急診壅塞是臺灣急診室每天幾乎都會碰到的嚴重問題之一，急診過度壅塞造成了負面醫療結果、醫療品質下降、也無法即時提供健全的醫療服務。救護車分流是可行的辦法之一，意指救護車會繞過沒有能力再接受病患的醫院，改送到其它醫院，在許多醫療體系中，救護車分流已經被視為標準作業程序，在制定一個合理的政策之前，必須先研究救護車分流的效度。

此研究提出「輸入－處理－輸出」模式的概念模型，並用電腦程式語言撰寫操作模型模擬醫院的動作，經由變動救護車分流的啟動時機、救護車分流種類和每次開啟時間，而對壅擠度、病患等待時間和異常病患人數造成的影響，來決定眾多救護車分流策略所帶來的影響。藉由參數的調整，此模擬模型可以呈現不同規模的急診室。研究結論可以提供許多洞見，來制定有效的救護車分流策略。

The problem of overcrowding is one of the serious issues that almost every emergency department (ED) in Taiwan has to face on daily basis. ED crowding results in adverse medical outcomes, decline in quality of care, and lack of the ability to provide instant medical care. One of the viable (but not necessarily preferable) solutions to ED overcrowding is ambulance diversion (AD). That is, ambulances would bypass the ED’s unable to provide emergency medical service, and send patients to another emergency department. In many medical systems, ambulance diversion is being seen as a standard operating procedure, whose effectiveness needs to be carefully studied before making a sound policy.

In this research, an input-throughput-output simulation model is proposed for simulating ED operation. A computer simulation program is developed based on this model to evaluate various AD initiating criteria, patient-blocking rules, and AD intervals. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the impact of various AD policies. By appropriate parameter settings, this simulation model can represent medical resource providers of different scales. The results we obtained may offer insights for making effective AD policies.

目錄
中文摘要ii
Abstract iii
目錄iv
圖次vii
表次viii
第一章緒論1
1.1 研究背景. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 研究動機. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 研究目的. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
第二章文獻探討5
2.1 建立急診室的數學模型的方法. . . . . . . . . . . . . . . . . . . . . . 5
2.1.1 公式法. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.1.2 迴歸模式. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1.3 時間序列分析. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1.4 隊列理論. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1.5 系統動力學. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1.6 離散事件模擬. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1.7 選用離散事件模擬的原因. . . . . . . . . . . . . . . . . . . . 10
2.2 使用離散事件模擬研究病患流的分配方式. . . . . . . . . 10
第三章預備知識13
3.1 機率與統計. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1.1 機率模型. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1.2 隨機變數. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1.3 機率質量函數. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.1.4 伯努力試驗. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.1.5 多項式分佈. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.1.6 伽瑪分佈. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.1.7 隨機過程. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.1.8 卜瓦松過程. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.1.9 中央極限定理. . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.2 急診室的標準作業流程. . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2.1 名詞解釋. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2.2 急診室標準流程. . . . . . . . . . . . . . . . . . . . . . . . . . 17
第四章急診室模型與救謢車分流20
4.1 模型架構. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.2 救護車分流策略. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
第五章離散事件模擬、統一塑模語言與模擬程式24
5.1 離散事件模擬. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.1.1 研究系統的方法. . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.1.2 離散事件模擬的基本概念. . . . . . . . . . . . . . . . . . . . 26
5.1.3 名詞解釋. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
5.1.4 事件排程演算法. . . . . . . . . . . . . . . . . . . . . . . . . . 27
5.1.5 離散事件模擬模型之元件與組織. . . . . . . . . . . . . . . . 28
5.2 統一塑模語言. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
5.2.1 使用者案例. . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
5.2.2 活動圖. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
5.2.3 循序圖. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
5.3 模擬程式. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
第六章模擬實驗38
6.1 模擬設定. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
6.2 實驗次數. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
6.3 實驗一. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
6.4 實驗二. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
6.5 實驗三. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
6.6 實驗四. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
第七章限制、結論與未來展望47
7.1 限制. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
7.2 結論. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
7.3 未來展望. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
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