建立手術時間預測模式來從事電腦化手術室排程

Building an operating time forecasting model to optimize computerized operating room scheduling

陳德芳(Der-Fang Chen)

指導教授 ： 蘇喜

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.01321

摘要

全民健康保險制度實施以來，由於財政支出節節上升，使得政府及健保局不斷祭出各種新的政策及辦法，造成國內的醫療環境變化非常快速，實施已有幾年的總額預算制度的給付點值每年不斷下降，政府增加財政預算的比例有限，雖然醫院不斷開源增加自費項目的收入，但是資源有限、開源不易，因此如何節省支出降低成本變成是醫院管理者首要重視努力的目標。
手術室的營運作業對於外科系的醫療業務有相當重要的影響，由於手術室是單位人力成本高，且投入儀器設備資本相當昂貴，所以醫院管理者應重視其管理效率，及其資源是否有被妥善利用，因此手術室管理亦是醫院管理者關心的重點。
在既有的空間及設備下手術室每天可執行的手術次數，端賴手術室有無有效率的管理，而手術室管理最重要的議題就是排程問題，排程好壞會直接影響手術室的使用效率及營運效益。
在大型的醫院中，尤其是醫學中心的手術室的手術排程往往是相當的緊湊，一旦出現意料之外的事情，常常會影響後面手術排程的進行，甚至嚴重到使當天所有的排程變得紊亂無章，不但影響手術醫師的情緒及手術室相關工作人員的士氣，同時也容易引致病人及其家屬的不滿，故不容忽視手術室排程的重要性。
本研究主要目的是利用本院過去一年度手術室的所有相關資料做有系統的分析，特別是著重於每一術式的手術時間的最常分佈和手術時間變異的分析以及手術時間的預測，以供手術室排程人員作排程作業時的參考。本研究的方法是利用統計學的廻歸分析法來探討影響手術時間的因素，利用複廻歸法來探討自變項和依變項的關係: 自變項為病人性別、病人年齡、病患疾病種類(與手術式有關)與來源(門診或住院)、麻醉方法、醫師別及醫師年資等七個變項，依變項為手術時間的對數值，以供分析了解每一自變項對依變項的影響力大小。然後更進一步使用一般線性模式和分層分析法，希望同時知道各種手術式及手術時間和自變項之間影響的相關性，從而建立起可應用的手術時間預測模式，以期應用在電腦化的手術室排程。
研究結果發現手術式本身及麻醉方式就決定了大部分的手術時間，而在本研究中的其他自變項中，會因為不同的手術式而產生或多或少不同程度的影響力，因此在設計「電腦化的手術排程設計」時，就可以參考過去該醫師在特定疾病代碼下，所要執行的手術式項目及麻醉方式，再佐以病人性別及年齡---等等因素，預測該手術所可能花費的時間，如此對於排程人員而言可以預先掌控相當的資訊，對每天手術室手術排程就能有莫大的助益。

關鍵字

手術室 ； 開刀房 ； 手術時間 ； 預測模式 ； 電腦化手術室排程

並列摘要

Background:
With the continuing growth of cost since the implementation of national health insurance program in 1995, government and Bureau of National Health Insurance (BNHI) have tried all the efforts in alleviating the public's financial burden. Aim to cut the medical expenses while providing "universal coverage” and excellent quality of care, national health insurance program had taken the acts that implemented global budget payment system and quality-based payment method. In July 2001, the BNHI began to revise the fee schedule, by mainly taking reference from the US concept of the resource based relative value scale (RBRVS) and by fixing points for various medical services to rationally reflect the value of resources. The financial risk has thus been transferred to those who provide health care. To pursue for financial stability on operation, all the hospitals in Taiwan must be more efficiently reducing the running cost.
The operation unit involved intensive manpower and high-cost equipments. The efficiency and efficacy of the operation system on operation unit would greatly impact on the hospital finance. To be efficient on operation running system is now the paramount in hospital management. Among the many factors that impacted on the running system, operation scheduling by surgical time estimation is the most important one to eliminate unwanted cost and increase care quality.

Methods:
This study is to establish mixture models that estimate operating time distribution to schedule surgical agenda effectively. It retrospectively reviewed all the patient profile related to surgical procedures that taken place in operating room in study hospital from Jan.1st to Dec.31th, 2004. The dependent variable for analysis was operating time; the independent variables included: operating code related to surgery, patient gender, age, outpatient or inpatient as patient source, method of anesthesia, surgeons and their seniority years. The multiple regression analysis was used to test the relationship between operating time and the above independent variables (Model 1~4). To determine how the variables predicted operating time and develop an operating time forecasting model, general linear model with stratification was used (Model5~6). This forecasting model will serve as a basis for computerized scheduling system.
Results:
In the first four models, we find that variability in operating time is mainly affected from operating code-related surgery. The relationship between operating time and other variables are different according to different operations. In model 5 and 6, the variable of the surgeon itself will provide more accuracy in operating time estimation in building an operating time forecasting model.

並列關鍵字

operating room ； operatng time, ； scheduling ； forecasting model

參考文獻

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