縮短葉克膜手術前準備時間之專案

A Proposal for Shortening Preoperative ECMO Preparation Time

手術前準備時間太長會增加病人手術危險性及預後。現況發現葉克膜手術前準備時間平均47分，造成原因：一、人員面：工作職責不明確，重複準備用物及缺乏相關知識、須再調度專科人員、不清楚病人單位位置；二、制度面：無相關教育訓練、未制定手術標準作業、手術訊息聯絡路徑繁瑣及缺乏稽核制度；三、設備面：術前才消毒器械、包布及材料多未整合、等待電梯時間過長。改善方案：舉辦在職教育、制定手術標準作業指引本、制定人員調度機制、修正手術訊息聯絡路徑、定期稽核機制、設置專用物料車、設立專用電梯感應卡與管理機制。改善後手術前準備時間平均9.6 分，達到改善目的，減少手術前準備時間，降低病人風險，提升手術醫療服務品質。

Unnecessary lengthening of preoperative preparation time is proven to increase surgical risk of patients. The average preoperative ECMO preparation time was 47 minutes which is considered to be long. The prolonged time may have been due to the following reasons, 1) Personnel reasons: unclear working responsibilities, repeated material preparations, lack of pertinent information and uncertainties of patient’s ward location; 2) Systemic reasons: no training program, no standard operating procedures, ineffective network for operation coordination, and the lack of an audit system; 3) Facility reasons: Integrated sterilized surgical instruments and drapes availability, long elevator waiting times. Improvement measures we implemented include holding in-service training, making standard operating procedures guidelines for ECMO operations, setting up a personnel dispatch system, simplifying operation coordination network, executing regular auditing procedures, designating an ECMO material case cart, designating an elevator sensor card and regulating its use. The average preoperative ECMO preparation time reduced to 9.6 minutes and our goal of shortening the preoperative preparation time, thus lower the surgical risk of patients and improving the quality of surgical service has been achieved.