【作者】 李岚；

【导师】 吴晓丹； 步磊；

【作者基本信息】 河北工业大学 ， 管理科学与工程， 2016， 硕士

【摘要】 在国内大型医院的急诊中,“看病难”一直是一个亟待解决的问题,急诊科的入口病人流量过大,造成急诊室的过度拥挤,住院病人较长时间的滞留,增加住院成本;病人未得到治疗直接离开,医患矛盾严重,甚至增加病人死亡率;医疗人员压力过大,降低病人的满意度。在医疗改革中,转诊制度和医联体模式开始推广,关于转诊制度的优势、劣势和建议也开始探索,但是很少有研究专注于转诊分流的量化研究。本文针对“大型医院急诊室中的留观病人向社区医院进行分流”的问题进行研究,根据国内医院的实际情形,以天津市某大型综合医院为背景,考虑留观系统人数对第一阶段服务时间的影响,以及滞留与第二阶段服务时间的交互作用,使得对滞留的估计更为准确。基于此,本研究特别考虑服务时间这一变化因素,建立了基于分流的两阶段住院仿真模型,在验证模型有效性的基础上,设计了四种分流规则进行仿真研究。通过仿真分析得出住院病人的滞留可能性、留观室的实际服务时间、资源利用率和诊治完成率的关键性能指标,探讨了分流比例、分流时间和分流阈值对各评价指标的影响,分析比较,最后确定相对较优的分流方案,即按照阈值进行分流,在看诊率仅降低2.01%的基础上,将两个住院病房病人的平均滞留可能性分别在11.90%和10.93%的基础上降低4.43%和5.04%,为医院管理人员提供理论依据和决策参考。更多还原

【Abstract】 Emergency service issues has long been a difficult problem in large general hospital,it becomes more and more difficult for patients to see doctors.Emergency department become overcrowding due to big flow,which leading to higher blocking probabilities,higher cost,lower finished rate,even increased mortality,higher staff stress,and patient’s satisfaction were reduced.In the medical reform,the two-way referral system and medical alliance began to promote,the limitation and suggestions about the referral system also be explored,but few studies have focused on the quantitative research on referral.In this paper,we study the problem that the patients in observation room of general hospital were diverted into public hospital.Based on actual situation in general hospital in Tianjin city.Considering influence of patients’ number in observation room and blocking on service time,then we could estimate blocking probabilities more accurately.We developed an empirically based two-stage diversion simulation model.We further evaluated four diversion rules by average blocking probabilities,average service time,medical resource utilization and service rate key performance indicators.Finally,the optimal diversion rules were determined,patients were diverted based on threshold value,and the average blocking probabilities of inpatient were reduced by 4.43% and 5.04% from 11.90% and 10.93%on the basis of service rate decreased by 2.01%.This paper provided hospital administrators with theoretical basis and decision-making reference.更多还原