門診時段及醫師特質對就診流程品質之影響

Timing and Physician Characteristics on the Process Quality of Outpatient Clinics

探討醫師特質及門診時段對於門診就診流程品質之影響，提供改進醫院門診管理及提升門診醫療品質的參考。本研究利用台灣某公立醫學中心的電腦資訊門診系統，收集自2008 年3 月至8 月之內科部專任主治醫師非教學門診各診次之開診時間、關診時間、掛號人數、實際看診人數等資料，計算各診之延遲開診時間、總看診時間、平均每病人次看診時間等就診流程品質變項，再以變異數分析及多變項線性迴歸探討醫師特質及門診時段對於門診就診流程品質之影響，並以相關係數探討各就診流程變項間之相關。大部分醫師均準時或提前看診，僅有少數醫師延遲看診。門診就診流程各變項的平均值為：延遲開診時間 -2.5±24.8 分，總看診時間248.3 ±64.8 分鐘，掛號人數44.5±21.8 人，實際看診病人數40.4±20.6人，每病人次看診時間7.6±4.9 分。在138 位專任主治醫師中，平均開診時間延遲15 分鐘以上的只有3位 （2.2％）；總看診時間超過240 分的有64 位 （46.4％）；平均實際看診人數在50 人以上的有33 位 （23.9％）；平均每病人次看診時間小於3 分鐘的有3 位 （2.2％），介於3 至5 分鐘之間的有23 位 （16.7％）。醫師次專科別會影響門診流程變項。與男醫師比較，女醫師提早開診的多、總看診時間較長、每病人次看診時間也較長。不同週間日的診次，門診就診流程變項會有不同。實際看診人數及總看診時間上下午並無明顯相差，但平均每病人次看診時間下午診較長。醫師特質及門診時段會影響門診流程變項。內科部大多數醫師準時或提前開診，但掛號人數及實際就診人數多、總看診時間長。某些診次掛號人數偏多，而平均每病人次實際看診時間偏短。本研究顯示，依據總看診時間之長短調整上下午診次安排，可以增加診間利用。醫療院所應對如何改進門診就診流程品質持續追蹤管理。

To evaluate the effects of physician characteristics and clinics characteristics on the process quality of outpatient clinics. Administrative database during the period of March 2008 to August 2008 of the outpatient clinics at one medical center in Taiwan were accessed through computer information system. Data of starting times, closing times, registered patient numbers, and visited patient numbers were collected. Process quality variables such as delaying time to start clinics, total time per clinic, and average examine time per patient were calculated. Effects of physician characteristics and clinics characteristics on the process quality variables were analyzed by Anova. Correlations between process quality variables were analyzed by Pearson’s correlation. Most of physicians attended their clinics on time or even earlier than schedule, only a few physicians delayed to start their clinics. The average process quality variables for the department were: delayed time -2.5±24.8 minutes, total time per clinic 248.3 ±64.8 minutes, registered patient number 44.5±21.8，visited patient number 40.4±20.6, average examine time per patient 7.6±4.9 minutes. Among 138 full-time visiting staffs, only 3 (2.2%) had average delayed time more than 15 minutes. Sixty-four physicians (46.4%) had average total time per clinic more than 240 minutes. Thirty-three physicians (23.9%) had average visited patient number more than 50. Three doctors (2.2%) had average examine time per patient shorter than 3 minutes, and 23 physicians (16.7%) had average examine time per patient between 3 to 5 minutes. Comparing to male doctors, female doctors arrived clinics earlier, had longer total time per clinic, and longer examine time per patient. Clinics on different weekdays had difference in process quality variables. The visited patient number and total time per clinic did not differ significantly between clinics in different daytime. However, the average examine time per patient was significantly longer in the afternoon clinics. Physician characteristics and clinics characteristics will affect the process quality variables. Quality of out-patient clinics deserves more concern. We suggest monitoring the process quality variables continuously.