為了提升中部某教學醫院之出院病患上午出院比率，因此請醫生預開MBD(May be discharged)出院通知單，以減少新入院病患之候床時間。樣本醫院正在實施ISO（國際品質標準International Organization for Standardization），而入出院候床時間設定為品質監測指標之一，茲以此為探討議題。樣本醫院預開MBD可使病患提早準備出院，減少候床時間。假如醫生未預開MBD，病人及家屬就無法事先做出院準備，醫院無法排床，造成住院病患候床時間延遲，醫院占床率降低。例外：小兒科、重症病患以及家暴和性侵等案例，由於病情不穩定，無法預開MBD。改善措施： 1.病患候床超過一天以上，安排社工安撫病患。 2.入出院準備的病患，到院內設置的無障礙空間等候。 3.轉院病患由轉院中心負責安排。 4.給予預開MBD之主治醫師，每預開一位病人的MBD其獎勵金100元。 5.提升資料庫系統使醫生能掌握更多病人狀況，預開出院通知單。效果：提升上午出院率及占床率。
To improve the morning discharge rate at a teaching hospital, hospitals need to request that physicians issue pre-opening MBD (may be discharged) notices, which make possible the reduction of waiting time for new admissions. Admission waiting time is one of the criteria used to assess quality set forth in ISO (International Organization for Standardization) quality management system used by some hospitals. If doctors issue MBDs, patients can be discharged earlier, normally in the morning. This would reduce the waiting time for new admissions. However, if doctors do not issue pre-MBD, patients and their relatives are not able to prepare properly for discharge in the morning and hospital beds cannot be released. This will also reduce the occupancy rate for hospital beds. Meanwhile, there are exceptions, including pediatric patients, patients with severe conditions as well as victims of domestic violence and sexual abuse. The condition of these patients are sometimes are unstable, and not suitable for the issuance of a pre-opening MBD. Improvements: (1) If patients have to wait more than one day for admission, then social workers might work to appease disgruntled patients. (2) Hospitals can set up a barrier-free waiting area for discharged and admission patients. (3) Referral centers can help to arrange patients transfer to other hospitals when needed. (4) Attending physicians can be rewarded NT$100 for each pre-issue MBD. (5) By upgrading the information and database system, physicians can easily understand situation and issue MBD notice. Results: Following these suggest may increase morning discharge rate morning and increase occupancy rate.
