以精實原則與時間動作研究，改善急件檢驗報告時效

Using Lean Principles and Time-and-Motion Study to Improve Stat Tests Turnaround-Time (TAT)

背景：因實驗室的臨床顧客需要更快速的檢驗報告，故我們常用檢驗報告時間(TAT)來監控實驗室滿足顧客此需求的能力，特別在緊急檢驗時(1)。本研究試圖將精實原則應用在實驗室自動化部門，以提供更快速的檢驗報告，來滿足顧客需求。方法與材料：透過時間與動作研究(Time and Motion Study)來鑑別檢驗流程中的瓶頸，進而發展出精實策略方案。特別在下列事項實施精實變革：1.急件自動化部門工作環境重新調整設備佈置(layout)。2.標準化全院常規與急件生化採檢管，統一改為Heparin管。3.引進高速離心機處理生化與血液凝固檢驗檢體、整合型生化儀器同時操作一般生化與心臟標誌檢驗、workcell自動化模組工作站之血液與尿液常規檢驗系統。4.打破編制指派由檢體收發處人員負責生化、血液、鏡檢三個部門檢體上機，並導入單件作業流程One Piece Flow，在此三個部門檢體不分Routine一般件與STAT急件，收件立即處理，建立無間斷的檢體處理程序。結果：本實驗室剔除10分鐘的急件檢驗報告時限，急診檢驗結案時程大減33%（30分鐘減為20分完成），並達成新TAT品質目標－－急診生化、血液、尿液檢驗報告20分鐘內完成率皆大於90%。結論：應用精實原則可改善檢驗報告時效，提升臨床醫師滿意度。

Background: Since our clinical customers demand faster results, we use TAT to monitor our ability to meet these demands, particularly in stat tests. We adopted Lean principles into the automation departments to provide faster reports. Methods: Time-and-motion study was performed to identify bottlenecks in the stat testing processes and to develop Lean strategies. Specifically, the following changes were implemented: (1)streamlined renovation to the stat/routine department layouts. (2)standardized heparin tube for all routine and stat chemistry. (3)added a rapid centrifuge for chemistry and coagulation tests, consolidated cardiac marker and general chemistry testing onto single analyzer, improved workflow for hematology and urinalysis subsequent to workcells implementation. (4)assigned one dedicated staff to dispatch and load samples to analyzers and introduced one-piece flow, sample can be processed continuously as they arrive, no longer distinguish between stat and routine testing. Results: We minimized the stat TAT thresholds by 10 minutes(33% reduction in TAT), and surpassed our new TAT goal of reporting 90% of stat results within 20 minutes in Chemistry, hematology and Urinalysis for emergency department. Conclusion: Use of Lean principles improved TAT resulting in increased physician satisfaction.