本研究當中,我們評估新的住院分流策略-短住病房策略,對於急診室壅塞的影響。
決策變數為短住病床當中的床數。績效指標是 “國際急診室壅塞指標” (NEDOCS)。
使用的方法論為離散事件模擬 (DES)。模擬模型建立於台大醫院-雲林分院 3 個月的
歷史資料。本研究中呈現“短住病房”對於“國際急診室壅塞指標”的影響, 並且證實“短住病房”確實改善急診室壅塞。 模擬結果顯示 NEDOCS 壅塞的比率由原本的 77 % (尚未導入短住病房) 降至 57 % (導入 10 張短住病房)。 若導入 16 張短住病房, 壅塞的比率再降至 52。本研究使用的模擬方法較其他論文完整;輸入分析中,我們使用191種隨機變數描述急診室。模式建構中我們使用共同隨機亂數提升模擬的精確性。輸出分析中,我們利用動態時間校正 (DTW) 與自我相關移動平均法的殘差和 (ARMA)檢驗系統穩態。並且此論文評估可以落實的改善方案 (短住病房)。

In this study, we investigate the effect of a new boarding policy - short stay observation ward (SSOW), on the overcrowding efficiency in emergency department
(ED). The decision variables are no. of short stay beds for least acuity ED patients. The performance measurements used are national emergency department overcrowding score (NEDOCS). Discrete event simulation (DES) is used as a analysis tool to evaluate the strategy. Also, common random number (CRN) technique is applied to enhance the simulation precision. The DES model was based on a
census of 6 months’ patients who were treated in the ED of the National Taiwan University Hospital Yunlin Branch. Our results show that the new short-stay boarding significantly impacts the NEDOCS score and this analysis provides a quantification of the impact of boarding on emergency department patient crowding. Moreover, the proportion of the severer days (NEDOCS score≥ 100) would decrease from 77% to 57% in the best case when the SSOW increased from 0 to 10; and decrease from 57% to 52% in the best case when the SSOW increased from 10 to 16. Our study outperforms the previous work in that we provide thorough
DES study and a implementable strategy (SSOW).

致謝i
摘要i
英文摘要ii
目錄iii
表目錄v
圖目錄vi
第1章
緒論 1
1.1 問題定義與描述 2
1.2 績效指標 2
1.3 符號簡寫與名詞解釋 3
第2章 文獻回顧 4
2.1 策略回顧與整理 5
2.2 輸入分析回顧與整理 5
第3章 急診室模型描述 6
第4章 輸入分析 8
4.1 用於分類之隨機變數 8
4.2 用於描述作業時間之隨機變數 9
第5章 模擬模型建構 10
5.1 模擬模型建構 10
5.2 共同隨機亂數 (Common Random Number) 12
第6章 輸出分析 16
6.1 暫態與穩態分析 16
6.2 國際急診室壅塞指標 (NEDOCS) 18
第7章 敏感度分析 21
7.1 共同隨機亂數的敏感度分析 21
7.2 有界機率分配的敏感度分析 22
第8章 結論與貢獻 22

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