醫院空床之Rasch分析

Rasch Analysis of Hospital Bed Vacancy

10.6595/BDCM.2008.3(2).2

錢才瑋(Tsair-Wei Chien)；王文中(Wen-Chung Wang)；溫義輝(Yih-Huei Uen)

Rasch測量 ； 病床管理 ； 品管循環 ； 醫院評鑑 ； 接受者操作特徵 ； Rasch measurement ； hospital bed ； Deming Cycle ； hospital accreditation ； receiver operating characteristic

致遠管理學院學報

3_2期（2008 / 09 / 02）

15 - 32

繁體中文

傳統上以平均佔床率最低的病床或是單位，進行檢討與分析。往往佔床率低的病床或單位，皆有其特殊的任務或使命，以致管理的成效不佳。本研究以某個案醫院某月883張一般病床為例，利用Rasch(1960)模式分析出每張病床之空床力以及每日之空床期望值。此外，變異數分析發現不同種類的病房有著不同的空床力；空床受到週內星期幾的影響；週別間未呈統計顯著性差異。Rasch的標準化殘差大小排列分析出最需優先列入檢討的754(2.8%)病床日，此數量遠低於傳統分析的2,303總空床日，也可聚焦進行空床的根本原因分析。個案醫院每日呈現前日一般病床的空床名單，各病房及住院組需每日填註空床的可能原因。次月利用本研究資料探勘殘差分析前月最需優先列入檢討的病床，對照各單位所填註的空床原因進行再解析。發現ICU轉至一般病床取銷聯繫不夠所致空床機會最高，新手聯絡門診病患來住院聯繫失常次之。本研究以醫院重要資產的病床管理對醫院履行新制評鑑所強調的PDCA品管循環提供客觀且科學的實例介紹。

Recent hospital accreditation calls for much attention upon PDCA of Deming cycle. Traditional analysis of bed occupation focuses on locating those beds with the highest vacancy rate of occupation. In this study we use Rasch technique to analyze the data of 883 hospital beds in 30 days to quantify the bed vacancy prevalence of each bed and the threshold of each day. One-way ANOVA showed that different room types showed different magnitudes of vacancy prevalence; different dates in a week also showed different magnitudes of threshold. An analysis of the standardized residuals identified 754 most unexpected vacant daily beds (2.8%), which need further investigation with top priority. This number was much smaller than that was identified from traditional analysis of 2,303 vacant beds. Hence, it was easier to trace causes of these vacant beds. Poor communications with intensive care unit and with reservation for hospitalization were found to be the most two likely causes of vacant beds. Through an empirical example, Rasch technique demonstrates its application on Deming's quality control cycle, which is emphasized by recent hospital accreditation in Taiwan.

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