營運成本的控管是醫院經營管理的重點之一，手術房之使用成本更是醫院營運高消耗項目，而手術房使用效率則跟手術之排程有相當關聯。由於手術之排程有其限制，例如醫生排班或手術房之使用限制等，因此一般仰賴有經驗的相關人員排程。但若排程方式不理想，可能會造成手術房超時機率過高，或利用率過低等情況發生。為了提升手術房利用率及控制超時成本，本研究以南部某醫學中心婦科手術房資料為例，利用混合對數常態建立各手術時間之分佈，再根據不同手術組合的分佈模擬估計該組合之超時機率與成本。然後在排程過程中，針對不同手術類型與其狀態類別給予不同評估測度，再加入醫生排班限制及手術分類狀態誤判機率等因素，利用手術評估測度進行最小化排程，稱為最小測度排程策略。在模擬中，搭配手術評估測度和混合對數常態分佈模擬出手術房排程，與實際資料比較得知，若依照此模擬方法進行排程，確實能有效控管超時成本。

Controling the running cost of the operating rooms is one of the key points for the hospital management. The cost of operating rooms is high consumption items for the hospital. The effectiveness of operating room is associated with the operating scheduling. Because there are some restrictions for the operating scheduling, for example, the working schedules of doctors or restrictions on the use of the operating rooms. So operating scheduling usually depends on experienced staffs. However, if the schedule is not good enough, it may cause the overtime probability become too high or the utilization rate too low.
This work uses data set from the gynecology department of a major teaching hospital in southern Taiwan. Mixture log-normal distributions are identified to be acceptable statistically in describing the operating times. We estimate the overtime probabilities and corresponding costs according to the combinations of different operating types. In the process of making up the schedules, measures are assigned according to the operating types as well as their status. Moreover, there may also be some restrictions with respect to misjudgment of the operating status by the doctors due to possible unexpected complications during the operations. Here, we provide a scheduling strategy, called the minimum scoring strategy, for minimizing the operating times based on the possible operations coming into the system and complying restrictions mentioned above, using the scoring measures assigned. From the simulation results, the proposed method can effectively reduce overtime probabilities and costs, as well as the idling times of the operating rooms.

論文審定書 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
誌謝 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
摘要 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv
1 前言 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 研究簡介 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2.1 說明與基本統計量 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2.2 文獻探討 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3 手術超時機率評估 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
3.1 手術起始與結束時間散佈圖 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.2 Kaplan-Meier 法比較手術差異 . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.3 利用對數混合常態模擬估計現有手術組合 . . . . . . . . . . . . . . . . . . . . 8
4 手術排程模擬 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
4.1 手術模擬排程方法 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4.2 手術模擬排程結果 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5 結論與建議 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6 參考文獻 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
7 附附附錄錄錄 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
7.1 附錄一 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
7.2 附錄二 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
7.3 附錄三 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

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