以系統模擬探討臺大醫院急診室作業瓶頸改善之研究

Abstract

臺大醫院面臨著嚴重的急診室壅塞問題，過多的病患與家屬停留在急診部使得內部空間不足，造成服務品質的低落，並增加院內感染風險。解決壅塞問題的辦法之一是增加急診系統的輸出量，其中可以透過轉診的方式到其他適當的醫院，能讓病患及時獲得更好的醫療照護和結果，因此轉院的運作對於病患在急診部停留時間的影響便是一個很好的研究主題。 本研究透過實際觀察與歷史紀錄所獲得的資料探討臺大醫院急診室的作業流程。運用AnyLogic模擬軟體建構符合臺大醫院急診室流程的模型，並以中央健康保險署所重視的醫院指標確認模擬結果與真實情形無異，接著進一步以敏感度分析和t檢定的方法探討轉院數與針對瓶頸點的疏導方案對於停留時間之影響。 研究的結果發現，模型能有效呈現輸入變數的變化。當內、外科的轉院率由0.00487提高至0.006，便能顯著的降低停留時間超過48小時以上的人數比率達17%以上。當轉院率提高至0.007的時候，能顯著的降低停留時間超過48小時以上的人數比率達20%；此外，也能略為減少停留時間超過24小時以上的人數比率。若針對瓶頸處加強轉院制度的實行，病患的停留時間將會大幅減少，能使停留時間超過48小時以上的人數比率減少45%以上，而等待時間超過24小時以上的人數比率會減少3%以上。

National Taiwan University Hospital has serious problems of emergency department (ED) overcrowding. Excessive patients and their families cause emergency department lack of interior spaces, which results in poor service quality. Moreover, this problem increases the risk of hospital infection. One solution to the ED crowding is to increase output of the emergency system. Transferring patients to another hospital is a good way to increase the output for patients can receive timely medical care and save the waiting time. Therefore, the impact of transfer rate on the length of stay in ED is a good research topic. We created a computer simulation model based on observation and institutional data. And we take the indicators which were valued by National Health Insurance Administration to confirm that the simulation results match the real situation. Then we use sensitivity analysis and t test methods to investigate the impact of transfer rate on the length of stay in ED. Results show that the simulation model can effectively depict the changes of input variables. If transfer rate increases from 0.00487 to 0.006, the ratio of the patients who stay for more than 48 hours will be reduced by more than 17%. If transfer rate increases from 0.00487 to 0.007, the ratio of the patients who stay for more than 48 hours will be reduced by more than 17% and the ratio of the patients who stay more than 24 hours will be reduced slightly. If we focus on the bottleneck which is serious ED overcrowding and strengthen the implementation of transfer system, the length of stay will be substantially reduced. If the capacity of the bottleneck is limited by 50 patients, the ratio of the patients who stay for more than 48 hours will be significantly reduced by more than 45% and the ratio of the patients who stay for more than 24 hours will be reduced by more than 3%.