考虑滞留的急救一体化床位资源优化配置研究-管理科学与工程专业毕业论文.docxVIP

Dissertation Submitted to Hebei University of Technology for The Master Degree of Management Science and Engineering BEDS CONFIGURATION AND OPTIMIZATION IN MULTISTAGE EMERGENCY SYSTEM WITH BLOCKING by Jian Huang Supervisor： Prof. Wu Xiaodan December 2014 I I PAGE PAGE IV 摘 要 急诊科负责对紧急、危重病人进行救治，做为医疗救护的第一站运转高效至关重要。 国内人口基数大、医疗资源相对匮乏，大型医院急诊部时常拥堵不堪，滞留现象十分普 遍且持续时间较长，究其原因在于住院床位不可获得导致难以顺利流转，造成急诊科成 为病床不足情况下的“等候区”。 完善院内急救一体化制度，关键在于打通医疗抢救流程的绿色通道，保持与急救相 关的床位保持可用。即合理优化配置急诊科与下游相关科室的床位尤为重要。本文以天 津市某大型三甲医院为研究背景，结合国内急诊滞留特点，基于上下阶段部分服务台服 务对象的内在一致性，首先分析上阶段病人滞留对下阶段服务台数与服务时长的影响， 再确定上阶段有效服务台数与有效服务时长，从而使得对整个多阶段医疗服务系统的滞 留影响估计更准确。在此基础上，依靠排队模型求得的相关指标，建立了以总滞留可能 性最小为目标的数学规划模型，对各科室床位进行优化配置，其结果对多阶段床位资源 的配置优化具有重要意义。 关键词：排队论，仿真，滞留可能性，资源利用率，床位能力规划 III III PAGE PAGE IV ABSTRACT As the first stage of health care，Emergency department(ED) is responsible for acute patients rescuing and maintaining efficient operation of ED is crucial. With large population and the relative lack of healthcare resources in China, a lar ge domestic hospital emergency department is often overcrowded. Blocking is widespread and of long duration. The reason lies in the downstream beds are unavailable lead to a rough flow, making ED becomes a “holding area” under the condition of beds insufficient. Improve the integration system of emergency hospital, the key lies in making the rescue resource easy access, maintaining the related beds available. It is particularly important taking the optimization of the ED and its related downstream bed alloc ation into consideration. This paper takes a large hospital in Tianjin as the research background, take full account of the domestic emergency retention characteristics. Based on the internal consistency of the upper and lower stage services, firstly analysis blocking effects on servicers and service time of the lower stage, then determine the effective servicers and effective service time of the upper stage. The new heuristic for tandem systems performs better. On this basis, re