臺灣博碩士論文加值系統

本論文緣起於產學合作, 由於近年來由於人口急速增加, 民眾對於急診醫療的需求正在逐年上升, 但在醫療資源有限的情況之下, 造成各大醫院急診部門人滿為患, 時常呈現過度擁擠的狀態。而高流量的急診室就有較高的機會發生醫療糾紛, 在面臨急診壅塞問題時, 而且當急診就醫人數過度增加, 超過配置人力及設備時, 就很容易導致急診過度負荷, 此種窘境排擠真正急重症病患所需資源, 會嚴重影響急診服務品質, 甚至危急病人安全。因此本研究使用系統模擬針對研究對象建立急診模擬模型, 探討目前急診室之模擬是否符合真實情形, 其中所採用之績效指標為National Emergency Department Overcrowding Scale(NEDOCS) 急診複合指標評估目前急診室的擁擠程度,決策變數以短住病床釋出率來驗證短住病房策略之可行性, 以提供急診醫療未來在舒緩急診室壅塞之參考指標。
本研究結果顯示在不變動現有之急診人力資源總體數量下, 不同的短住病床釋出程度會導致NEDOCS指標不同, 本研究提出之策略能夠使急診室的壅塞程度降低6-22%的效果。

Emergency Department(ED) crowding, a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, has become an increasingly significant public health problem. One way to solve this problem is to decrease the boarding time of emergency patients, but the amount becoming a limitation factor as the demand is growing rapidly. When the number of emergency patients increases over the allocation of manpower and equipment, emergency is likely to be overloaded. Such a situation might crowd out the resources for critical patients, seriously affect the emergency service quality, and reduce the morale of staff before the patients being safe.
In this research，a discrete-event simulation approach was used to model Emergency Department’s (ED) patient flow to investigate the effect of inpatient boarding on the ED efficiency in terms of the National Emergency Department Overcrowding Scale(NEDOCS) score. The decision variable in this model was the short stay units, defined as the number of beds in short stay room designed for the least patients. Our analysis shows that the Overcrowded+ (a NEDOCS score over 100) ratio decreased 6-22% when the short stay units changed from 9 to 15.

摘要.......I
Abstract.......II
目錄.......i
表目錄.......iii
圖目錄.......iv
第1章 緒論.......1
1.1 研究背景.......1
1.2 本研究目標之急診室現況.......3
1.3 研究動機.......3
1.4 研究目的.......4
1.5 研究流程.......5
1.5.1 績效評估與討論.......6
1.5.2 決策變數.......7
第2章 文獻回顧.......8
2.1 急診醫療.......8
2.2 急診室過度壅塞文獻.......9
2.3 國內急診過度壅塞狀況.......10
2.4 急診室中系統模擬的應用.......12
第3章 研究方法.......14
3.1 研究對象.......14
3.2 研究方法.......14
3.2.1 資料收集.......16
3.2.2 系統模擬模型建立.......16
3.3 系統模擬執行步驟.......16
3.4 NEDOCS參數定義.......18
第4章 模擬模式構建.......20
4.1 研究限制.......20
4.2 研究樣本統計分析.......20
4.3 模型流程分析.......22
4.4 模型系統工具與建立.......26
4.4.1 模型系統工具.......26
4.4.2 急診流程參數設定.......27
4.4.3 急診資源配置.......34
4.4.4 模型作業流程.......35
4.5 模型驗證.......35
第5章 績效分析與比較.......37
5.1 新增短住病房設定之影響.......37
5.2 本文所提方法新增短住病房之績效.......37
第6章 結論與未來研究.......39
6.1 結論 .......39
6.2 本文貢獻.......39
6.3 未來研究與建議.......40
參考文獻.......41
附錄.......44

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