(2), 173-180.

5. Auchincloss, A. H., Riolo, R. L., Brown, D. G., Cook, J., & Diez Roux, A. V. (2011). An agent-based model of income inequalities in diet in the context of residential segregation. American journal of preventive medicine, 40(3), 303-311.

6. Bagust, A., Place, M., & Posnett, J. W. (1999). Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ: British Medical Journal, 319(7203), 155.

7. Baker, D. W., Stevens, C. D., & Brook, R. H. (1991). Patients who leave a public hospital emergency department without being seen by a physician. JAMA: the journal of the American Medical Association, 266(8), 1085-1090.