Application of discrete-event simulation modeling to project the effect of limiting the work hours of visiting staff on medical service volume: the case of 6 surgical specialties
應用離散事件電腦模擬技術推估主治醫師工時限制對我國醫療服務提供之影響－以六個外科系專科別為例
Journal
Taiwan Journal of Public Health
Journal Volume
38
Journal Issue
6
Pages
617-632
Date Issued
2019
Author(s)
Abstract
Objectives: Research is lacking on the effect of implementing work-hour limitations for hospitals' visiting staff in terms of the provision of medical services and accessibility to the public. This study used discrete-event computer simulation to estimate the effect of limiting the work hours of visiting staff on the medical service volume of 6 surgical specialties in hospitals under the National Health Insurance system. Methods: In-depth interviews and questionnaires were used to collect data on visiting staff's work content, elapsed working time, and scheduling logic. We also analyzed the National Health Insurance claims database to obtain the annual volume of outpatients, examinations, and surgical services and the total elapsed time. Based on these data, we developed a medical service model for the 6 surgical specialties and proposed 3 work-hour limitation models (maximum weekly working hours/maximum hours of continuous work: 80/28, 76/28, and 72/24); the effects of the models on the provision of medical services were compared. Results: Compared with the model currently applied for visiting staff, the model in which work hours were reduced led to decreased outpatient volume and delay in the surgical schedule. It had a greater effect on hospitals with an accreditation level lower than that of regional hospitals. The work-hour limitation model with a maximum of 72 working hours per week and a 24-hour limit on continuous duty had the greatest effect on the provision of medical services. Conclusions: The model and research results established in this study provide the competent authorities with a reference when making decisions regarding the limitation of work hours for visiting staff.
Type
journal article