以ECRS分析急診檢驗作業時間之改善

Using ECRS to Analyze Turnaround Time Improvement in Emergency Rooms

無論是病患、家屬或醫療團隊等，都希望能儘快的得知檢驗報告以便後續診治處理，尤其是身處最前線、搶救生命的急診室，黃金救援時間－永遠是分秒必爭。本研究運用工作程序分析及流程改善概念，以流程程序圖來發掘急診檢驗流程中隱藏的系統性問題，利用剔除、合併、重排與簡化（Eliminate, Combine, Rearrange, Simplify；ECRS）技巧，消除作業中不必要的時間浪費，建立更節約時間、更具經濟效益的作業方式。分析結果發現，在個案實驗室急診生化檢驗流程中，共發掘六個問題，包括離心時間太久、等待離心、人工稀釋作業、等候人員點選螢幕釋放報告、人員不斷來回走動及等待人員走過來撕下報告等。經由本研究提出三大改善方案包括重新佈置設備、以自動化取代人工作業，及變更離心設計等，總共剔除3 項步驟，重排2 項等待作業及簡化1 項操作等，將原來17 項步驟減為14 項，刪除 9.7 公尺的搬運距離。臨床應用結果，比較2010 年與2011 年2-4 月同期改善前後的急診生化報告完成時間，由平均值30.5 分鐘縮減為24.3 分鐘。同時，符合急診檢驗加成的申報件數比例，由76.1% 提高至82.9%。

Laboratory reports are essential for correct diagnosis and treatment. Therefore, obtaining reports as soon as possible is important for both medical team members and patients. This is especially true in the emergency room, where saving time usually means saving lives. In this study, through work process analysis and process improvement concepts to shorten the operation time and achieve time-saving, cost-effective work flow was achieved using ECRS skills. There were six problems in the laboratory, including excess centrifugal time, excess waiting time for centrifugation, inappropriate dilution operations, unnecessary clicks on the screen for the release of the reports, inappropriate spatial arrangement, and the unnecessary need for staffs to remove the reports. Therefore, we redesigned the spatial arrangement, replaced the manual operations by automatic operations, and changed the centrifugal designs. We reduced the operation steps from 17 to 14, and shortened the transportation distance by 9.7 meters, through removal of 3 operation steps, rearrangement of two steps, and simplification of one step. Compared to the performance of the old flow (Feb-Apr, 2010) and the new flow (Feb-Apr, 2011), the time needed to obtain the reports improved significantly (average, 30.5 minutes vs. 24.3 minutes), and the proportion of the operation time which met the criteria for extra reimbursement increased from 76.1% to 82.9%.