基于仿真的病人滞留与床位配置研究

A Simulation Study of Blocking Effects on Patient Flow and Beds Allocation

在大型医院的急救一体化模式中,急诊室与下游住院科室床位配置不合理,往往引起急诊部拥堵不堪,病人等待时间较长等问题。特别考虑病人在急诊室滞留的同时接受下一阶段服务,且服务不可抵消的急诊过程,建立考虑滞留的急诊部两阶段床位配置仿真模型,在科室优先权不同的情景下,从滞留可能性的角度研究床位配置对急诊效率的影响,确定相对较优的床位配置方案,四种权重系数方案下滞留可能性依次降至6.00%、4.27%、5.45%、5.11%。最后对病人的到达率进行灵敏度分析。

In the context of emergency integrated mode in big hospitals, unreasonable bedsallocation between upstream EDs and downstream related inpatient departments leads to EDcongestion and longer blocking times. The model of patient flow was proposed, wherein if thedownstream departments are full, patients would accept second-stage service at the same time iftheir first-stage services are blocked. An empirically based two-stage bed allocation simulation wasproposed to optimize beds allocation under four different department priorities, and blockingprobability decreased to 6. 00%, 4. 27%, 5. 45%, 5. 11% under optimal beds allocation. Multiplesensitivity analysis tested the variation of the results to changes in patient arrival rate.