門診等候時間之探討－－以某區域醫院為例

The Study of Waiting Time of Out-patient Departments in A Regional Hospital

在全民健保實施及部份負擔級距差異不明顯下，使得而大型醫療院所由於過多病人就醫，衍生出令人詬病的「三長兩短」問題，然而對被服務的病人而言，「感受」與「實際」的等候時間是有顯著差異的，且等候時間愈長差距越大。但因爲病情的不確定性、作業流程的障礙，使得醫師難以維持一定的看診時間，以致病人抱怨等候時間過久等問題時有所聞。因此深入瞭解醫院門診病人等候時間的狀況及問題，將是醫院品質推動所需重視之重點。本研究依個案醫院實際運作狀況及看診人數分配情形，以分層抽樣方式了解門診就醫過程中所經歷之各項流程與窗口中所需耗用之等候時間，研究結果顯示門診全體平均等候時間爲23.26分鐘。掛號平均等候時間爲0.75分鐘；抽 血平均等候時間爲2.38分鐘；放射檢查平均等候時間爲4.05分鐘；候藥時間最長爲67.63分鐘、候藥平均時間爲7.92分鐘。而在掛號等候、門診候診及領藥等候上達統計上顯著差異。等候時間的長短及等候的滿意度，多是因病人的情境因素引起，除了改善内部流程的時間閒置的問題外，還要從病人的角度去改變病人對時間的認知，本研究發現若能有效的改善服務行爲或增加一些貼心的服務，將可調整大多數對等候上的感覺或病人就醫流程的順暢，而達成醫療服務成本有效的利用，與讓病人覺得個案醫院是間有效率與服務品質極佳的醫院的目標。

Due to the practice of National Health Insurance and lack of significant difference among different co-payment levels, there are over-loaded patient visits at large scale hospitals, which cause the problem of 'three-long & two-short.' There is a significant difference between the waiting time of what patients psychologically felt and what they actually experienced. Moreover, the difference gets larger as the waiting time increases. Uncertainty of the illness and obstacles of operation process make it hard for physicians to keep up with their service time at the same, which result in the complaints of long queue. Therefore, in order to improve the quality of medical service, it is very important for us to understand the facts and problems of the waiting time of out-patient departments. The study used stratified sampling based on actual operation and patient visits to get different waiting time of each procedure and stop occurred in the whole process. The study found out the average waiting time for out-patient department was 23.26 minutes, 0.75 minute for registrar, 2.38 minutes for blood sampling, 4.05 minutes for radiology exam, 7.92 minutes for getting prescribed medicine. There are significant differences of waiting time within service shifts of: registrar, physician offices, and pharmacy. Situational factors result in the satisfaction of the length of waiting time mostly. Not only to improve the idle time in the service process, but to change the psychological cognition of the patients. This study found that, if we can improve our service or provide some services during the waiting time, those will ease the discomfort of waiting, improve the process of the visit, increase the cost-effectiveness of medical service, and reach the goal which makes patients realize the efficiency and high quality of the case hospital.