臺灣博碩士論文加值系統

在醫療產業競爭激烈的環境下，各醫院期望在加強成本控管考量外，同時能提供良善適切的醫療服務。由於手術室是醫院重要營收來源之一的單位，加上其本身建製成本高，內含高科技設施器材，又具跨科部合作等特性，因此為了更有效的管理，去觀察影響手術室績效之因子間的關係。

本論文利用模擬技術，依據手術室流程建構模型。針對改變恢復室數量、病患報到時間分佈變異數、調整各科別所分配手術室數量，討論對於手術室使用率、恢復室使用率、病患等候時間、開刀房逾時時間的變化為何，供醫院管理人員針對手術室管理作為參考。

手術室之表現好壞成果，依據管理者之需求而對不同指標有所倚重，視在醫院營收、外部顧客、內部員工滿意度等多方面之重視程度，依其重要性調整該因子之權重，以達減少成本，增加營運績效之目的。

Hospitals not only expect to reinforce on costs controlling but to provide the proper medical services in the keen competition of the medical industry. Because operating rooms are one of the most profitable sources of a hospital which are with high building costs ,contain variety of high-tech equipment, feature the ability to corporate with cross branch department. To manage efficiently, observing the relationship between the operating room performance factors.

The thesis utilizes simulations to build models according to operation room procedures. Focus on using the changes of quantity of PACU, variances of patience check-in time distribution and regulation for the operating rooms』 quantity of each department to discuss the results in operating room usage rate, PACU usage rate, patience waiting time and the delay time of operating room. According to the results, hospital administration manager could take this as reference for managing operating rooms.

The achievement quality of operating room differs from manager』s demands: hospital』s operation income, customers/employees satisfaction…etc. To adjust the factor』s weight according to the importance to reach the purpose to reduce costs and increase operation efficiency.

指導教授推薦書………………………………………………….………i
口試委員會審定書………………………………………………………ii
授權書……………………………………….…………………………..iii
誌謝……………………………………………………………………...iv
摘要 .......................................................................................................... VI
ABSTRACT............................................................................................ VII
目 錄 ................................................................................................... VIII
第一章 緒論 ......................................................................................... - 1 -
1.1 研究背景與動機 .......................................................................... - 1 -
1.2 研究目的 ...................................................................................... - 3 -
第二章 文獻探討 ................................................................................. - 4 -
2.1 手術室管理 .................................................................................. - 4 -
2.2 手術室排程 .................................................................................. - 7 -
2.3 手術室績效 ................................................................................ - 10 -
2.4 模擬方法與工具 ........................................................................ - 12 -
第三章 研究方法 ............................................................................... - 15 -
3.1 實驗步驟 .................................................................................... - 15 -
3.2 研究變項定義 ............................................................................ - 18 -
3.2.1 投入變項 ............................................................................ - 18 -
3.2.2 產出變項 ............................................................................ - 18 -
第四章 實驗設計與分析 ................................................................... - 20 -
4.1 實驗參數之設定 ........................................................................ - 20 -
4.2 實驗結果與分析 ........................................................................ - 21 -
4.2.1 更動恢復室數量之實驗結果 ............................................ - 21 -
4.2.2 改變病患報到時間分佈變異數之實驗結果 .................... - 24 -
4.2.3 各科別手術室數量調整之實驗結果 ................................ - 29 -
第五章 結論與未來展望 ................................................................... - 34 -
5.1 結論 ............................................................................................ - 34 -
5.2 未來展望 .................................................................................... - 36 -
參考文獻 ............................................................................................. - 37 -
一、中文部份 ................................................................................... - 37 -
二、英文部份 ................................................................................... - 38 -

一、中文部份
[1] 蔣安仁，2004，「開刀房利用最佳化之研究」，國立中山大學醫務管理研究所碩士論文
[2] 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
[3] 張文成，2002，「建立手術室之多層級作業基礎成本與管理制度」， 國立台灣大學醫療機構管理研究所碩士論文
[4] 林重賢，2002，「手術時間預測模式建立」，國立台灣大學醫療機構管理研究所碩士論文
[5] 蘇喜，1994，「改善手術房服務系統產能之研究」，行政院國家科學委員會專題研究計畫成果報告
[6] 林怡君，2003，「運用模擬技術於手術室排程管理 --以某醫學中心為例」，國立台灣大學醫療機構管理研究所碩士論文
[7] 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
[8] 莊景有，2005，「以BIP與GA方法應用於手術指派與排程問題之研究」， 國立台北科技大學商業自動化與管理研究所碩士論文




二、英文部份
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[9] Dygert, C. B., & Jacobs, R. (1998). Juran: A Lifetime of Influence.
Journal of Management Consulting, 10(2), 79-81.
[10] Irem O. (2000). Allocation of surreries to operating rooms by goal programming. Journal of Medical Systems, 24(6), 339-78.
[11] Viapiano, J., & Ward, D. S. (2000). Operating Room Utilization: The Need for Data. International Anestgesiology Clinics, 38(4), 127-140.
[12] Breslawski S, Hamilton D. (1991). Operating room scheduling. Choosing the best system. AORN Journal, 53(5), 1229-1237.
[13] Harris AP, Zitzmann WG. (1998). Operating Room Management - Structure, Strategies & Economics. Moshy-Year Co.
[14] MCQuarrie DG. (1981). Limits to efficient operating room scheduling. Lessons from computer-use models. Archives of Surgery, 116(8), 1065-71.
[15] Jerry Banks. (1998). Handbook of simulation. Principle, methodology, advances, applications and practice. Wiley - Interscience. New York.
[16]Franklin Dexter, MD, PhD, and Rodney D. Traub, PhD. (2002). How to Schedule Elective Surgical Cases into Specific Operating Rooms to Maximize the Efficiency of Use of Operating Room Time, Anesth Analg, 94, 933-942
[17] Adlam T., Faulkner R., Orpwood R., Jones K., Macijauskiene J., Budraitiene A.(2004). The installation and support of internationally distributed equipment for people with dementia. IEEE Transactions on Information Technology in Biomedicine, 8(3), 53-257.