應用模擬技術縮短辦理出院程序時間之實證研究-以南部某區域醫院為例

An Empirical Study Using Simulation Technology to Improve Hospital Discharge Time – A case study of Southern Regional Hospital

洪國偉(Kuo-Wei Hung)

指導教授 ： 張純明

長榮大學/管理學院/企業管理研究所/碩士(2007年)

https://doi.org/10.6833/CJCU.2007.00097

摘要

隨著國民生產毛額的增加，醫療保健越來越受國人重視。近年來許多民間企業開始投入醫療產業，也將私人企業的經營管理理念應用到醫療機構上。病患對醫療機構的需求，除了追求良好醫術之外，逐漸重視效率與等待品質，而提升品質的先決條件是降低等候時間。本研究透過個案訪談，發現個案醫院在病患辦理出院手續的過程中，常發生病患因不耐等候過久而抱怨的案例，對於個案醫院而言，如何降低病患等待的時間與變異是項重要的課題。
本研究運用模擬軟體eM-Plant建構個案醫院的出院流程模型，並提出建議方案，供醫院管理人員決策之用。本研究共提出四個建議方案：方案1將現有後進先出法的流程更改為先進先出法，模擬的結果病人等候時間的標準差由原先的21.02分鐘改善為14.27分鐘；方案2加入行動護理站，模擬的結果整體的等候時間由原先的78.41分鐘降低到47.37分鐘，且標準差更是從先前的21.02分鐘降低到11.63分鐘；方案3將專科護理師的工作項目進行優先順序I、II的劃分，模擬的結果平均等候時間與標準差分別改善為45.00與14.97分鐘；方案4又分為4a、4b與4c，係探討加入「預開出院」的措施於現況模型、方案1以及方案3之後的表現，模擬結果顯示隨著預開出院比例增加，無論方案4a、4b或4c均可以大幅度的減少病人出院總等候時間。
本研究所提建議方案，多屬低成本負擔，而方案2之行動護理站，導入成本雖高，可多方面改善醫院效率。因此整體而言，本研究可對個案醫院提供極高的應用價值。

關鍵字

模擬理論 ； 醫院管理 ； 流程改善

並列摘要

With the growing of GDP, personal health care become more and more important. Many private enterprises begin to invest and apply operations management in health care industries. The patients demand not only for high medical care but also good service such as less waiting time and high efficiency. During our interview with management in case hospital, it is mentioned that some patient complaints are due to long waiting time when discharged from hospital. Therefore, it becomes an important issue for the case hospital to improve the waiting time and increase the quality of service.
In order to solve problems, this research applies simulation technology with eM-Plant package. Present discharge process model is first set up. Some of the process steps are modified, new criteria are applied and data are analyzed. We end up with four feasible solutions. In the first one, the original last-in-first-out assignment rule is replaced by first-in-first-out. The simulation results demonstrate a significant reduction in the standard deviation of waiting time, from 21.02 to 14.27 minutes. In the second one, after the mobile nursing station is added, the average waiting time is significantly reduced from 78.41 to 47.37 minutes and the standard deviation is reduced from 21.02 to 11.63 minutes. In the third one, we divide RN’s working items into priority I and priority II. The simulation results demonstrate a significant reduction in the average waiting time, from 78.41 to 45.00 minutes and the standard deviation is reduced from 21.02 to 14.97 minutes. In the last one, the pre-discharge policy is embedded in foregoing solutions. The simulation results demonstrate a significant reduction in the average waiting time.
Our study results provide good solutions for the management of case hospital. It shows that the waiting time for discharged patients can be greatly improved. Besides solution 2, our solutions are low cost and hence can provide great value for the management of case hospital. Although solution 2 may be costly, it generally raises efficiencies in various fields for the hospital. Conclusively, our research makes good contribution for the case hospital.

並列關鍵字

Simulation Method ； Hospital Management ； Process Improvement

參考文獻

20. 黃興進(2002)。醫療資訊管理系統研究議題之探討。資訊管理學報，9，101-116。

21. 葉進儀、陳民枝(2001)。應用模擬技術及參考國外門診流程於國內醫療院所門診流程改善之研究，Journal of Da-Yeh University，10(2)， 91-99。

22. 葉進儀、陳民枝、吳軍劼(2002)。使用UML 與模擬技術於醫院急診室流程改善之研究---以中部某區域醫院為例，大葉學報，11(1)，91-102。

27. 蘇喜、李敏禎(1998)。病人候診時間之模擬研究－以某醫學中心家庭醫學科為例。中華民國公共衛生學會雜誌，17(5)，359-403。

28. 蘇喜、李敏禎、劉嘉玲(1998)，某醫學中心家庭醫學科病人候診與看診時間之研究。中華民國公共衛生學會雜誌，17(6)，495-511。