運用團隊資源管理縮短緊急手術等待時間

Using Team Resource Management to Shorten the Waiting Time for Emergency Surgery

目的：時間是緊急手術搶救生命的關鍵，延遲手術不但會影響疾病的預後，甚至導致病人死亡，因此縮短接刀時間是重要的關鍵。本研究目的在縮短緊急手術接刀時間，提升30 分鐘內接刀比率，來降低死亡或失能的風險，確保醫療服務品質。方法：經現況分析發現，緊急手術接刀平均時間過長，是影響病人安全之重要隱憂。專案採訪談與資訊管理系統進行原因收集與分析，執行期間從2013 年3 月到2014 年2 月，研究透過團隊資源管理，擬定改善對策，統一訊息傳遞方式、制定緊急手術標準作業流程、設置緊急手術專用手術房等。結果：在醫療團隊協同合作下，平均接刀時間由之前的43.61 分鐘鐘縮短至18.75分鐘，呈現顯著差異（p < .001）；30 分鐘內接刀率則由29% 提升到為97.37%，呈現顯著差異（χ2=53.57，p < .005）；死亡率與住院天數前後無顯著差異。結論：本研究之改善確實可縮短緊急手術等待時間，並積極維護病人生命安全，提昇手術照護品質。

Objectives: Time is the key to saving lives. A delay in surgery can affect the prognosis of a disease, and even lead to death. Therefore, to shorten the waiting time for emergency surgery is important. Our study aimed at shortening the “decision-to-incision” time for emergency surgery to 30 minutes to reduce the risk of death or disability and to ensure the quality of medical services. Methods: After the current situation analysis, the waiting time for emergency surgery is too long, and the safety of patients worries. [This is a conclusion rather than part of the Methods and should be deleted.] We collected data related to the waiting time for emergency surgery in our hospital and analyzed the reasons for delays. We improved the safety of patients through team resource management, a unifi ed messaging system, developed improvement measures, developed standard operating procedures for emergency surgery, and set up a dedicated emergency surgery room. Results: During the implementation of team resource management between January 2013 and February 2014, the average waiting time for emergency surgery decreased from 43.61 min to 18.75 min (p <.001), and the waiting time within 30 min was increased from 29% to 97.37% (χ2=53.57, p <.005). No signifi cant reductions in the mortality rate and hospital length of stay resulted from the implementation of team resource management. Conclusions: Our study shortened the waiting time for emergency surgery, thus protecting the safety of patients and improving the quality of surgical care.