醫療機構急診流程模擬效率最佳化之探討

The study of the optimal effectiveness of emergency treatment procedure simulation at medical institutions

簡任玉(Ren-Yu Jien)

指導教授 ： 廖宏昌

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00156

摘要

急診主要目的在於立即給予患者緊急適當之處理，是各醫院中重要的一環，急診醫學更於民國87年起正式被衛生署承認為一主專科。而我國於民國85年開始實施全民健保後，雖提高了民眾就醫之可近性，卻也相對造成急診就診人次上升。當急診就醫人數增加時，在超過醫院現有人力及設備資源、急診空間有限，及不良之流程設計與資源分配等各種需求超過供給的情況下，更加提高急診繁忙程度，及急診工作過度負荷與拉長病患滯留時間，進而形成「急診壅塞」的情況。
本研究以中部某醫學中心急診內科病人為主要研究對象，以資料中發生急診壅塞最為嚴重月份之病患急診就醫流程資料取出，利用急診病患各流程下實際就診時間為模擬之依據，透過統計推演出各流程下之統計分配，建構出急診病患看診作業流程之模擬系統。
為解決急診壅塞以及急診病患滯留於急診時間過長之問題，本研究係根據「輸入—處理效能—輸出」之急診壅塞概念模型於模擬醫院中分別導入各改善方案之組合於模擬系統中。以各改善方案之組合模擬輸出值，利用反應曲面法配適出各改善方案組合之最佳配適迴歸方程式。最後，利用各項最佳配適迴歸方程式，經由基因遺傳演算法及敏感度分析下，擬定各項改善目標之改善方案組合。
本研究結果發現，越在不發生急診壅塞時，實施將不緊急病患柔性勸導至門診之改善方案下，越會降低平均每位病患候診時間、平均每位病患治療時間、平均每位病患滯留時間以及平均每日急診壅塞指數。而在優先急診病患使用檢查室之改善方案下，確實有效改善平均每位病患治療時間以及平均每位病患滯留時間。並且，透過優先急診病患入院之方案下，有效降低平均每位需入院病患候床時間、平均每位病患治療時間、平均每位病患於急診之滯留時間，以及平均每日急診壅塞指數。

關鍵字

急診 ； 急診壅塞 ； 輸入—處理效能—輸出

並列摘要

The purpose of emergent medical services is to provide urgent and appropriate care to those in need, which is a critical part of each hospital. Since 1998, emergency medicine was recognized as one of the medical specialty by the Department of Health. After the implementation of the National Health Insurance in 1996, the accessibility of medical services was improved greatly, however, the usage of emergency department also increased rapidly. The so-called emergency department crowding occurred when the needs of the emergency services exceeds the current man-power, equipment invested and room space, causing an increase of both the work loading and the patient waiting time.
This study extracted the data of the patients who visited the emergency department for internal medicine diseases in a medical center in middle-Taiwan from the most crowded month, from which we simulate and construct a simulation system according to the actual time of the each process by analyzing the time of cost for each process.
To solve the emergency department crowding, this study integrate improvement project combinations based on a conceptual model of emergency department crowding using the input—throughput—output principle. By using the simulating combination output value for each improvement project, via response surface methodology, to fit the best regression model within, we determine the final project of improvment for each target through genetic algorithms and sensitivity analysis.
This study concludes: when there is no emergency department crowding, the average waiting time, treatment time, stay time and the crowding index could be minimize if we gently persuade the not-urgent patient to the outpatient clinic. When under the project of emergent patient exams first, the average treatment time and stay time could be efficiently improved. Also, through the emergent patient admits first project, the average bed-waiting time, treatment time, stay time and average daily crowing index could be minimized.

並列關鍵字

Emergency Department ； Emergency Department Crowding ； input—throughput—output

參考文獻

[32] 胡勝川(2010)。急診專科十年回顧。台灣醫界雜誌，53(5)，53-54。

[81] 蔣雅君，謝雅惠，趙秀雄，杜淑敏及姚鈺(2002)。放射線部檢查報告作業時效之探討。醫務管理期刊，3，41-60。

[51] Wen-Han, C., Chie-Hsuan, H., & Cheng-Ho, T. (2007). Time survey of triage emergency department patients during rush and non-rush periods, Journal of Emergency and Critical Care Medicine, 18(1), 21-30.

[2] 梁亞文、蔡哲宏、陳文意(2011)。非緊急急診病人特性及其相關因素探討。

[8] 黃金安、賴其勳及胡哲安(2006)。急診醫療服務與其他醫療服務之類別間關係。臺灣公共衛生學雜誌，25，384-393。