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研究生:蔣安仁
研究生(外文):An- Jen Chiang
論文名稱:開刀房利用最佳化之研究
論文名稱(外文):Operating Room Utilization Optimization
指導教授:郭美惠郭美惠引用關係羅夢娜羅夢娜引用關係周瓊珍周瓊珍引用關係
學位類別:碩士
校院名稱:國立中山大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:61
中文關鍵詞:對數常態分佈手術室利用率
外文關鍵詞:Lognormal distributionoperation roomutilization.
相關次數:
  • 被引用被引用:18
  • 點閱點閱:799
  • 評分評分:
  • 下載下載:147
  • 收藏至我的研究室書目清單書目收藏:6
全民健保的實施,醫療市場更自由的被使用,由於政策的關係公家體系的醫院將無公務補助,而病例計酬與總額預算制度之施實,使得醫療機構間因財務之因素互相競爭趨向白熱化,所以各種體系醫院管理階層皆致力於提升手術室營運,病患亦期望得到適切的醫療服務與品質而且醫療院所邊際利潤減少,所以如何達到有效率管理減少成本耗用,增進內外顧客滿意度,加強醫療市場之滲透度,提昇財務績效,比對手更有競爭力,已成為醫療機構企業首要目標。
本研究以南部某醫學中心婦產科,婦科手術研究對象,主要探討住院病患手術之時間,應用對數常態(log-normal)分佈及相關統計方法,來討論手術房之利用率、超時機率來表現出最佳化之手術排程及相關成本分析,以期提供給院方做為未來經營的方針。
Appropriate utilization of the operating room (ORs) requires a balance of many conflicting resources. This cannot be done without an understanding of the role of the OR in the finances of the institution, the missions of the institution, the actual data concerning utilization and costs.
Economics of the OR environment have changed dramatically in the past 10 years. For example, technological advances have led to the introduction and advancement of minimally invasive surgical procedures, which are purported to decrease morbidity, reduce hospital length of stay, and improve outcome. However, many of these procedures actually increase OR cost, time and supplies. The increased costs of minimally invasive surgery would not have been a problem in the past, due to the additional costs would have been easily adsorbed because of the large profit margin associated with surgical procedure. Under the implementation of the NHI, the DRG, capitated payment, and global budget, it is not surprising that this area is earmarked by many hospitals as a place to reduce expenses. Therefore, all of us working in the OR must be cost efficient and maximize productivity for long-term success.
Accurate estimation of operating times is a prerequisite for the efficient scheduling of the operating suite. In this study, authors sought to compare surgeons’ time estimates for elective cases and to ascertain whether improvements could be made by statistical modeling.
The study was conducted in the GYN department at the VGHKS from 2000, Jan. to 2003, June. Author calculates operation time distribution (lognormal) and variance, and operation time finishing probability, costs, and comparing operating time difference between surgeons.
第一章、緒論
1.1 研究背景與動機-------------------------------------------------------- 03頁
1.2 研究範圍----------------------------------------------------------------- 03頁
1.3 研究限制----------------------------------------------------------------- 04頁
1.4 研究方法----------------------------------------------------------------- 04頁
第二章、文獻探討
2.1 手術室管理-------------------------------------------------------------- 05頁
2.2 手術室相間關文獻探討----------------------------------------------- 05頁
第三章、個案背景資料
3.1 背景資料----------------------------------------------------------------- 06頁
3.2 手術室背景-------------------------------------------------------------- 15頁
3.3 手術室排刀原則-------------------------------------------------------- 15頁
3.4 研究對象----------------------------------------------------------------- 15頁
3.5 資料收集方式----------------------------------------------------------- 16頁
第四章、研究方法
4.1 變項定義----------------------------------------------------------------- 17頁
4.2 資料處理與統計分析法----------------------------------------------- 18頁
第五章、統計結果
5.1 描述性統計---------------------------------------------------------------20 頁
5.2 數據之撿定---------------------------------------------------------------22 頁
5.3變異數分析(ANOVA)---------------------------------------------------25 頁
5.4 線性迴歸模型------------------------------------------------------------27 頁
5.5 術式別與手術時間變異分析------------------------------------------30 頁
5.6 Duncan多重全距檢定(Duncan’s Multiple Range Test) ---------37 頁
5.7 利用回歸模型探討醫師別、年資、性別、病人年齡------------39 頁
第六章、手術超時機率與對應成本之估計
及討論
6.1 手術別---------------------------------------------------------------------41 頁
6.2 醫師別---------------------------------------------------------------------42 頁
6.3 超時機率、最佳化排程------------------------------------------------43 頁
6.4 醫療活動因素分析與計算實際成本---------------------------------44 頁
第七章、結論建議
7.1 結論------------------------------------------------------------------------51 頁
7.2 建議------------------------------------------------------------------------51 頁
附錄參考文獻
1. Dexter F. and Macario A. (1996) Applications of information systems to operating room scheduling. Anesthesiology, Dec; 85(6) 1232-4.
2. Dexter F. (1996) Application of prediction levels to operating room scheduling. AORN Journal; 63:607-15.
3. Dexter F. and Macario A. (1999) Decrease in case duration required to complete an additional case during regularly scheduled hours in an operating room suite: a computer simulation study. Anesthesia & Analgesia, Jan; 88(1): 72-6.
4. Dexter F., Macario A. and Neill L. (2000) Scheduling surgical cases into overflow block timecomputer simulation of the effects of scheduling strategies on operating room labor costs. Anesthesia & Analgesia, Apr; 90(4): 980-8.
5. Dexter F.and Rodney D. (2000) Statistical metbod for predicting when patients should be ready on the day of surgery. Anesthesiology, 93(4): 1107-14
6. Dexter F. (1996) Applications of Information Systems to Operating Room Scheduling. Anesthesiology 85:1232-4.
7. Dahiya RC.and Guttman I. (1982) Shortest confidence and prediction intervals for the lognormal. Can J stat, 10:277-91.
8. Eckhard Limpert, Werner A. (2001) Log-normal distributions across the sciences: keys and clues. Bioscience, 51(5): 341-52.
9. Harris, Andrew P. Willian G. and Zitzmann, Jr.(1998) Operating room management structure, strategies & econmics. Mosby-Year Book, Inc.
10. John A., Lawrence, Jr and Barry A. (2001) Pasternack Applied Management Science, 2nd edition
11. Hogg R.V. and Tanis E.L. (1993) Probability and statistical inference. New Jersey: Prentice Hall.
12. Kenedy, S. Operating Room Management. 1994. Clin Anesth Updates. 5(4): 1-14
13. Macario A.and Dexter F. (2000) Effect of compensation and patient scheduling
on OR labor costs. AORN Journal, Apr; 71(4): 860, 863-9.
14. Mazzei WJ. (1999) Maximizing operating room utilization: a landmark study. Anesthesia & Analgesia, Jul; 89(1): 1-2.
15. MCQuarrie DG. (1981) Limits to efficient operating room scheduling. Lessons from computer-use models. Archives of Surgery, Aug; 116(8): 1065-71.
16. Montgomery D.C. (2001) Linear regression analysis. New York: Wiley.
17. Montgomery D.C. (1997) Design and analysis of experiments. New York: Wiley.
18. Ronald A., Gabel, John C., Kulli B., Stephen Lee, Deborah G. Spratt and Denham S. Ward, (1999) Opearting Room Management, Butterworth-Heineman.
19. Tyler. Donald C. and Caroline A. (2003) Determining optimum operating room utilization, 96:1114-21.
20. Zhou Jinshi and Dexter F. (1999) Relying Solely on Histotical Surgical Times to Estimate Accurately Future Surgical Times Is Unlikely to Reduce the Average Length of Time Cases Finish Late. J of Clinical Anesthesia 11:601-605.
21. 田芳南,1993,“大型醫院手術室空間配置及利用之調查分析,”國立台灣大學公共衛生研究所碩士論文.
22. 翁宗聖,2000,“應用排程理論探討手術室排程之研究--以骨科為例,”私立中原大學工業工程研究所碩士論文.
23. 陳秀珠,1994,“醫院手術室排程系統之個案研究,”國立陽明醫學院醫務管理研究所碩士論文.
24. 傅玲,1993,“影響手術成本與收費相關因素之探討(一):手術工時研究,”榮總護理,第十卷,第四期,pp.430-438.
25. 彭建文,1999,“流程管理在臨床診療之應用研究--以痔瘡診療流程為例,”私立中原大學工業工程研究所碩士論文.
26. 謝祐綾,2000,“手術室排程系統之研究-以大腸直腸外科為例,”私立中原大學工業工程研究所碩士論文.
27. 蘇喜,1994,“改善手術房服務系統產能之研究,”國立台灣大學公共衛生研究所國科會專題計劃成果報告,計劃編號:NSC82-0412-B-002-486.
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