降低住診病人晨間採血檢驗報告逾時率

A Project to Improve the Time-Effectiveness of Routine Morning Blood Tests

背景：臨床配合醫師開立醫囑習慣及需禁食之檢驗項目，醫囑皆為隔日清晨採檢，護理人員皆於早上4點至5點執行檢體採集，此時段採檢，容易中斷病人睡眠及降低住院滿意度，也因過度集中送檢，在大夜班人力不足下，使得檢驗報告逾時率偏高。目的：檢驗報告逾時率由62.3%下降至19.3%以下。解決方法　2013年於神內科病房，調查造成檢驗報告逾時率之原因及針對所確立的問題及考量專科特性，進行相關作業流程改善，首創晨間分流機制，檢驗單增列需禁食時間提示、創新冰浴檢體運送管使用，以達縮短檢驗報告等候時間，進而提昇照護品質。結果　以independent t-test、two tailed test進行改善前後逾時率與滿意度的統計檢定分析，結果發現：整體逾時率由62.3%下降至18.0%（t=7.07, p ＜ .001），急件逾時率由66.9%下降至21.3%（t=7.36, p ＜.001），普通件逾時率由52.4%下降至17.8%（t=5.37, p ＜ .001）；病人對採檢滿意度由51.0%提升至93.0%（t=51.10, p ＜ .001）；護理人員對採檢滿意度由54.2%提升至94.0%（t=12.26, p ＜ .001）。結論　在專案的進行下，團隊成員運用創新概念，以病人為中心思考解決方案，打破陳舊的觀念，以創新的採檢分流機制，達到降低檢驗報告逾時率之目標，病人夜間睡眠也不中斷，更提升採檢的滿意度，達到護病雙贏局面。

Background & Problems: Morning blood sampling, conducted around 4am to 5am, is routinely ordered due to nothing-by-mouth (NPO) requirements and clinical practice norms. However, this routine may interrupt the normal sleep of patients and decrease the satisfaction of patients with the care received. However, our night-shift staff is not able to take all blood samples during this time, resulting in a high rate of overdue reporting. Purpose: To reduce the overdue rate of laboratory result from 62.3% to less than 19.3%. Resolution: In 2013, we performed interventions including the process reengineering of blood sampling to meet the needs of laboratory result flows and the upgrading of equipment in our neurology ward. The reengineering strategies used included the redistribution of blood sampling times in order to decrease testing for unnecessary items. The equipment upgrades improved the ability of the carrier in the pneumatic tube systems to carry the chilled blood samples. An independent two-sample t-test was used to compare the overdue rate before and after the interventions. Results: The overall overdue rate for the blood sampling to laboratory flow improved from 62.3% before the intervention to 18.0% (t=7.07, p ＜ .001) after the intervention. Furthermore, the overdue rate for the testing done at the stat laboratory improved from 66.9% to 21.3% (t=7.36, p ＜ .001), while the overdue rate for the testing done at the non-stat laboratory improved from 52.4% to 17.8% (t=5.37, p ＜ .001). Besides, the satisfaction of both inpatients and nurses with regard to blood-sampling flow improved from 51% and 54.2%, respectively to 93% (t=51.10, p ＜ .001) and 94% (t=12.26, p ＜ .001). Conclusions: Our process reengineering strategies and the upgrading of the pneumatic tube system successfully reduced the overdue rate for the blood sampling and increased the satisfaction of inpatients.