System Dynamic Modeling For Research On Time-interval Controlled Appointment Of General Outpatient Clinic

Caused by overcrowding outpatients,concentrated visiting time and uneven distribution of human flow,such situation as long waiting time,short visiting time and full workload of medical staff is common in large class A tertiary general hospitals in China.The traditional treatment mode is no longer suitable for the actual needs of patients.The relevant government departments at higher levels have proposed appointment registration several times,in which the full implementation of time-interval controlled appointment of general outpatient clinic is the main policy content and requirement.Although the difficulty in seeing a doctor and making registration is relieved,the disorder and randomness of patients' medical treatment have weakened the fundamental advantages of the appointment service and the effect of reform.Outpatient appointment service at different time intervals is a complex study with interaction and dynamic changes,which requires comprehensive and dynamic analysis from many angles and directions.Relying on the theory and method of system dynamics,this study focuses on outpatient treatment process and defines core influencing factors.A basic model is built based on the historical data of flexible work system during the rush hours of general outpatient service in dermatology department of a large class A tertiary general hospital.Then a simulation test is conducted with different management policies to intervene,and an intervention model is established of full-site registration with fixed number of doctors and fixed working hours and time-interval controlled appointment registration.The advantages and disadvantages of the basic model and the policy intervention model are compared.Based on system dynamics,the innovation point of this study is to explore time-interval controlled appointment combined with the current situation of outpatient service in major general hospitals.Intervention simulation shows that partial time-interval controlled appointment has a significant effect on alleviating patients' long waiting time during peak period.As long as the appointment ratio reaches a certain degree,the application effect of flexible work management can be achieved with less doctor labor as a whole.Increasing the rate of appointment registration is an important guarantee for the effective implementation of the appointment service.Under the condition that the appointment registration rate is not up to a certain level,a reasonable allocation is made of doctors' working hours and number of doctors,and a quantitative simulation model of optimal time-interval appointment service is designed in the case of a specific proportion of appointments,which shows good operation results and saves a lot of unnecessary non medical time on the basis of fair treatment.