运用六西格玛法缩短危重患者从病房到重症监护室的转运时间

Shortening Transfer Time of Critical Inpatients from Ward to Intensive Care Unit: Based on Six Sigma

目的探讨缩短危重患者从病房到重症监护室转运时间的护理管理方案。方法 2015年11月至12月,实地调研普通病房转运至重症监护室抢救的30例危重患者,运用六西格玛DMAIC五步法,将转运流程细化为7个主流程及22个子流程,确定转运过程中的质量关键点,识别对患者安全转运产生影响的关键因素。提出改进措施为配置多功能危重患者转运车、设计危重患者转运重症监护室前核查表、增加危重患者转运小组、加强低年资护士培训、运用SBAR标准交接模式等。实施系列控制方案后,2016年5月至6月再次调查30例危重患者的转运资料。结果改进后,在不增加转运人员和确保患者安全的前提下,危重患者从病房至重症监护室的总转运时间显著缩短(t=15.052,P<0.001),抢救成功率从91.67%提高至98.01%。结论运用六西格玛DMAIC方法重建了危重患者从病房到重症监护室的转运流程,能有效缩短转运时间,提高抢救成功率。

Objective To shorten the transfer time of critical inpatients from wards to intensive care unit （ICU）. Methods From Novem-ber to December, 2015, 30 critical inpatients transferred from wards to ICU were investigated, and analyzed with Six Sigma DMAIC five-step method. There were 7 main processes and 22 sub-processes refined in transfer procedure, as well as the key quality points and the factors influencing the safety of transferring. Some improvement advice were recommended, including multifunctional transfer cart, Check-list before Transfer to Intensive Care Unit for Critical Patients, setting up transport group, training for young nurses and application of SBAR communication. Other 30 critical inpatients transferred from wards to ICU, from May to June, 2016, after the series of control pro-grams, were investigated. Results After improvement, the total transfer time from wards to ICU decreased （t=15.052, P〈0.001）, without the increase of human power and unsafety issues. The rescue success rate increased from 91.67%to 98.01%. Conclusion The process transfer-ring patient from wards to ICU has been reengineered based on Six Sigma DMAIC management, that reduces the time and improve the res-cue success rate.