DC 欄位 | 值 | 語言 |
dc.contributor | 指導教授:莊裕澤 | - |
dc.contributor | 臺灣大學:資訊管理組 | zh_TW |
dc.contributor.author | 徐志育 | zh_TW |
dc.contributor.author | Hsu, Chih-Yu | en |
dc.creator | 徐志育 | zh_TW |
dc.creator | Hsu, Chih-Yu | en |
dc.date | 2014 | - |
dc.date.accessioned | 2014-11-30T03:21:37Z | - |
dc.date.accessioned | 2018-06-29T13:44:24Z | - |
dc.date.available | 2014-11-30T03:21:37Z | - |
dc.date.available | 2018-06-29T13:44:24Z | - |
dc.date.issued | 2014 | - |
dc.identifier.uri | http://ntur.lib.ntu.edu.tw//handle/246246/263657 | - |
dc.description.abstract | 本論文是以臺北市某醫學中心為了要提高急診轉住院病人占全院住院病人的比率及縮短這些病人在急診的停留時間以減少急診壅塞,於民國98年底至100年1月間實施的品管圈專案內容為藍本。品管圈由相關醫療、護理及行政部門的主管組成跨團隊小組,由醫療副院長擔任召集人,品質管理中心為負責單位。
團隊首先以醫療失效模式與效應分析(HFMEA)就急診病人轉住院流程中,分析每一個失效模式,依其失效原因的危害指數矩陣先做評分;在找出評分高者( | zh_TW |
dc.description.abstract | The thesis is based on the implementation of a quality control circle (QCC) with an aim at increasing the admission rate from the emergency department (ED) with respect to the total number of inpatients of the hospital (ARED), and at shortening their length of stay (LOS) so as to alleviate ED crowding in a medical center in Taipei during a period from late 2009 to January 2011. The team was composed of chiefs from related multidisciplinary units such as medical, nursing and administrative departments in which medical vice superintendent acted as the team leader and quality management center was responsible for the project.
The QCC team adopted Healthcare Failure Mode and Effect Analysis (HFMEA) to evaluate every failure mode in the process of patients admitted from ED. For those causes of failure mode with a hazard score of 8 or higher (³ 8) from the Hazard Scoring Matrix, the team members attempted to improve the process through face-to-face communication and coordination under the assistance of information technology ( IT ).
At the end of the project, the above causes of failure mode improved significantly and the goals were achieved as to ARED, shortening of LOS and the transfer rate.
LOS consists of (1) waiting time for physician visit at ED, (2) management time, and (3) waiting time for transfer to ward. LOS can also be viewed equivalently to summation of the time waiting for service and service time at all stations through which a patient passes. In general, waiting time for service includes not only the waiting time before service but also the time the patient waiting for decision from the physician for the next step. The latter is crucial to shortening LOS. The success of the project lies in holding on the latter key factor through face-to-face communication and coordination, attitude and leadership with accountability, and the assistance of IT to alleviate the impact of the factor on and to shorten LOS of the inpatients from ED.
Implementation of this project yields some implications in management as follows: first, finding out key factors and their weight (e.g., HFMEA in this project) can facilitate the achievement of the goal; second, flow processes with consensus could be written as standard operation procedure (SOP) with which the members to comply, whereas those not with consensus would need face-to-face mutual communication and “⑃-shaped” coordination; third, attitude and leadership with accountability is of help to reach the goal; and finally, IT should be used to facilitate management. | en |
dc.description.tableofcontents | 目 錄
口試委員會審定書 I
謝 辭 II
中文摘要 III
THESIS ABSTRACT V
目 錄 VII
圖目錄 IX
表目錄 X
第一章 緒 論 1
1.1 前言 1
1.2 研究背景與動機 2
1.3 研究目的 3
1.4 論文假設與限制 4
第二章 文獻探討 5
2.1 急診壅塞 5
2.2 醫療失效模式與效應分析(Healthcare Failure Mode and Effect Analysis) 7
2.3 等候理論(queuing theory) 10
2.4 當責(accountability) 12
2.5 論文理論模式 13
2.6 急診轉住院病人在急診各服務站接受服務的時間 14
第三章 研究方法 15
3.1 醫療失效模式與效應分析(HFMEA) 15
3.2 成立跨部門工作團隊 16
3.3 跨團隊會議與溝通 16
3.4 病人在急診的流程及定義病人在急診的停留時間 16
3.5 統計方法 19
第四章 資料分析與研究結果 20
4.1. 資料分析 20
4.2. 研究結果 27
4.3. 縮短病人停留在急診的時間 33
4.4. 本專案主要指標在實施前與實施後之比較 35
4.5. 控制 35
第五章 討論與建議 36
5.1. 討論 36
5.2. 本專案帶來管理上的意涵與建議 39
5.3. 限制 39
參考文獻 41
中文部分 41
英文部分 43
附 錄 後記 45
圖目錄
圖2 1 潛在失效模式的嚴重度分級 8
圖2.2潛在失效模式的發生率分級 9
圖2.3 失效模式的危害指數矩陣 9
圖2.4 等候系統 10
圖2.5 多線序列式服務站型態 12
圖2.6 ARCI中的A個人/個體當責 13
圖3.1 急診轉住院流程 15
圖3.2 病人在急診的流程 17
表目錄
表2.1 醫事司急診檢傷五級標準分類標準 5
表2.2 負責與當責的比較 13
表4.1 風險分析及決策樹分析是否進行矯正 21
表4.2 本專案實施前各項指標、訂定目標閾值、以及實施後成效值 28
表4.3 2009-2010年個案醫院急診病人轉住院在急診的停留時間 29
表4.4 2009, 2010年個案醫院急診檢驗報告達成率 30
表4.5 2009, 2010年臺北市某醫學中心急診檢驗報告達成率 31
表4.6 急診病人檢查一般X光等候時間 32
表4.7 急診病人檢查電腦斷層(CT)等候時間 33
表4.8 2009及2010年急診部門作業量 34 | zh_TW |
dc.format.extent | 2213622 bytes | - |
dc.format.mimetype | application/pdf | - |
dc.language | zh-TW | - |
dc.rights | 論文公開時間:2014/08/08 | - |
dc.rights | 論文使用權限:同意無償授權 | - |
dc.subject | 醫療失效模式與效應分析 | zh_TW |
dc.subject | 急診 | zh_TW |
dc.subject | 停留時間 | zh_TW |
dc.subject | 急診壅塞 | zh_TW |
dc.subject | 當責 | zh_TW |
dc.subject | 資訊科技 | zh_TW |
dc.title | 運用風險控管縮短急診轉住院病人在急診停留時間之研究
—以臺北市某醫學中心實施專案的經驗為例 | zh_TW |
dc.title | Research on Using Hazard Score Risk Control to Shorten Inpatients’ Stay at the Emergency Department — Experiences from a Project at a Medical Center in Taipei | en |
dc.type | thesis | en |
dc.identifier.uri.fulltext | http://ntur.lib.ntu.edu.tw/bitstream/246246/263657/1/ntu-103-P00747001-1.pdf | - |
item.fulltext | with fulltext | - |
item.openairecristype | http://purl.org/coar/resource_type/c_46ec | - |
item.cerifentitytype | Publications | - |
item.openairetype | thesis | - |
item.grantfulltext | open | - |
顯示於: | 管理學院碩士在職專班(EMBA)
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