精益A3管理工具在提高STEMI患者绕行急诊科直达导管室的应用与探讨

Application and Discussion of Lean A3 Management Tool in Improving STEMI Patients'Direct Access to Catheter Room by Bypass Emergency Department

目的探讨以精益A3管理工具,在提高地市级医院胸痛中心STEMI患者绕行急诊科直达导管室比例中的实践与应用.方法选取2021年1月1日至2022年3月31日在浙江省台州医院就诊的94例STEMI患者,2021年1月1日至12月31日为改进前的对照组(n=79),2022年1月1日至3月31日为改进后的观察组(n=15).观察组以A3管理工具进行数据测量,提出快赢措施,并以思维导图进行测量,针对影响因素进行优化整改,分析改进前后的效果.结果对照组绕行率为41.77%(33/79),观察组绕行率提高至86.67%(13/15),结果对比观察组有明显提高,差异有统计学意义(p<0.01),且每月绕行率稳定在50%以上。结论精益A3管理工具能优化胸痛中心诊疗服务流程,提高STEMI患者绕行急诊科直达导管室的比例.

Objective To explore the practice and application of lean A3 management tool in improving the proportion of STEMI patients bypassing the emergency department and going directly to the catheterization laboratory in the chest pain center of the prefecture-level hospital.Methods A total of 94 STEMI patients who were treated in Taizhou Hospital of Zhejiang Province from January 1,2021 to March 31,2022 were selected.Patients from January 1 to December 31,2021,were in the control group before improvement(n=79)and patients from January 1 to March 31,2022,were the improved observation group(n=15).The A3 management tool was used in the observation group for data measurement,and quick win measures were proposed.The mind map was used to measure.The influencing factors were optimized and rectified,and the effects before and after the rectification were analyzed.Results The bypass rate of control group was 41.77%(33/79)while the bypassing rate of observation group increased to 86.67%(13/15).The results were significantly improved compared with the observation group,and the difference was statistically significant(p<0.01),and the monthly bypassing rate was stable above 50%.Conclusion The lean A3 management tool can optimize the diagnosis and treatment service process of the chest pain center,and increase the proportion of STEMI patients bypassing the emergency department and going directly to the catheterization laboratory.