题名

手術室管理與模擬流程最佳化之探討-以中部某醫學中心為例

并列篇名

The study of the optimal procedure in operating room management by using simulation—Medical Center as an example

DOI

10.6834/CSMU.2014.00204

作者

陳睿騏

关键词

手術室 ; 手術室模擬 ; 績效指標 ; 最佳化 ; Operating Room ; OR simulation ; performance index ; optimization

期刊名称

中山醫學大學醫療產業科技管理學系碩士班學位論文

卷期/出版年月

2014年

学位类别

碩士

导师

廖宏昌

内容语文

繁體中文

中文摘要

隨著社會越來越富裕,醫療科技不斷進步,人民對於健康意識的增長,進而造成醫療保健支出愈來愈龐大。台灣衛生福利部自2004至2012年統計住院手術人次,由3,499,066人上升至4,592,685人,比率上升約13%,這樣穩定上升的比率可得知,民眾對手術室的需求越來越高,相對而言,當民眾持續進入手術系統時,流程管理更顯得重要,不僅要有效運用醫療資源,提高服務品質外,更重要的是能將時間有效的降低,減少人員空閒及手術室閒置,進而提高手術室的產值及醫療品質,並且降低營運成本。 本研究以中部某醫學中心手術室病患之時間流程之實際資料進行研究,本研究以病患之流程時間做為根據,並搭配各項手術室指標(等候區時間、恢復室時間、每日平均人數、手術室利用率)之實際值、模擬值做為模擬資料。以EXCEL函數公式搭配常態分配模擬出各項數值,整理出各指標之數值,建構出本研究之手術室流程模擬系統。 為了找出手術室流程之各項指標最佳化之配置,本研究以醫院實際資料搭配模擬值導入模擬系統中,進而比較出實際值與模擬值之差異。將各項配對數值以反應曲面法配置出最佳化迴歸方程式,並將迴歸方程式利用基因遺傳演算法找出方程式中各變項之最佳解,即為各指標之「最佳配置」。最後,利用敏感度分析觀察輸出值與輸入值之關係是否有潛在錯誤,以確認最佳配置之完整性。 本研究結果發現,各項配置組合並非最小值或最大值即為最佳化。等候區時間配置在最小(min),可以降低流程時間與人力成本,提升績效值;每日平均人數若為最大(Max),可以減少員工閒置與提升績效值;手術室利用率與恢復室時間處在適中範圍(in range),配置即為最佳。改善與目標:等候手術時間平均降低9.258分鐘,手術室利用率平均提升11.87%,每日平均人數可提升至28.5人以上,恢復室時間控制在160.82分鐘以內皆為最佳。

英文摘要

As a society becomes more affluent, and medical technologies more advanced, the public’s awareness of their health expands; consequently, healthcare expenses soar. The statistical data collected between 2004 and 2012 by the Ministry of Health and Welfare shows that the number of people visiting inpatient surgery increased from 3,499,066 to 4,592,685, a rate of 13%. Such a steady increase suggests that the public’s demand for surgical rooms is increasing. Consequently, OR procedure management has become more important when the public is subsequently in the surgical system. It is not only the allocation of medical resources that has to be more effective in order to improve service quality. More importantly, the time required for OR procedures must be reduced, and staff and OR idle time must be reduced in order to enhance OR revenue, improve healthcare quality and lower business operating costs. The research data used in this paper is the actual OR patient-processing time of a medical center in central Taiwan. This paper adopted the real-life patient-processing time as the base, and incorporated the actual value and simulation value of each OR index (patient’s time spent in the waiting room and the post anesthesia care unit (PACU), average daily number of patients, and OR utilization rate) as the simulation data. This paper utilized the formula function of EXCEL, applied normal distribution to obtain simulated values, and subsequently sorted out indicator values, and then constructed the simulation system for OR procedures. To find the optimal fit for every indicator of the OR procedure, this paper introduced the hospital’s realistic data and simulation value into the simulation system to compare the differences between actual values and simulation values. Using response surface methodology, an optimal regression formula was found for each of the paired values. A genetic algorithm was applied to the optimal regression formula to obtain the best solution for every variable, i.e. “optimal configuration” for each indicator. Lastly, sensitivity analysis was performed to observe the relationship between input and output data, and to validate the accuracy of the optimal configuration. Research findings of this paper show that optimal configuration does not imply that the configuration is a combination of maximized or minimized values alone. In fact, when the waiting time is at a minimum, which reduces procedure time, and manpower costs, and thus improves performance value; the average daily number of patients is at a maximum, which reduces the staff’s idleness and improves performance value; and with the OR utilization rate and PACU time within moderate ranges, the configuration is at its optimal solution. Improvement and Target: OR waiting time should be reduced by 9.258 minutes, OR utilization rate should be increased by 11.87%, average daily number of patients should be increased to 28.5 people, and PACU time should be under 160.82 minutes, to fit the optimal model.

主题分类 醫藥衛生 > 醫院管理與醫事行政
健康管理學院 > 醫療產業科技管理學系碩士班
社會科學 > 管理學
被引用次数
  1. 駱品妏(2015)。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。中山醫學大學醫療產業科技管理學系碩士班學位論文。2015。1-78。