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博碩士論文 etd-1123107-153445 詳細資訊
Title page for etd-1123107-153445
論文名稱
Title
排程管理介入措施對手術室管理品質之影響
Effect of scheduling management on operating room management quality
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
103
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2007-11-07
繳交日期
Date of Submission
2007-11-23
關鍵字
Keywords
手術室管理品質、第一台手術延遲
Operating room management quality, Delayed first surgery of the day
統計
Statistics
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中文摘要
現今,醫療業在總額給付環境,正面臨愈來愈難經營醫療環境,及病患導向需求環境,良好的醫療服務態度及組織的變革是必需的。 手術室的營運作業對於外科的醫療業務有相當重要的影響,由於手術室人力成本高,且投入儀器設備相當昂貴,所以應重視其管理效率。
在手術室既有的空間及設計每天可執行的手術人次,端賴手術室有無有效率的管理,而手術室管理最重要的就是排程問題,排程好壞會直接影響手術室的績效及營運成本。
本研究旨在探討某醫學中心手術室排程管理對於手術室管理品質的影響。研究樣本為某醫學中心回溯描述性研究;兩組樣本之選擇採立意分派,即2003年6月1日至2004年6月30日間第一台手術為介入前,2004年7月1日至2005年6月30日間第一台手術為介入後;手術室管理品質指標為手術病人人次、手術房間使用率、手術排程取消率、護理人員加班人次與加班費、第一台手術異常延遲時間及延遲率。所收集的資料以ANOVA及χ2檢定、複邏輯斯迴歸(Multiple logistic regression)、t 檢定進行資料分析。介入措施內容包含:排程管理員對第一台手術安排協調、制訂護理人員接病患流程、制訂門診病患報到流程及制訂工友人力調度準則等,使手術排程順暢。
研究結果顯示:介入措施後差異為手術病人人次下降8.4%;手術房間使用率在介入前後平均在84.3%以上,但介入後下降6.05%;排程取消率降低0.76%;手術室成本以護理人員加班人次與加班費用來計算有明顯下降;第一台手術開始的延遲時間顯著降低(10.05分鐘比2.35分鐘);第一台手術開始之延遲率顯著降低(52.8﹪比12.3﹪)。本研究結果可作為醫院、外科部及手術室管理者在手術室成本及績效管理品質之參考。
Abstract
Objective Healthcare system now, with global budget payment, is facing an increasing challenge mainly due to patient oriented environment, more demand for service quality and organizational re-arrangement. Also due to the high cost of personalle and equipments in the operation room , it is quite important to maintain the high efficiency of management to encompass high volume of surgeries. Staffing and scheduling is the most important issue in the management of the operating room and has direct impact on the operational efficiency, cost and revenue.
The purpose of this study is to investigate the influence of staffing and scheduling of the operating room on its efficiency.
How we control the sum of the patients requiring operation under present circumstances lies on whether or not we have efficient management of the operation room. The most important part among it depends on the ability of schedule arrangement, which directly influence the performance audit and cost.

Materials and Methods:The purpose of this study is to discuss the impact of schedule arrangement on cost in the operation room of one medical center. Retro spective descriptive design. Those first operations performed from July 1st, 2003 to June 30th, 2004 were collected into the controlled group while those performed from July 1st, 2004 to June 30th, 2005 were gathered into the experimental group. Indicators of the effect including the sum of the patients receiving operation, the utilization rate of the operation room, the cancellation rate of scheduled operation, the number of overtime nursing staff and overtime payment, the delayed rate and time of the first operation. We use ANOVA, x2 test, multiple logistic regression and t test to analyze these data. We will discuss issues as the followings to smooth our operation schedule: the arrangement of the fist operation by program manager, setting up a flow chart for nursing staff while admitting the patients, establishing a check-in flow chart for patients of out-patient department and deployment of pageboys.

Results: The data showed that the incidence of delaying surgery were decreased by 8.4% in the experiment group as compared to the control group. The operation room occupation rate increased to 84.3% in control group, as compared to 78.25% in experiment group. There is 0.76% decrease in the rate of canceling operation schedule . The number of nursing staff who worked overtime and the overtime payment decreased significantly. The time needed from patients entering operation room to the operation began also decreased significantly. The rate of delaying the first scheduled operation decreased from 52.8% to 12.3%.

Conclusion: Operation room managers, leader in department of surgery, and hospital managers could take our results as reference in improving efficiency and decreasing cost.
目次 Table of Contents
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究流程 4
第二章 文獻探討 5
第一節 手術室管理 5
第二節 手術室排程 8
第三節 第一台手術準時開始………………………….………….………..12
第四節 手術室管理成本與績效…………………………………..………..14
第三章 研究方法 19
第一節 研究架構 19
第二節 研究設計 20
第三節 研究對象 24
第四節 研究工具 36
第五節 資料分析方法 40
第四章 研究結果與討論 41
第一節 手術病人人次 41
第二節 手術房間使用率 43
第三節 預定手術排程取消率 45
第四節 護理人員加班人次與加班費 47
第五節 第一台手術延遲時間 48
第五章 結論與建議 70
第一節 結論 70
第二節 研究限制 74
第三節 建議 75
第四節 後續研究建議 76
參考文獻 77
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