運用失效模式與影響分析來改善門診病人採檢的流程

Improving the process of outpatient blood sampling by using failure mode and effects analysis

目的：門診病患採檢等候過久是檢驗科最大的報怨區塊，為了改善門診病患對採檢等候時間的抱怨，進行此專案的研究。
方法：我們運用失效模式與影響分析（Failure mode and effects analysis,FMEA），對「門診病人等候採檢流程」，再根據JCAH（JointCommissiononAccreditation of Healthcare Organizations, JCAHO）風險評量表，以風險的生率（risk occurrence rate, O）、嚴重度（severity, S）、偵測（detectionability, D）為評估基準，作量化的評估，根據潛藏的前三項高風險因子，擬定執行改善計畫。
結果：擬定改善對策：（一）更換一對一的叫號系統。（二）門診抽血櫃台重新整修，新增簽收電腦設備二台。（三）門診抽血櫃台重新設計規劃，增加抽血櫃台的位置及人力，並將試管的擺放規則化。最後以「顧客抱怨等候時間的案件」及「上午顧客抽血平均等候時間」為管制方法，來矯正及改善顧客採檢等候的抱怨事件。
結論：經由FMEA 風險管理工具，分辨採檢流程上常常造成失效的風險所在，作為改善作業之順序設定，標準化及單純化的改進，並參考管制指標，使失效的風險免於發生，來達到防範於未然的效果。

Objective: The majority of complaints from outpatients to the central laboratory refer to the long wait to have blood samples drawn. This study was designed to reduce that time and avoid patient complaints.
Methods: Failure mode and effects analysis (FMEA) was conducted on the workfl ow pattern of outpatient sampling. Based on Joint Commission on Accreditation of Healthcare Organizations risk management guidelines, risk occurrence rate, severity, and detection ability were evaluated as the quantitative parameters Based on the three most common potential high-risk factors, a plan for improvement was drafted.
Results: Actions included: 1. A one by one queuing system; 2. Renovation of the sampling station and addition of a two receipt system. 3. Redesign of the blood sampling area and workfl ow pattern by adding more blood-drawing stations, reassigning manpower, and rearranging the blood-drawing tubes. The number of patient complaints about waiting time and average blood-drawing and waiting times were used to monitor the results.
Conclusion: Through FMEA risk management and identifi cation of areas of lost efficiency during blood sampling, an improved, standardized and simplified workflow plan was drafted to improve results.