桑基圖的製作與應用：以病人為焦點的查證方式

Production and Application of Sankey Diagrams: A Patient-Focused Verification Method

現行醫院評鑑基準，係以「病人為中心，運用照護的結構面、過程面與結果面去衡量品質」為基礎，更參考美國「Tracer」評鑑方法，導入以病人為焦點的查證方式，其臨床作業流程就需具體可視流量化。桑基流量圖係將病人經歷的事件軌跡視覺化，圖的製作尚未引導受評醫院將評鑑基準內化至日常工作中。本研究示範製作三具桑基圖（即急診病人的動向、病情惡化病人的處理、與門診病人的流向），來偵測作業流程的瓶頸。其情景係假設醫院電腦每日於任何給定的時段，下載作業流程內各節點間的病人流量、製作桑基圖的輸入格式，續以繪製桑基圖。這項製圖工程，可於評鑑時隨時抽檢醫院內某項病人流量的瓶頸，達到以醫院臨床作業流程現場查證取代部分書面審查的目的，降低醫院為準備評鑑資料而產生的困擾與壓力。桑基圖將病人流程瓶頸可視化，進而提升病人為中心的服務品質。

The current hospital evaluation criteria are based on the concept of ''patient-centered care'' using the structure, process, and outcome dimensions of care to measure the service quality. This approach also references the American ''Tracer'' evaluation method, introducing a patient-focused verification method, necessitating the visualization of clinical workflow processes. Sankey diagrams visualize the trajectories of events experienced by patients. However, the creation of these diagrams has yet to guide evaluated hospitals in internalizing the evaluation criteria into their daily operations. This study demonstrates the creation of three Sankey diagrams (i.e., the movements of emergency patients, the handling of deteriorating patients, and the flow of outpatient visits) to detect bottlenecks in operational processes. The scenario assumes that the hospital's computer system downloads patient flow data between each node in the workflow at any given time daily, formats it for Sankey diagram input, and then creates the Sankey diagrams. This diagramming project can be used during evaluations to randomly inspect patient flow bottlenecks within the hospital, partially replacing written reviews with on-site clinical workflow verifications, thereby reducing the distress and pressure hospitals experience when preparing evaluation materials. The Sankey diagrams visualize patient flow bottlenecks, thus enhancing patient-centered service quality.