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研究生:陳弘倫
研究生(外文):CHEN HUNG LUN
論文名稱:急診外傷病人臨床處置之排程研究
論文名稱(外文):Scheduling research on clinical procedures of trauma patients in emergency room
指導教授:許光宏許光宏引用關係
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
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:2007
畢業學年度:95
語文別:中文
論文頁數:89
中文關鍵詞:急診外傷病人排程系統模擬
外文關鍵詞:Emergency DepartmentOrdering of Treatment ProceduresSimulationScheduling
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急診人口增加,是世界性的趨勢,而急診在社會上扮演著守護全體國民健康第一道防線的重要角色,面對國內快速成長的急診人口,急診照護品質確實令人重視。美國馬里蘭州1960年代開始著手規畫緊急救護系統以來,台灣立法院亦於2006年通過「緊急醫療救護法」修正案,未來不僅醫院的急救能力要分成輕、中、重三級,還要專責處理重大外傷。因為健保制度更迭,急診病患之等候及診療時間較長,有賴管理科學之排程方法介入改善,以提高效率及醫療品質。
本研究使用個案醫院急診室外科病人2006年的資料檔共366,850筆,其中主要的檢傷主訴項目為:撕裂傷口4,287人、外傷後部位腫痛4,241人、可能有骨折者2,341人、車禍併軟組織受傷2,083人、軟組織挫傷1,286人、擦傷傷口1,089人與機械性壓傷1,086人。研究之另一目的乃在於檢驗急診外科部門成為獨立創傷中心的可行性,應用系統模擬探討其獨立營運時,外傷病人臨床處置之排程規劃,與調整資源配置後之影響。以SAS統計軟體進行初步資料處理,以eM-Plant軟體進行模擬分析。
本研究結果顯示,調整外傷病人接受醫療處置順序之排程,對於病人停留時間之影響有限,研究亦顯示加強臨床路徑之研究對醫療品質提升有較大助益;在資源配置上,以增減醫師之人力對於病人在急診停留時間上有顯著之影響。但X光機、CT、MRI等機台使用率不高,依照目前外傷病人之人數,個案醫院急診外科部,並不適合獨立成為創傷中心。本研究之結果,可為醫學中心急診部門未來組織流程變革之參考,對急重症醫療具有重要文獻價值。
Worldwide, the use of Emergency Department (ED) services has been increasing over the past few years. ED plays an important role in the health care system due to its particular tasks on caring patients with conditions awaited for timely treatments such as injuries and major trauma. The use of ED services has also increased rapidly in Taiwan and ensuring high quality of care in ED has become a focus. In the United States, the state of Maryland started to establish the emergency ambulance system (EMS) in the 1960s. According to the amendment of “Emergency Medical Care Act” passed in 2006, the prioritization of patients admitted to Emergency department has been assigned as three levels including mild, mediate, and high. Under the current system, patients generally have a long waiting time in the ED. This study is set forth to examine whether the quality and efficiency of emergency care will be improved by adjusting the order of procedures in the ED.
This study used the data of trauma patients in an emergency department a medical center in 2006. The database had 366,850 records and the chief complaints included laceration (n= 4,287), post-traumatic pain (n= 4,241), suspicious fracture (n= 2,341), traffic accident with soft tissue injury (n= 2,083), soft tissue contusion (n= 1,286), abrasion (n= 1,089), and mechanical crushing injury (n= 1,086). The study was conducted under the assumption that the trauma patients were treated is an independent center other than the rest of emergency patients. The simulation method was employed to rearrange medical resources and the order of treatment procedures. Evaluations were made to examine the effects and efficiency of the innovative arrangements while comparing with the convention ways. Data management was performed with SAS for primary statistical works and simulation was carried out with eM-Plant for the issues in re-scheduling.
The study has shown that the re-scheduling of treatment procedures brought limited benefits for reduction of patients’ waiting time. However, the development of standard packages for patient care was beneficial for quality of care as much important of the impacts from the number of physician on-duty on the patients’ waiting time were found in the analyses. The resources such as x-ray, CT and MRI deemed as bottle neck for trauma patients in emergency room were not seemed to be highly occupied; hence a declination of running independent trauma center based on current status was made from this study. This study gives some valuable points for considering re-engineering of emergency room in medical centers, which filled up the gaps of current understandings and myths of organizational restructures.
指導教授推薦書
口試委員審定書
長庚大學博碩士論文著作授權書 iii
誌謝 iv
中文摘要 v
Abstract vii
目錄 ix
表目錄 xi
圖目錄 xiii
第壹章 緒論 - 1 -
1.1 研究背景 - 1 -
1.2 研究動機 - 4 -
1.3 研究目的 - 6 -
第貳章 文獻探討 - 7 -
2.1 急診室現況 - 7 -
2.3 急診醫療的品質 - 12 -
2.4 排程的定義與實証研究 - 13 -
2.5 模擬技術的應用方式 - 18 -
2.6 模擬軟體 eM-Plant之簡介 - 21 -
第參章 研究材料與方法 - 24 -
3.1 研究對象 - 24 -
3.2 研究架構與研究方法 - 25 -
3.3 研究步驟 - 33 -
第肆章 研究結果 - 34 -
4.1 研究樣本描述 - 34 -
4.2 急診外科醫師看診與病人接受醫療處置之項目 - 39 -
4.3 作業流程模型 - 48 -
4.4 模型驗證 - 56 -
4.5 改善方案模型建構與結果 - 59 -
第伍章 討論 - 67 -
5.1 模擬結果之討論 - 67 -
5.2 研究限制 - 70 -
第陸章 結論與建議 - 72 -
6.1 結論 - 72 -
6.2 建議 - 73 -
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