两次PDCA循环持续改进骨科手术用血合理率及输血病历缺陷率

Two PDCA Cycles Continuously Improved the Blood Rationalization Rate in Orthopedic Surgery and the Defect Rate of Blood Transfusion Records

目的探讨两次PDCA循环法在改进骨科手术用血合理率及输血病历缺陷率中的应用及效果。方法应用PDCA循环法对骨科手术用血合理率及输血病历缺陷率进行持续改进,对骨科手术不合理用血及输血病历缺陷、自体输血率低等原因进行分析,从输血指征、现有政策及监管途径三方面对临床医师、麻醉医师、输血科工作人员及相关制度和流程,制定相应改进措施和持续改进计划,在计划实施过程中发现新的问题并启动第二轮PDCA循环,使改进环环相扣、逐步深入。结果 1) 2015年至2018年,骨科总手术量(1433例比1332例)及高出血风险手术量(70. 62%比43. 62%)逐年升高;改进后所有患者平均异体红细胞输注量(0. 48 U)及血浆输注量(0. 08 U)均低于改进前(0. 57 U、0. 45 U);改进后异体血输血总费用下调;改进后平均住院日和并发症发生率均低于改进前。2)骨科手术用血红细胞合理率由改进前64%提高至94. 53%,血浆合理率由改进前71%提高至91. 67%,病历完整率由改进前42. 2%提高至72. 09%,骨科自体输血率由改进前2. 95%提高至23. 47%。结论持续PDCA循环能更有效提高骨科手术用血合理率及输血病历完整性,相对单次PDCA循环具有更大优势。

Objective To explore the application and effect of two PDCA cycles in improving the blood rationalization rate and defect rate of blood transfusion in orthopedic surgery.Methods Application of PDCA circulation method in orthopaedic surgery and blood transfusion medical defects for continuous improvement,defect of orthopedic surgery and blood transfusion unreasonable records,analyzes reasons for low rate of autologous blood transfusion and from transfusion indications and current policy and regulatory pathway,for clinicians,anesthesiologist,blood transfusion department staff and related system and process,corresponding improvement measures and continuous improvement plan,find new problems in the process of plan implementation and start the second round of PDCA cycle,improve interlocking,in-depth step by step.Results 1)From 2015 to 2018,the total number of orthopedic surgeries(1433 cases vs 1332 cases)and the number of surgeries with higher blood risk(70.62% vs 43.62%)increased year by year.After improvement,the use of allogeneic red blood cells(0.48 U)and plasma(0.08 U)in all patients were lower than before(0.57 U,0.45 U).The total cost of allogeneic blood transfusion after improvement were lower than that before.The average hospital stay and complication rate were lower than before.2)The rationalization rate of blood used in orthopedic surgery increased from 64% to 94.53%,the plasma rationalization rate increased from 71% to 91.67%,the medical record integrity rate increased from 42.2% to 72.09%,and the autologous transfusion rate in orthopedic surgery increased from 2.95% to 23.47%.Conclusion Continuous PDCA circulation can effectively improve the blood rationalization rate and the integrity of blood transfusion records in orthopedic surgery.Compared with single PDCA circulation,continuous PDCA circulation has a greater advantage.