การพัฒนาแนวปฏิบัติเพื่อลดเวลารวมของผู้ป่วยนอกของแผนกอายุรกรรมในโรงพยาบาลด้วยการจำลองสถานการณ์แบบไม่ต่อเนื่องและการออกแบบการทดลอง

Abstract

The demand for healthcare services is increasing dramatically every year, according to the Ministry of Public Health's database. Both the public and private sectors are interested in coping with the situation, as well as the case study hospital. Because of the high volume of patients, the outpatient medicine department was chosen. Endocrinology, Cardiac, Pulmonology, Nephrology, and Neurology were chosen as the top five categories of patient disease to be studied since they accounted for 80 percent of all outpatients in the medical department. Many researchers tried to improve the healthcare service by using many tools and techniques to meet a variety of goals. But one of the most used indicators is time spent in the system. They aim to eliminate non-valued time to reduce overall time use as well as with this study. Based on observing and discussing with the authorities, there were three parts that affected the average patient’s time: the characteristics of the patient, such as the patient’s arrival and illness; the process and resource readiness; and other factors that may influence the time used significantly. Five factors were considered in this study: the pattern of patient arrival, adding physicians' resources at bottlenecks, the 30-minute delay in starting time in each shift of physician, 20% of patient's blood sample taken before appointment, and changing portion of patient's illness categories based on cause of outpatient illness data. A simulation computer software was chosen because of its ability to contract and modify the model elements to be reassembled with the actual system depending on statistics, allowing all factors to be studied at the same time without disrupting normal operations. The second tool is design of experiment, which is an approach used to examine the influence and correlation of factors to response. In this study, a full factorial with two levels was used to test five factors. By designating the lower level as regular practice and the upper level as altered practice. The simulation model of 32 scenarios according to all possible factors adjusted alternatives were ran. All findings undergo analysis of variance (ANOVA), and it is discovered that each of the five factors has a significant effect on the response, with some even exhibiting interaction effects. Response Optimizer was used to determine the best answer. It concluded that three factors should be adjusted at a higher level, implying that some of the morning's appointments should be moved to the afternoon, adding more physicians at bottlenecks could relieve stress and advance blood tested is effective to reduce overall time spent. However, two factors must be maintained: there should be no delay in beginning time, and the present patient percentage results in shorter patient time spent in system at 139.13 minutes compared to 155.39 minutes in the original. Based on the factors examined, three additional experiments were carried out. The appointment table was evaluated based on the physician's capability; 16.09 minutes were removed. In the second examination, 20, 25, 30, 35, and 40 percent of patients had their blood checked before their appointment. For every 5 percent of blood obtained, the overall time decreases by roughly 2 minutes. Lastly, in the third experiment, the sensitivity of patients' average time was assessed after adding 20 percent of patients for each type of illness. According to the findings, there is a considerable increase in overall time spent, increasing by 14.61 minutes and 5.85 minutes if the number of endocrinology and neurology patients rose by 20 percent. This suggests that the two categories require special attention because they both have an impact on the overall. To follow the addition examinations which recommended to adjust appointment table, encouraging partially patient to get blood check in advance and keep monitoring number of patient especially in endocrinology and neurology categories. However, before implying the suggestion in actual situation the review from authorize should conduct in order to improve current practice and higher patient’s satisfaction.