運用精實醫療重整日間手術安全作業流程

Using lean healthcare to optimize safe protocol of day surgery

本研究旨在精實日間手術流程；日間手術等候時間長會增加抱怨及影響滿意度，故降低手術病人等候手術時間並提升醫療照護品質為本研究之目的。統計2016年6月1日至2017年5月31日，日間手術運送病人延遲率79％；病人滿意度73.4％；流程週期效率（process cycle efficiency；PCE）為8.6％。解決方案：1.建構一條龍服務，精實日間手術流程。2.成立跨團隊衛教工作坊、安排在職教育、情境模擬演練及衛教競賽。3.跨團隊手術全期衛教、提供平安錦囊衛教包等措施。研究執行後手術等候時間由320分鐘降低至160分鐘達目標值；運送病人延遲率由79％降為21％；病人滿意度由73.4％提升至98.7％；精實PCE 8.6％提高至33.7％。本研究建構完善精實手術流程以跨團合作模式縮短病人手術流程等候時間，並介入手術全期衛教，降低焦慮進而提升病人安全及滿意度。

The purpose of this study is to streamline the procedure of day surgery. Long waiting time for day surgery will increase complaints and affect satisfaction. Therefore, reducing the waiting time for surgery patients and improving the quality of medical care is the purpose of this research. According to statistics, from June 1, 2016 to May 31, 2017, the delay rate of patient delivery during day surgery was 79%; patient satisfaction was 73.4%; process cycle efficiency (PCE) was 8.6%. Our solutions: 1. Build a one-stop service and a lean process 2. Set up cross-team healthcare education workshops, arrange on-the-job skill-education, scenario simulation exercises and healthcare education competitions 3. Cross-team surgery perioperative healthcare education, provide safety tips and healthcare education packages, etc. After the implementation of the study, the waiting time for surgery was reduced from 320 minutes to 160 minutes to reach the target value; the delay rate of transporting patients was reduced from 79% to 21%. Patient satisfaction increased from 73.4% to 98.7%; lean PCE increased from 8.6% to 33.7%. In this study, we constructed a complete and lean surgical procedure to shorten the waiting time of the patient's surgical procedure with a cross-professional team cooperation model, and introduced the perioperative healthcare education to reduce anxiety and improve patient safety and satisfaction.