PDCA循环法在提高首台择期手术准时开台率的应用

Application of PDCA cycle in improving the punctual opening rate of the first elective operation

目的以提升首台择期手术准时开台为案例,提供一套运用PDCA循环法,精细化管理的操作实践,不断完善首台择期手术准点开台率。方法调查2020年一季度首台择期手术开台情况,分析导致首台择期手术开台时间延迟的原因,并制定改进措施。结果 2020年第一季度,为医院实施精细化管理前,首台择期手术开台时间平均为09:28,准时率62.27%。延迟科室主要为儿外科(46.98%)、产科(40.54%)。延迟手术级别四级手术占比较高(84.38%)。从术前准备重要时间节点和时间段分析,手术医师入手术间时间较晚,患者入手术间至麻醉操作开始时间段较长。延迟原因主要为手术医师查房、晨交班;2020年4月医院根据调查发现问题,开展整改。对比医院实施精细化管理前后,首台择期手术在9:30之前开台比例逐步提高,2020年三季度开台时间准时率较2020年一季度差别有统计学意义(P <0.05)。结论医院成立专项质控小组,根据实际情况,修订管理制度和管理流程,建立持续改进管理指标;通过信息化手段,实现术前、术中、术后动态监管;制定科学的奖惩制度,加强医师对手术室运行效率的认知及自身责任感的提升;采用PDCA循环法,精细化管理,梳理现况、发现问题,有效干预,医院对首台择期手术准时开台实施管理是有效的。

Objective By taking a case study of improving the operating time of the first elective operating platform,to provide a set of application of PDCA cycle method and fine management of the operation practice so as to constantly improve the operating on-time operating rate.Methods By investigating the first elective operating table in the first quarter of 2020,analyzing the causes of the delay in operating table,and formulating improvement measures.Results In the first quarter of 2020,before the implementation of fine management in the hospital,the average operating time of the first elective operation was 09:28,and the punctuality rate was 62.27%.The main departments with delayed operations were pediatric surgery(46.98%)and obstetrics(40.54%).Among the delayed operation,the rate of Grade 4 was higher(84.38%).From the analysis of important time point and time slot of preoperative preparation,the time of surgeon entering operation is late,and the time between patient entering operation and anesthesia operation is long.In April 2020,the hospital carried out rectification according to the findings of the investigation.Compared with before and after the implementation of fine management,the proportion of the first operation before 9:30 increased.Compared with the first quarter of 2020,the punctual rate of opening time in the third quarter of 2020 is statistically significant(P<0.05).Conclusion The hospital establishes the Special Quality Control Group,according to the actual situation,revises the management system and the management process,establishes the continual improvement management target;establish the management index of continuously improving;realize the dynamic supervision before,during and after the operation by means of information;establishes a scientific reward and punishment system to enhance the operating room operating efficiency of physicians and their own sense of responsibility;adopts the PDCA circulation method,fine management,combing the current situation,finding problems,and effective intervention,the hospital of the first elective operating time management is effective.