隨機性門診病患之醫療指派規劃系統

A stochastic Clinical Model for Outpatient Scheduling with Patient no-shows and General Service Time

徐綱佑(Kang-Yu Hsu)

指導教授 ： 桑慧敏

國立清華大學/工學院/工業工程與工程管理學系/碩士(2010年)

摘要

醫療服務單位對門診病患的處理效率及門診病患預約指派的及時性，除了是實現良好醫療服務品質的重要因素外，也是病患滿意度的重要評估因素。然而，已預約病患未出現於醫療單位的情況將嚴重影響醫療服務的品質。在本研究中，我們建立一個採用超額訂位(overbooking)策略的隨機性醫療指派規劃模型，以平衡未出現病患對醫療服務單位帶來的不良影響。在本研究規劃環境中，我們將一個服務週期 (service period) 分割為數個時間區段 (slot)。病患預約要求為單一且序列性到達醫療服務單位，規劃系統將根據每個病患的未出現機率特徵，依序指派每個病患於未來某個時間區段的開始時間點作為其預約時間。同時，當一個病患已經被指派後，此病患的預約時間將不再被更改。我們的目標函式具有減少病患等待時間、降低服務週期結束時系統中等待服務人數、最大化醫院資源的使用率並同時創造最大利潤的能力。目標函式為單峰(unimode)的性質我們提供了證明。在此性質下，本研究提出之指派規劃法則將可以提供醫療服務單位對於一個服務週期中指派病患數量的準則。最後，我們測試了各種環境下，我們提出之指派規劃法則的績效表現以及敏感度分析，並針對各項參數的變化以探討對指派策略的影響。

關鍵字

超額預訂 ； 指派規劃 ； 病患未出現特徵 ； 門診醫療系統

並列摘要

For outpatients, efficiency of appointment scheduling is not only a important factor to guarantee the sufficient service quality, but also the criterion of client's satisfaction. However, the situation of patient no-show for pre-booked appointments wastes clinic resources, and decreases the quality of medical care. In this research, according to problems about patient no-show, a stochastic overbooking model is constructed and an appointment scheduling policy developed for outpatients with general service time. In a sequential patient call-in process, scheduler assigns patients to slots which split from a schedule horizon. As soon as an appointment is added to the schedule, it cannot be changed. An objective function published lately is used, capturing patient waiting time, staff overtime and patient revenue. The proof of unimodal property of objective evolution is provided. Finally, under a variety of conditions, the behavior of scheduling policy is investigated and compared with practical cases simultaneously.

並列關鍵字

Overbooking ； appointment scheduling, ； patient no-shows ； outpatient clinics

參考文獻

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Blanco White, M. J., & M, C. P. (1964). Appointment systems in outpatients' clinics and the effect on patients' unpunctuality. Medical Care , 2 (3), pp. 133-145.

Brahami, M., & Worthington, D. J. (1991). Queuing models for outpatient appointment systems: a case study. Journal of the Operational Research Society , 42, pp. 733-746.

Cayirli, T., & Veral, E. (2003). Outpatient scheduling in health care: a reviesw of literature. Production and Operations Management , 12 (4), pp. 519-549.

Cayirli, T., Veral, E., & Rosen, H. (2006). Designing appointment scheduling systems for ambulatory care services. Health Care Management Science , 9, pp. 47-58.