運用精實手法提升住院病人常規手術前麻醉照會之效能

Reinforcing Knowledge and Safety in Preoperative Counseling for Inpatients Undergoing Elective Surgery through Lean Healthcare Methods

效能管理是醫療機構之挑戰，醫療流程作業任一環節延遲，嚴重影響醫療團隊整體性評估效益。統計本院2021年平均每月698例常規手術，其中52.9%病人於麻醉照會時超過20分鐘等候、滿意度61.6%、術前焦慮16.3分、認知度65.7分，麻醉照會流程週期效益僅6.4%，堆疊負荷逐步增加病人負面感受，影響手術前心理健康，為安全環節鬆動之警訊。
導入精實針對等候時間及病人焦慮進行系統圖分析及三現原則確認14項真因、擬定27項解決策略，改善後麻醉照會等候時間降為12.5分鐘、術前焦慮降為7.1分、麻醉認知89.9%、流程週期效益提升至31.5%、滿意度90.4%，整體改善成效顯著。採跨團隊合作共同剔除浪費、流程精簡，降低病人等待與焦慮，將麻醉照會效能發揮極致，堅守高品質病人安全之首要目標。

Effectiveness management poses a significant challenge in healthcare institutions, where delays in any part of the medical process can impact the overall effectiveness and increase negative outcomes. In 2021 our hospital showed an average of 698 elective surgery per month, with 52.9% of patients experiencing over 20 minutes of waiting time during preoperative counseling. The overall satisfaction was 61.6%, with a preoperative counseling process cycle efficiency(PCE) of 6.4%, preoperative anxiety score of 16.3, and knowledge score of 65.7. The gradual increase in negative perceptions affects patients' preoperative mental health, signaling a warning for safety vulnerabilities.
To address these challenges, we applied lean healthcare methods targeting the reduction of waiting times and patient anxiety.
A systemic analysis identified 14 root causes and 27 resolution strategies. Following the implementation, waiting times decreased to 12.5 minutes, the preoperative anxiety score dropped to 7.1, anesthesia knowledge scores rose to 89.9%, PCE improved to 31.5%, and patient satisfaction increased to 90.4%. These significant improvements demonstrate the effectiveness of multidisciplinary collaboration in eliminating inefficiencies, reducing patient anxiety, and enhancing the overall quality and safety of preoperative counseling.