精益管理对急诊生化标本周转时间的影响

Effects of lean management on emergency biochemistry test turnaround time in clinical laboratories

目的研究精益管理对急诊生化标本周转时间(TAT)的影响。方法通过标准化操作、5S现场管理、评估仪器批量处理和人工单件流的效率、可视化管理,比较优化前后各阶段耗时、急诊生化标本TAT合格率、标本TAT超时较集中时间段的不合格率和标本采集不合格率。结果标本签收-标本入库、报告结果 -审核发布、标本入库-报告结果 3个阶段优化前耗时中位数(四分位数间距)分别为30(35)min、7(13)min、17(8)min,优化后分别为16(19)min、5(9)min、16(7)min;标本签收-标本入库、报告结果 -审核发布阶段优化前后差异有统计学意义(P均<0.01),标本入库-报告结果阶段优先前后差异无统计学意义(P>0.05);TAT总耗时分别为63(51)min、46(33)min,差异有统计学意义(P<0.05);TAT合格率从86.00%上升到95.37%(P<0.01);标本TAT超时较集中时间段的不合格率从3.42%下降到1.00%(P<0.01);不合格标本从优化前的0.24%下降到了优化后的0.17%(P<0.01)。结论临床实验室可通过精益管理提高流程效率,减少和避免差错的发生,缩短急诊生化TAT。

Objective To investigate the effect of lean management on emergency biochemistry test turnaround time（TAT） in clinical laboratories. Methods Based on the approaches of standardized operations, 5S on-site management, the efficiency evaluation of batch processing and one piece flow, and visual management, the median time of each workflow, the qualified rate of emergency biochemistry test TAT, the unqualified rate in a relatively concentrated period of TAT timeout and the unqualified rate of collected samples were compared before and after optimization. Results The median times （ interquartile ranges） of each workflow including sample receipt and storage, result audit and sample storage-resuh report before and after lean management were 30 （35） min, 7 （ 13 ） min, 17 （8） min and 16（19） min, 5（9） min, 16（7） min, respectively, and there were significant differences in the former two（all P 〈0.01 ） but not the third （ P 〉 0.05 ）. The median times （ interquartile ranges） of TAT before and after lean management were 63 （51 ） min and 46 （ 33 ） min, respectively （P 〈 0.05 ）. The qualified rate of TAT increased from 86.00% to 95.37% after lean management （ P 〈 0.01 ）. The unqualified rates in a relatively concentrated period of TAT timeout and collected samples decreased from 3.42% to 1.00% （P 〈0.01 ） and from 0.24% to 0.17% （P 〈 0.01 ）, respectively. Conclusion Lean management may improve process efficiency, reduce errors, and shorten emergency biochemistry test TAT in clinical laboratories.