通过外流障碍分析和流程改进,减少急诊病人的入院时间
Marjorie A Erdmann1, Ipe S Paramel1, Cari Marshall1
1Oklahoma State University, Spears School of Business, Center for Health Systems Innovation, Stillwater, Oklahoma.
The western journal of emergency medicine
|September 25, 2024
概括
实施精益医疗保健战略通过解决协作失败和"数字失明"来减少急诊室 (ED) 的登机时间. 这种患者流量的改善减少了入院患者的等待时间,提高了ED的效率.
科学领域:
- 医疗保健管理的管理
- 优化患者流量优化
- 精简的医疗保健方法.
背景情况:
- 住院患者等待住院病床的住院患者加剧了急诊室 (ED) 的拥挤,导致严重的延误.
- 患者流量调查对于识别和解决导致ED过度拥挤的外流瓶至关重要.
研究的目的:
- 调查患者流动,以识别和解决入院ED患者的流出延迟.
- 测量实施的解决方案对减少住院ED患者离开ED的等待时间的影响.
主要方法:
- 精益医疗保健方法被用来识别中西部医院的流量延迟和障碍.
- 实施了针对确定障碍的解决方案,随后进行了统计分析 (t 测试,回归),以比较干预前和后的等待时间 (ADtoD).
- 运行图分析评估了随着时间的推移改善的可持续性.
主要成果:
- 过程映射发现了18个延迟,其中61%与环境服务 (EVS) - 临床护理合作失败有关,78%与技术问题 ("数字失明") 有关.
- 干预后患者的平均等待时间 (ADtoD) 从96.4分钟显著减少到87.1分钟 (P=0.04),尽管ED体积增加.
- 回归分析证实,干预减少了每名患者的ADtoD12.7分钟 (P=0.01),避免了估计689小时的ED登机.
结论:
- 全系统的患者流量调查和有针对性的解决方案有效地减少了ED入院患者的登机.
- 解决"数字失明"和EVS-临床护理合作失败是改善患者流出和ED效率的关键.
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