運用團隊資源管理精實門診檢查作業

Lean Implementation in Utilizing Team Resource Management to Improve Outpatient Testing Procedures

目的：個案醫院門診檢驗檢查項目單張眾多、檢查排程時間複雜及檢查地點不易尋找是病人最常要求改善重要點項，有鑑於個案醫院秉持以病人為中心之目標，運用團隊資源管理精實門診檢查作業。方法：本專案以某區域級教學醫院為例，針對2012年10月01日至2013年12月26日共3,333,000張門診檢查單為樣本數。進行改善策略為：（一）整合門診檢查單張：批價／檢驗／檢查單張整合編列檢查順序、以病人為中心檢查資訊、減少資訊列印與節約耗材成本及利用資訊系統進行查閱、繕打報告。（二）簡化檢查作業流程：資訊系統簡化流程及單一條碼讀取資訊。（三）檢查位置清楚標示：各檢查單位標示編號及檢查單標示檢查位置編號。結果：（一）病人滿意度：2013年病人等候時間調查報告，提升名次第一名及第四名分別為等候檢驗／檢查時間及等候掛號／批價時間提升率分別為16.2%、13.6%。（二）精實醫療效益：整合門診檢查單張、整合門診檢查耗材費用、門診檢查單作業時間、精實檢查作業人力、檢查位置清楚標示之進步率分別為85.71%、9.16%、80.36%、40.75%、150%。結論：個案醫院「以病人為中心」重新規劃就醫流程，有效重塑檢查單張、簡化作業流程、營造友善環境。

Purposes: The most frequently requested improvements in outpatient testing procedures by patients are as follows: excessive documentation to schedule outpatient testing; complicated process to schedule examination appointments; and ease in finding the location of the examination. Considering the above requests, we aimed to improve the process involved in outpatient examinations with the introduction of Team Resource Management (TRM) as lean implementation. Methods: A total of 3,333,000 outpatient examination request forms were collected as study samples between 1 October 2012 and 26 December 2013 in a community hospital in Taiwan. Strategies: 1) The integrated outpatient checklist was developed to achieve the following: integrate the payment checklist, inspection sheet, and check sheet; provide patient-centered information to check results; reduce printing and save the cost of materials and supplies; and use information systems to review and format the report; 2) The examination procedures were simplified as follows: streamline the process through information systems; use a barcode to read the information; and access online information related to the checklist; 3) The location for the medical examination was clearly indicated, as follows: a site number was allocated to each examination unit; and the checklist was labeled with the site number of the medical exam. Results: Patient Satisfaction: According to the survey results regarding the length of time patients waited for medical tests in 2013, the ranking of waiting time for patients to receive medical tests and waiting for appointments or waiting in line for payment rose from 1st and 4th places with improvements of 16.2% and 13.6%, respectively. Outcomes for the Improved Lean Process Implementation: The rates of improvement related to the integration of request forms for scheduling outpatient testing, outpatient testing integration: for cost savings, time required to schedule appointments for testing, workforce reduction in medical testing, and appropriate signs and clear directions to the exam rooms were 85.71%, 9.16%, 80.36%, 40.75%, and 150%, respectively. Conclusions: Focusing on “patient-centered” goals, our hospital reorganized the entire process involved in patient visits, integrated the documentation for outpatient examinations, and streamlined the process to create a friendly environment.