基于精益管理理念的手术室医用耗材合理化应用路径研究

Research on the rational application path of medical consumables in operating room based on the concept of lean management

目的:探讨精益管理在改善手术室医用耗材合理化应用中的价值和创新路径。方法:分析手术室医用耗材合理化应用成本控制的必要性,制定其成本控制指标,基于决策实验室分析(DEMATEL)法构建精益管理模型,从采购、库管、使用和监督优化手术室医用耗材全生命周期成本控制路径。选取医院手术室常规配置使用的148种医用耗材,根据管理模式不同分为对照组和观察组,对照组采用传统管理模式,观察组采用精益管理模式,对比两组医用耗材的总量控制、库存管理和使用考核效果。结果:观察组的急诊科、泌尿外科、骨科、神经外科及其他外科手术室医用耗材总量控制比率分别为(96.52±4.96)%、(100.20±5.14)%、(98.82±5.62)%、(101.63±4.64)%和(104.53±7.18)%,均低于对照组,差异有统计学意义(Z=3.466,Z=3.869,Z=4.042,Z=2.743,Z=2.542;P<0.05);观察组手术室医用耗材临时取用时长、库房盘点整理时长、医用耗材积压占比和信息差错率分别为(1.39±0.46)min、(37.95±11.04)min、(0.52±0.43)%和(1.90±1.43)%,均低于对照组,差异有统计学意义(Z=3.977,Z=4.162,Z=3.416,Z=3.673;P<0.05);观察组采购计划完成率为(96.05±2.21)%,高于对照组,高值医用耗材占比和低值非收费医用耗材占比分别为(23.45±1.38)%和(45.59±1.96)%,低于对照组,差异有统计学意义(Z=2.401,Z=3.223,Z=3.122;P<0.05)。结论:基于DEMATEL法建立的精益管理模式能够提高手术室医用耗材总量控制达成率,改善不同类型医用耗材占比的合理性,规范库房管理流程,提升信息数据采集的有效性和采购计划的准确性。

Objective:To explore the value of lean management in improving the rational application path of medical consumables in operating room.Methods:The necessity of cost control in the rational application of medical consumables in operating room was analyzed,its cost control index was formulated,a lean management model based on decision-making trial and evaluation laboratory(DEMATEL)was constructed,and lifecycle cost control of medical consumables in operating room was conducted from procurement,inventory management,use and supervision.148 kinds of medical consumables routinely used in operating room of the hospital were selected and divided into control group and observation group according to different management modes.The control group adopted traditional management mode,and the observation group adopted the lean management mode.The total quantity control,inventory management and use assessment effects of the two groups of medical consumables were compared.Results:The proportion of total medical consumables control in the emergency department,urology department,orthopedics department,neurosurgery department and other surgical operating rooms in the observation group were(96.52±4.96)%,(100.20±5.14)%,(98.82±5.62)%,(101.63±4.64)% and(104.53±7.18)%,respectively,which were lower than those in the control group,the difference was statistically significant(Z=3.466,Z=3.869,Z=4.042,Z=2.743,Z=2.542;P<0.05).The duration of temporary taking of medical consumables in the operating room,the duration of warehouse inventory finishing,the proportion of backlog of medical consumables and the information error rate in the observation group were(1.39±0.46)minutes,(37.95±11.04)minutes,(0.52±0.43)%and(1.90±1.43)%,respectively,which were lower than those in the control group,the difference was statistically significant(Z=3.977,Z=4.162,Z=3.416,Z=3.673;P<0.05).The completion rate of procurement plan in the observation group was(96.05±2.21)%,which was higher than that in the control group,the proportion of high-value medical consumables and low-value non-charged medical consumables in the observation group were(23.45±1.38)%and(45.59±1.96)%,respectively,which were lower than those in the control group,the difference between was statistically significant(Z=2.401,Z=3.223,Z=3.122;P<0.05).Conclusion:The lean management mode can improve the achievement rate of total quantity control of medical consumables in the operating room,standardize the warehouse management process,improve the effectiveness of information and data collection,improve the accuracy of procurement plans,and improve the rationality of the proportion of different types of medical consumables.