加護病房管理模擬流程最佳化之探討─以中部某醫學中心為例

The study of optimal simulation process of the ICU management, taking a medical center as an example

駱品妏(Pin-Wen Lo)

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(2015年)

https://doi.org/10.6834/CSMU.2015.00188

摘要

近年來醫療科技的進步以及時代的快速發展，民眾對醫療健康的需求與知識增加，對於醫療資源自主權明顯提高，使得醫療健保費支出和成本不斷增長。在醫療院所加護病房是屬於重症醫療部門，它的存在是不可或缺的，且需要醫院醫師跨科別進行討論協助了解病情的重要部門。
當民眾進入內科加護病房系統時，流程的管理明顯重要，不僅要減少醫療資源的浪費且有效的運用，提升醫療品質與人力配置最佳化，在這些情況下，將時間有效的降低、減少人員空閒及加護病房閒置格外重要，進而提高加護病房的產值與醫療品質，並有效降低營運成本。
本研究以中部某醫學中心內科加護病房工作流程作為研究對象，利用離散模擬事件的方法，依據加護病房實際流程資訊推演出各流程分布情況，建構加護病房流程模擬架構，並運用反應曲面法的回歸模型，再利用基因演算法找尋最佳方案，以降低總流程時間以及總人資成本，提供醫院管理者做為決策之依據。
本研究結果發現：(1)總流程時間(Y1)時：病患住進加護病房的時間約5~10分鐘、編制治療指令的時間約60~90分鐘、每日平均人數約10~13人、內科加護病房利用率約14間的情況下，能夠使流程時間最小化。(2)總人資成本(Y2)為最佳方案：病患住進加護病房的時間約5~10分鐘、編制治療指令的時間約20~40分鐘、每日平均人數約10~13人、內科加護病房利用率約14間的情況下，能夠使總人資成本最小化。(3)在理想函數(Y3)之最佳方案：病患住進加護病房的時間約15~20分鐘、編制治療指令的時間約20~40分鐘、每日平均人數約3~7人、內科加護病房利用率約8間的情況下，為總流程時間(Y1)以及總人資成本(Y2)之最佳平衡點，因此理想函數(Y3)之最佳解為較佳之方案。

關鍵字

內科加護病房 ； 內科加護病房模擬 ； 人資成本 ； 流程模擬最佳化

並列摘要

With the advancement of the medical technology in the rapidly development society， the demand for medical care knowledge has been increased. While patients have more autonomy toward the choice of medical resources, the medical care insurances and costs would be relatively be increased. Intensive Care Unit (ICU) is a critical care unit that cannot be left out in hospital organizations, in which doctors, physicians, and other medical care professionals should go on interdisciplinary discussion and collaboration to offer better medical care service.
While patients transferring into the Medical Intensive Care Unit (MICU), the administration of operation procedure becomes obviously important, in order not to waste but optimally utilize medical resources to increase medical care service. In such circumstances, hospital managers should effectively decrease the treatment time of MICU, the idle time of medical care professionals, and the standby time of ICU wards so as to increase the medical care quality and MICU benefit, and simultaneously, decrease the MICU operating costs.
The research was based on the MICU of a d medical center in central Taiwan, utilizing the method of Discrete Event Simulation (DES) and Response surface methodology (RSM) to construct the simulation framework for MICU procedure. Afterward, genetic algorithms were used to seek optimal solutions for hospital decision-making managers to decrease the total workflow procedure time and the total human resources cost.
The research findings showed that Y1 is the optimal solution to minimize the total workflow procedure time, in which the time patients admitted to ICU would be approximately 5-10 minutes, the treatment time would be approximately 60-90 minutes, the daily average patients would be approximately 10-13 patients, and the utilization rate of ICU wards is 14 wards. Y2 is the optimal solution to minimize the total human resources cost, in which the time patients admitted to ICU would be approximately 5-10 minutes, the treatment time would be approximately 20-40 minutes, the daily average patients would be approximately 10-13 patients, and the utilization rate of ICU wards is 14 wards. Y3, the ideal function, is the optimal solution, to make a balance between Y1, total workflow procedure time, and Y2, the total human resources cost. In Y3, the time patients admitted to ICU would be approximately 15-20 minutes, the treatment time would be approximately 20-40 minutes, the daily average patients would be approximately 3-7 patients, and the utilization rate of ICU wards is 8 wards.

並列關鍵字

Medical intensive care unit ； MICE Simulation ； Human resource costs ； Optimization Simulation

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