運作一個有效率的醫院急診部門(HED, Hospital Emergency Department)，基本上須經由其成本支出改善及急診醫療資源(Provider Staffing)最佳化、動態配置等核心要素，給予系統模式來設計。隨著HED來客(病患)率動態變化，以排隊理論作為設計之核心重點，本研究提出一套系統最佳化規劃，提供HED管理部門作決策參考。方法: 本研究論文針對HED醫療資源需求變異、動態佈署與HED醫療成本支出最佳化之間的互動，採用排隊理論中之M/M/S/K模型(多重伺服器、病患有限等候容量的排隊模型)，作為設計之核心重點。原則上，醫院急診部門(HED)的來客(病患)率有其階段性或可預估之週期性，來客率多量或量少期間兼而有之。以排隊理論中之M/M/S/K模型為主，推導相關數理方程式，醫療成本支出最佳化為核心重點，來動態佈署其HED醫療資源。結果: 本研究論文主要之創意，在於將醫院急診部門的醫療資源視同於M/M/S/K模型中的多重伺服器(Multi-server)，將急診部門有限等候空間視同於伺服器之Queue Buffer。此種新的設計模式，以排隊理論為數理基礎，建構出醫療資源平台的後勤體系，同時推導相關數理方程式，建立系統必要性能函數，完成成本最佳化之計量研究；最後吾人也使用模擬工具驗證成本模式的可行性。結論: 因此針對HED的醫療資源體系，以HED來客(病患)率有其階段性或可預估之週期性，有效率佈署寶貴的醫療資源，為經營成本最佳化為導向，本研究成果確實提供了一個有效可行的系統規劃，作為醫院急診部門管理部門作決策參考。關鍵字：醫院急診部門，醫療資源，排隊理論模型，成本最佳化 As hospital administrators evaluate potential approaches to improve cost, quality, and throughput efficiencies in the hospital emergency department (HED), the deployment or distribution of valuable medical resources emerges to be the dominate challenge to health policy makers. An improvement of emergency services is an important stage in the development of healthcare system. The research on optimal deployment of medical resources appears to be an important issue of HED long-tern management. The HED’s performance in terms of patient-flow and of available resources can be studied using the queue-based approach. The kernel point of this research is to approach the optimal cost on distributing HED resources using queuing theory. To model the proposed approach for qualitative profile, a generic HED system is mapped into the M/M/S/K queue-based model for application. On quantitative work, a comprehensive mathematical analysis on cost pattern has been made in detail. Relevant simulations have also been conducted to validate the proposed optimization model. The design illustration is presented to demonstrate the application scenario in HED platform. Hence the proposed approach indeed provides a feasibly cost-oriented decision support framework to adapt HED management requirement.Keywords: optimization, hospital emergence department, queue-based methodology.
