住院部和门诊部过度拥挤缓解优化研究

发布时间：2024-04-14 11:25

　　急诊室人满为患已成为世界各地强烈关注的话题,与护理质量、患者结局的降低、死亡率、医生以及病人的不满等密切相关。紧急部门人满为患可能基于各种外部和内部因素。外部因素可能包括专科病房、床位管理单元(BMUs)、实验室等的低效操作。住院手术管理是一个非常复杂的现象,基于各种医疗条件。因此,由于操作效率低下导致的病人流量不足,造成瓶颈,最终紧急部门人满为患(Zhao et al.,2015)。因此,选择了住院手术管理,以减轻在新加坡一家主要公立医院(努哈)国立大学医院急诊室人满为患的情况。内部因素可能包括门诊就诊的急诊科,有轻微的医疗状况。据观察,在国立大学医院急诊科就诊的病人中,约有68.6%是根据稳定的医疗状况、人员伤亡或转诊到其他医院出院的。这68.6%的病人引起了我们的注意。根据Uscher-Pinesetal.(2013),在美国就诊的病人中,至少有30%的人患有轻微的医疗状况。中国区级医院面临挑战的相似性(Tuetal.,2015b)。即使在丰富了足够的急救部门的能力后,中国的地区级医院急诊部门也变得人满为患(Li etal.,2016)。与此同时,中国的初级保健资源约有41%的未...

【文章页数】：150 页

【学位级别】：博士

【文章目录】：
Abstract
Abstract (In Chinese)
CHAPTER 1 Introduction
    1.1 BACKGROUND
    1.2 SIGNIFICANCE OF STUDY
    1.3 RESEARCH PROBLEMS
        1.3.1 First Research Problem
        1.3.2 Second Research Problem
    1.4 SCOPE OF THE STUDY
    1.5 RESEARCH OBJECTIVES
        1.5.1 Associated with First Research Problem
        1.5.2 Associated with Second Research Problem
    1.6 STRUCTURE OF THE THESIS
CHAPTER 2 Literature Review
    2.1 INPATIENT OPERATIONS MANAGEMENT
    2.2 OUTPATIENT FLOW MANAGEMENT
        2.2.1 Healthcare Delivery System in China
        2.2.2 Healthcare Challenges in Rural China
        2.2.3 Healthcare Challenges in Urban China
        2.2.4 Offline Healthcare Service Satisfaction
        2.2.5 e-Hospitals and ED Overcrowding
        2.2.6 m-Health
        2.2.7 m-Health Innovation in China
        2.2.8 Government Support
        2.2.9 Technology Acceptance Model and Trust
Part Ⅰ First Research Problem Inpatient Operations Management
    CHAPTER 3 Inpatient Operations Management to Mitigate EDOvercrowding in a Singaporean Hospital
        3.1 INTRODUCTION
            3.1.1 Healthcare: USA and Singapore
        3.2 NATIONAL UNIVERSITY HOSPITAL,SINGAPORE
            3.2.1 History
            3.2.2 Quality of Healthcare
            3.2.3 Resources
            3.2.4 Dilemma
            3.2.5 Dealing with ED Overcrowding
        3.3 INPATIENT WARDS
            3.3.1 Critical Care Wards
            3.3.2 General/ Specialty Wards
            3.3.3 Gynecology Wards
            3.3.4 Pediatric Wards
        3.4 RESEARCH METHODOLOGY
        3.5 INPATIENT ADMISSION SOURCES
            3.5.1 Emergency Department (ED)
            3.5.2 Intensive Care Unit (ICU)
            3.5.3 High Dependence Wards (HDWs)
            3.5.4 Elective Patients (EL)
            3.5.5 Same-Day-Admission (SDA) Patients
        3.6 HOSPITAL OPERATIONS
            3.6.1 Emergency Department Operations
            3.6.2 BMU Operations
            3.6.3 Transfer from ED to Inpatient Wards
            3.6.4 Inpatient Ward Operations
        3.7 ANALYSIS
            3.7.1 Possible causes of ED overcrowding and expected bottlenecks
            3.7.2 Ishikawa Fish Bone Analysis
                3.7.2.1 Human resources
                3.7.2.2 Resources (Machinery and Capacity)
                3.7.2.3 Processes
                3.7.2.4 Stakeholders
        3.8 DISCUSSION
            3.8.1 Alternative solutions to reduce ED overcrowding
            3.8.2 Optimal policy and its execution
                3.8.2.1 Existing discharge process
                3.8.2.2 Optimal solution
                    3.8.2.2.1 Discharge forecast
                    3.8.2.2.2 Early discharge policy
                    3.8.2.2.3 First discharge round
                    3.8.2.2.4 Second discharge round
                    3.8.2.2.5 Discharge lounge
        3.9 CONCLUSION
Part Ⅱ Second Research Problem Outpatient Flow Management
    CHAPTER 4 Outpatient Healthcare Service Delivery Model of Chunyu Yisheng
        4.1 INTRODUCTION
        4.2 RESEARCH METHODOLOGY
        4.3 THE CASE OF CHUNYU YISHENG
            4.3.1 Start-up
            4.3.2 Financing
            4.3.3 Product Development
            4.3.4 Establishment of the Business Model
            4.3.5 Mode of Consultation and Charges
        4.4 Discussion, Implication, and Conclusion
        4.5 Limitations and Future Research
    CHAPTER 5 Mobile-based Outpatient Healthcare Service Delivery Model: DivertingOutpatient Flow Prior Visiting Territory-Tier Hospitals to Mitigate ED Overcrowding
        5.1 INTRODUCTION
        5.2 MOBILE-BASED OUTPATIENT HEALTHCARE SERVICE DELIVERY MODEL
        5.3 THEORETICAL MODEL AND HYPOTHESIS
            5.3.1 Technology Acceptance Model
            5.3.2 Perceived Ease of Use
            5.3.3 Perceived Government Support
            5.3.4 Trust
            5.3.5 Perceived Usefulness
        5.4 METHOD
            5.4.1 Research Setting
            5.4.2 Measurement
            5.4.3 Questionnaire Design and Data Collection
            5.4.4 Data Analysis
        5.5 RESULTS
            5.5.1 Common Method Bias
            5.5.2 Demographic Information
            5.5.3 Measurement Model
            5.5.4 Structural Model
        5.6 DISCUSSION
            5.6.1 Implications
            5.6.2 Limitation and Future Research
    CHAPTER 6 Discussion, Conclusion, Implications, and Future Research
        6.1 DISCUSSION AND CONCLUSION
        6.2 IMPLICATIONS
            6.2.1 Practical Implications
            6.2.2 Theoretical Implications
        6.3 FUTURE RESEARCH
References
Acknowledgement
List of Publications
Appendix for Chapter 5
    Cover Letter for Survey Instrument
    Part "A" of Survey Instrument
    Part "B" of Survey Instrument



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