精實醫療管理於手術室之應用

Lean Management in the Medical Operating Room

2015年8月開始，跨部門的外科團隊針對住院病人，從被通知要進行手術到離開手術室的流程，進行價值流程圖建構。藉由導入並實施精實與六標準差方法，消除整個手術過程的無增值步驟，來分析手術時間延遲的潛在原因。本專案在實施精實流程前後之重要改善如下：第一台刀準時劃刀率由65.5%提升至84.1%、第一台刀等待麻醉誘導時間由15.7分鐘降低至12.2分鐘、手術前一天完成麻醉訪視比率由94.8%提升至97.4%、緊急手術60分鐘內進入手術室時間，由改善前76分鐘降低至44.8分鐘，同時手術室護理人員離職率也由21%降至5.4%。 In August 2015, a multidisciplinary surgical improvement team constructed a value stream map of the entire surgical process from the moment a patient is informed of the surgery to the moment when the patient leaves the operating room. Lean and Six Sigma methodologies were introduced and implemented by eliminating non-value added steps across the entire surgical process to analyze potential causes of delays for operating cases. The main findings of this project in comparing the results before and after the implementation of the lean process are an increase from 65.5% to 84.1% in percentage of the first operation at the hospital in the morning beginning on-time, with the wait time for anesthetic induction shortened from 15.6 minutes to 12.2 minutes. There was also an increase in completion of the pre-operative anesthesiologist visits from 94.8% to 97.4%. In addition, the waiting time for emergency operations expected to be performed within 60 minutes was shortened from 76 minutes to 44.8 minutes The turnover rate of operating room nursing staff was also decreased from 21.1% to 5.4%.

In August 2015, a multidisciplinary surgical improvement team constructed a value stream map of the entire surgical process from the moment a patient is informed of the surgery to the moment when the patient leaves the operating room. Lean and Six Sigma methodologies were introduced and implemented by eliminating non-value added steps across the entire surgical process to analyze potential causes of delays for operating cases. The main findings of this project in comparing the results before and after the implementation of the lean process are an increase from 65.5% to 84.1% in percentage of the first operation at the hospital in the morning beginning on-time, with the wait time for anesthetic induction shortened from 15.6 minutes to 12.2 minutes. There was also an increase in completion of the pre-operative anesthesiologist visits from 94.8% to 97.4%. In addition, the waiting time for emergency operations expected to be performed within 60 minutes was shortened from 76 minutes to 44.8 minutes The turnover rate of operating room nursing staff was also decreased from 21.1% to 5.4%.