提升第一臺手術下刀準時率

First Operation Punctuality Rate Improvement Program

手術室佔醫院醫療成本相當高，若能提高手術室的使用率，加上良好的流程管理，將能使人力及物力達到有效的運用。筆者發現本院手術室第一台刀常因未準時下刀，而造成開刀房醫護人員延遲下班，甚而引起抱怨。經由現況調查發現第一台手術下刀平均準時率為69.2%，主要導因有門診手術病人晚報到、術式準備時間較長、住院病人沒有做麻醉諮詢、住院病人沒有做手術部位標記，因而影響手術排程及病人等候時間。因此本專案目的為藉由手術團隊合作，提升第一台手術下刀準時率。經由修訂門診術前電訪標準及衛教單內容、指導人員術前電訪方法、修訂接病人流程、制定稽核辦法及罰則、與外科護理長宣導術前準備事項及流程、術式準備較久的刀優先麻醉等改善方案後，第一台刀手術下刀準時率由69.2%提升至96.0%，顯示改善手術照護品質，將可提升手術團隊之工作效率與手術室管理效益。

Operation rooms are one of the most costly areas of hospital. The use of manpower and material resources could be more efficient through maximizing the efficiency of use of operating room and process management. We noticed that the punctuality of starting the first operation in our operation rooms are often delayed, and thus result in overtime working and complaint of staffs. A survey of the current situation at our hospital showed a mean punctuality rate of 69.2%, with problems mainly consisting of late check-in by outpatients longer surgical preparation time, failure to provide pre-anesthesia consultation to inpatients, and failure to mark the surgical site. The objective of this project was to enhance the punctuality rate of starting the first operation through surgical teamwork. After having introduced measures of improvement, such as revision of the norm for preoperative telephone interviews and education pamphlets, staff training in preoperative phone interview, revision of patient transportation procedures, establishment of an auditing and penalty system, introduction of standard and procedures of preoperative preparation with head nurse, and introduction of the priority of anesthesia for operations that require longer preparation. After implementing of the improvement project, the punctuality rate of starting the first operation increased from 69.2% to 88.4%. Our result reveals that the work efficiency and the management benefit can be improved through enhancing quality of surgical care.