PDCA应用于临床急救用血的实效性分析

Application effectiveness of PDCA in emergency blood management

目的探讨PDCA(循环管理)应用于临床急救用血管理的实效性。方法收集本院各临床用血科室2021年1月—2022年6月的急救用血病例资料,观察配血时间、取血时间、急救用血率,以输血科实施(验)PDCA期间(2021年7月—12月)为界,分为PDCA实验组(简称实验组,n=287),PDCA实验前组(简称对照组1,2021年1—6月,n=516)和PDCA实验停止后组(简称对照组2,2022年1—6月,n=277),根据科室性质做亚组分析,分别为内科、外科、ICU。对实施前阶段中非急救用血占用急救通道问题应用PDCA做持续改进;使用Kruskal-Wallis检验和χ^(2)检验比较3组间配血时间、取血时间、急救用血率的变化。结果实验组、对照组1、对照组2的配血及取血时间(M,min)分别19.00 vs 45.50 vs 23.00及22.00 vs 44.00 vs 25.00(均为P<0.05);其分别在内科为19.00 vs 47.00 vs 24.00及23.00 vs 56.00 vs 30.50、外科为18.00 vs 57.50 vs 14.00及32.00 vs 41.00 vs 24.00、ICU为20.00 vs 42.00 vs 23.00及16.50 vs 34.00 vs 12.50(均为P<0.05)。实验组、对照组1、对照组2急救用血率分别为6.9%(287/4141)vs 11.0%(516/4689)vs 6.8%(277/4089);其分别在内科为6.3%(175/2769)vs 11.8%(297/2512)vs 6.7%(186/2789)、外科为5.9%(24/405)vs 3.6%(44/1213)vs 7.4(37/501)、ICU为9.1%(88/967)vs 18%(175/973)vs 6.8%(54/799)(均为P<0.05)。结论输血科应用PDCA能有效缩短临床急救用血的配血与取血时间,提高急救输血的成功率,应用价值明显,值得临床推广应用。

Objective To explore the effectiveness of PDCA(Plan-Do-Check-Act Cycle Management)in clinical emergency blood management.Methods The data of emergency blood-using cases from January 2021 to June 2022 in each clinical department of our hospital were collected to observe the blood matching time,blood retrieving time,and emergency blood-using rate.They were divided into PDCA experimental group(Experimental group,July to December 2021,n=287),pre-PDCA experimental group(Control group 1,January to June 2021,n=516)and post-PDCA experimental cessation group(Control group 2,January to June 2022,n=277).Subgroup analysis was performed according to different departments,which were Internal Medicine Department,Surgery Depatment,and ICU.The situation of non-emergency blood use occupying emergency lanes in the pre-implementation period was continuously improved using PDCA,and the differences in blood matching time,blood retrieving time,and emergency blood-using rate among the three groups were compared and analyzed by Kruskal-Wallis test and chi-square test.Results The blood matching time and blood retrieving time(M,min)in the experimental group,control group 1 and control group 2 were 19.00 vs 45.50 vs 23.00 and 22.00 vs 44.00 vs 25.00,respectively(P 0.05),and were 19.00 vs 47.00 vs 24.00 and 23.00 vs 56.00 vs 30.50 in Internal Medicine Department,18.00 vs 57.50 vs 14.00 and 32.00 vs 41.00 vs 24.00 in Surgery Department,20.00 vs 42.00 vs 23.00 and 16.50 vs 34.00 vs 12.50 in ICU(P0.05).The rate of emergency blood use in the experimental group,control group 1,and control group 2 were 6.9%(287/4141)vs 11.0%(516/4689)vs 6.8%(277/4089),respectively(P0.05),and were 6.3%(175/2769)vs 11.8%(297/2512)vs 6.7%(186/2789)in Internal Medicine Department,5.9%(24/405)vs 3.6%(44/1213)vs 7.4%(37/501)in Surgery Department,and 9.1%(88/967)vs 18%(175/973)vs 6.8%(54/799)in ICU(P0.05).Conclusion The adoption of PDCA in Blood Transfusion Department can effectively shorten the blood matching time and blood retrieving time for clinical emergencies and improve the success rate of emergency blood transfusion.