Hashimoto F, Bell S
Department of Medicine, University of New Mexico School of Medicine, Albuquerque 87131, USA.
J Gen Intern Med. 1996 Mar;11(3):182-4. doi: 10.1007/BF02600274.
Patient flow in an appointment-based, outpatient internal medicine clinic involving multiple, sequential providers-registrar, triage nurse, physician, and discharger-was studied using computer simulation. Provider task time distributions were obtained through a time-motion study and then input into the computer program, which simulated the clinic situation well. Time interval and sensitivity analyses yielded insights into staffing levels, appointment times, and clinic dynamics. A bottleneck provider was shown, and patient time in the clinic was related to the time of appointment and was slowed by having too many doctors in the clinic. Subsequent operational changes significantly decreased the average observed patient total time in clinic from 75.4 (SD 34.2) minutes to 57.1 (SD 30.2) minutes (p < .001, t test).
我们使用计算机模拟研究了一家预约制门诊内科诊所的患者流程，该诊所涉及多个连续的医疗服务提供者，包括挂号员、分诊护士、医生和出院协调员。通过时间动作研究获得了医疗服务提供者任务时间分布，然后将其输入计算机程序，该程序对诊所情况进行了很好的模拟。时间间隔和敏感性分析为人员配备水平、预约时间和诊所动态提供了见解。研究显示了一个瓶颈环节的医疗服务提供者，并且患者在诊所的时间与预约时间有关，诊所医生过多会使患者时间延长。随后的运营变革显著降低了观察到的患者在诊所的平均总时间，从75.4（标准差34.2）分钟降至57.1（标准差30.2）分钟（p <.001，t检验）。
