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研究生:陳雅華
研究生(外文):Ya-Hua Chen
論文名稱:應用等候理論推估手術室人力配置
論文名稱(外文):Application of Queueing Theory on Staffing Allocation in Operation Room
指導教授:莊玉如莊玉如引用關係
指導教授(外文):Yuh-Jue Chuang
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:104
中文關鍵詞:手術室等候理論人力規劃手術房間配置
外文關鍵詞:Operating roomQueueing theoryStaffing planningOperation room allocation
相關次數:
  • 被引用被引用:7
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  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
由於就醫可近性及醫療技術提高,民眾手術量在近年來有增加的趨勢,然而,醫院服務設備及醫護人力擴充不易,間接造成手術室擁擠及病人等候之狀況,影響醫療服務品質。等待問題對服務品質的重要性已日漸受到企業的重視,然而,有關等待問題的論述在國內卻相當稀少,為了對手術室等待問題作更深入的了解,本研究以等候理論之作業研究方法來推估手術室各科房間配置及醫護人力之調配,運用醫院的手術記錄資料計算各等候理論績效之參數值,評估手術室的服務水準。此外,系統可以協助管理人員根據不同的管理需求,如:提高手術室利用率、減少病人等待時間等,調整參數值,預測系統變化的狀態,做為決策之參考。
最後,本研究根據個案醫院的手術資料,推導各手術科別之等候系統現況,結果顯示個案醫院耳鼻喉科、大腸直腸肛門外科及腦神經外科有可能出現病人到達率過高的狀況;一般外科、骨科、整型外科、心臟血管胸腔外科、耳鼻喉科、大腸直腸肛門外科及腦神經外科的病人平均等待時間可能過長,因此,本研究也藉由改變各科到達率及手術房間配置數了解系統變化的情況,並提出一手術房間配置與人力規劃策略以減少病人等候時間,同時維持系統利用率。
Because it is easy to seek medical advice and medical technology improves, the operation amounts of people have a trend of increase in recent years. However, it is difficult for the hospital to expand equipment and doctors and nurses' staffing, cause the crowdedness of operating room and the waiting of patients, and influence medical care quality. Waiting is the importance to serve quality of the question to be paid attention to by the enterprise. However, quite rare argumentations of waiting in operation room are discussed in the literature. This research use operation method of queueing theory to estimates the operation room disposing and doctors and nurses' staffing. We use the operation record material of the hospital to calculate the performance parameters of queueing theory and evaluate the service level of quality in operating room. In addition, the administrative staff can adjust parameter values of system according to different management demands, for instance: Improve utilization ratio of operating room, reducing patients in waiting time, etc., to predict system changes and assist decision making.
Finally, this research according to the operation materials of the case hospital, derive the systematic waiting situation of every operation department. The result shows that the arrival rates of the patients are too high in ENT dept., PRO dept., and NS dept. The average waiting time may be too long in ORTH dept., PL dept., CVS dept. ENT dept., PRO dept., and NS dept. Our research also change the arrival rate of patients and re-dispose operation room number of each department to understand the situation of the system changes. We also propose a scheme for operation room and staffing allocation to reduce patient waiting time and maintain the systematic utilization ratio at the same time.
目錄
圖目錄 ix
表目錄 x
第一章、緒論- 1 -
1.1 研究背景及動機- 1 -
1.2 研究目的- 4 -
1.3 研究範圍- 5 -
第二章、文獻探討- 6 -
2.1 醫院等候問題及手術室作業- 6 -
2.2 等候理論與模型之探討- 14 -
2.3 等候理論於醫院之應用- 27 -
第三章、研究材料與方法- 31 -
3.1 研究對象及材料- 31 -
3.2 研究架構- 36 -
3.3 研究前提假設- 37 -
3.4 研究工具- 38 -
3.5 名詞定義- 39 -
3.6 研究方法- 40 -
第四章、研究結果- 45 -
4.1 描述性統計- 45 -
4.2 等候理論參數檢定值- 53 -
4.3 等候成本- 64 -
4.4 改變各科到達率- 66 -
4.5 改變各科房間配置數- 75 -
4.6 手術房間配置與人力規劃之決策- 84 -
第五章、結論與建議- 88 -
5.1 結論 - 88 -
5.2 研究限制- 90 -
5.3 未來研究方向- 92 -
參考文獻- 94 -
附錄一:個案醫院手術房間使用分配表- 99 -
附錄二:各科各時段到達率- 101 -
附錄三:等待時間最適機率分佈- 102 -
附錄四:到達間隔時間最適機率分佈- 103 -
附錄五:手術時間最適機率分佈- 104 -

圖目錄
圖1.1:台灣歷年平均每日手術人次- 2 -
圖2.1:等待名單系統階段圖- 7 -
圖2.2:英國等候門診諮詢之人數變化趨勢圖- 8 -
圖2.3:英國等候住院治療之人數變化趨勢圖- 8 -
圖2.4:個案醫院手術未準時開始之原因 - 12 -
圖2.5:等候系統基本結構圖- 15 -
圖2.6:成本模型圖 - 23 -
圖2.7:手術室等候系統圖- 26 -
圖3.1:個案醫院手術室手術作業流程圖 - 34 -
圖3.2:研究架構圖 - 36 -
圖3.3:等待手術系統圖- 39 -
圖4.1:手術來源別(門診、急診、住院)之等待時間95%信賴區間- 48 -
圖4.2:手術各科別之等待時間95%信賴區間- 49 -
圖4.3:病人等待時間次數分配圖- 50 -
圖4.4:平均每日每間手術人次- 51 -
圖4.5:平日及週末各時段平均病人到達人次- 51 -
圖4.6:手術室白班各科系統利用率累加 - 63 -

表目錄
表2.1:服務階段及排隊方式分類表- 20 -
表3.1:手術房間分配表- 32 -
表3.2:手術室人力配置表- 32 -
表4.1:樣本資料表- 46 -
表4.2:各科別平均手術時間與標準差- 47 -
表4.3:各科別平均等待時間- 49 -
表4.4:各科手術房間配置天日及比例- 52 -
表4.5:婦產科之等候理論參數值- 55 -
表4.6:婦科之等候理論參數值- 55 -
表4.7:產科之等候理論參數值- 56 -
表4.8:一般外科之等候理論參數值- 57 -
表4.9:泌尿科之等候理論參數值- 57 -
表4.10:骨科之等候理論參數值- 58 -
表4.11:整型外科之等候理論參數值- 58 -
表4.12:眼科之等候理論參數值- 59 -
表4.13:心臟血管胸腔外科之等候理論參數值- 59 -
表4.14:耳鼻喉科之等候理論參數值- 60 -
表4.15:大腸直腸肛門外科之等候理論參數值- 60 -
表4.16:腦神經外科之等候理論參數值- 61 -
表4.17:小兒外科之等候理論參數值- 61 -
表4.18:手術室之服務閒置成本及等候成本係數- 65 -
表4.19:到達率所表示之間隔時間- 66 -
表4.20:婦產科到達率變化之等候理論參數值- 68 -
表4.21:一般外科到達率變化之等候理論參數值- 69 -
表4.22:一般外科到達率變化之等候理論參數值(續)- 69 -
表4.23:泌尿科到達率變化之等候理論參數值- 70 -
表4.24:骨科到達率變化之等候理論參數值- 70 -
表4.25:整型外科到達率變化之等候理論參數值- 71 -
表4.26:眼科到達率變化之等候理論參數值- 71 -
表4.27:心臟血管胸腔外科到達率變化之等候理論參數值- 72 -
表4.28:耳鼻喉科到達率變化之等候理論參數值- 72 -
表4.29:耳鼻喉科到達率變化之等候理論參數值(續)- 73 -
表4.30:大腸直腸肛門外科到達率變化之等候理論參數值- 73 -
表4.31:腦神經外科到達率變化之等候理論參數值- 74 -
表4.32:小兒外科到達率變化之等候理論參數值- 74 -
表4.33:婦產科房間數配置變化之等候理論參數值- 77 -
表4.34:婦科房間數配置變化之等候理論參數值- 78 -
表4.35:產科房間數配置變化之等候理論參數值- 78 -
表4.36:一般外科房間數配置變化之等候理論參數值- 79 -
表4.37:泌尿科房間數配置變化之等候理論參數值- 79 -
表4.38:骨科房間數配置變化之等候理論參數值- 80 -
表4.39:整型外科房間數配置變化之等候理論參數值- 80 -
表4.40:眼科房間數配置變化之等候理論參數值- 81 -
表4.41:心臟血管胸腔外科房間數配置變化之等候理論參數值- 81 -
表4.42:耳鼻喉科房間數配置變化之等候理論參數值- 82 -
表4.43:大腸直腸肛門外科房間數配置變化之等候理論參數值- 82 -
表4.44:腦神經外科房間數配置變化之等候理論參數值- 83 -
表4.45:小兒外科房間數配置變化之等候理論參數值- 83 -
表4.46:手術室各科利用率(ρ)、與平均到達率的變化( )及預定手術房間數(s)- 86 -
表4.47:手術室各科房間最適配置數(白天班)- 87 -
英文部分
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中文部分
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