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

駱品妏

doi:10.6834/CSMU.2015.00188

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加护病房管理模拟流程最佳化之探讨─以中部某医学中心为例

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

骆品妏 , 硕士　　导师：廖宏昌　　

繁体中文 DOI： 10.6834/CSMU.2015.00188

内科加护病房；内科加护病房模拟；人资成本；流程模拟最佳化； Medical intensive care unit ； MICE Simulation ； Human resource costs ； Optimization Simulation

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摘要 │ 参考文献 (45) │ 国际计量

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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.

参考文献 ( 45 ) 〈TOP〉

[4] Shafi, S., Nathens, A. B., Cryer, H. G., Hemmila, M. R., Pasquale, M. D., Clark, D. E., Fildes, J. J. et al. (2009) The Trauma Quality Improvement Program of the American College of Surgeons Committee on Trauma. J Am Coll Surg,209(4). 521-530.
连结：
[5] Shyr-Juh Chang, Hsing-Chin Hsiao, Li-Hua Huang, Hsihui Chang(2011) Taiwan quality indicator project and hospital productivity growth,39(1). 14-22。
连结：
[8] Nadzam DM., Turpin R., Hanold LS. et. el.(1993) "Data-driven Performance Improvement in Health Care：The JointCommission ’s Indicator Measurement System(IMSystem). "The Joint Commission Journal on Quality Improvement , November,19(11) ,493-500.
连结：
[9] 卫生福利部(2013)医院品质绩效量测指标系统，医院品质绩效量测指标系统与落实品质改善试办计画，102年度指标年报，1-6。
连结：
[10] Joint Commission on Accreditation of Healthcare Organization（JCAHO）（1989）. Characteristics of Clinical Indictor. Quality Review Bulletin, 15（11），330-339.
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