A "time-and-motion" study of endoscopic practice: strategies to enhance efficiency
A "time-and-motion" study of endoscopic practice: strategies to enhance efficiency
复制标题
DOI：
10.1016/j.gie.2008.03.1116
复制
发表时间：
2008-12-01
影响因子：
7.7
通讯作者：
Leong, Wai Ling
中科院分区：
文献类型：
--
作者：
Harewood, Gavin C.;Chirysostomou, Kristia;Leong, Wai Ling
背景资料：随着对内窥镜资源需求的不断增长，实现最佳效率变得越来越重要。目的：本研究采用时间和运动的方法来评估一家大型教学医院的内窥镜检查部门的效率，并确定提高效率的策略设计：在研究期间前瞻性地观察连续内窥镜检查程序，并记录每个程序的各个组成部分的时间间隔。三级转诊教学医院。患者：进行内窥镜检查的连续性患者。干预：内窥镜数据的前瞻性记录。主要结果测量：每个程序的各个组成部分的时间间隔。结果：数据前瞻性记录了400个程序：197个EGD，123个结肠镜检查，32个柔性乙状结肠镜检查，和48个双重程序（EGD）和柔性乙状结肠镜检查或结肠镜检查）。确定了几种提高效率商（EQ）的策略，EQ是内窥镜医生从事手术或完成术后文书工作的时间比例：（1）雇用人员事先获得静脉通路和患者同意，EQ增加了10.8%，（2）使用每个内窥镜医生2个房间的模型，EQ增加了51.2%，（3）在内窥镜检查前使用人员获得患者同意并镇静患者，使EQ增加了30.9%，（4）消除内窥镜医生的术后文书工作，结合预先同意和镇静以及2室模型，使EQ增加了63.3%。局限性：研究结果代表了三级转诊中心单个内窥镜检查单位的经验，可能无法推广到门诊手术中心或其他医院的内窥镜检查单位。程序时间组件以外的因素可能会影响效率的2室每endoscopistmodel.Conclusions：一个时间和运动的方法可以用来确定策略，以提高内窥镜的效率。内窥镜性能的质量，我的方面永远不应该在试图提高效率时妥协（Gastrointest Endosc 2008;68：1043-50）。
Background: With the growing demand on endoscopic resources, achieving optimal efficiency has assumed increasing importance.Objective: This study adopted a time-and-motion approach to assess efficiency in the endoscopy unit of a large teaching hospital and to identify strategies to enhance efficiencyDesign: Consecutive endoscopic procedures were prospectively observed over the study period, and time intervals of the individual components of each procedure were recorded.Setting: Tertiary-referral teaching hospital.Patients: Consecutive patients undergoing endoscopy.Intervention: Prospective recording of endoscopic data.Main Outcome Measurements: Time intervals of the individual components of each procedure.Results: Data were prospectively recorded for 400 procedures: 197 EGDs, 123 colonoscopies, 32 flexible sigmoidoscopies, and 48 double procedures (an EGD) and a flexible sigmoidoscopy or colonoscopy). Several strategies to improve the efficiency quotient (EQ), the proportion of time that the endoscopist is engaged in performing the procedure or completing postprocedure paperwork, were identified: (1) employing personnel to obtain prior intravenous access and consent of patients increased the EQ by 10.8%, (2) using a 2-rooms-per-endoscopist model increased the EQ by 51.2%, (3) using personnel to both obtain consent and sedate the patient before an endoscopy increased the EQ by 30.9%, and (4) eliminating postprocedure paperwork for the endoscopist in conjunction with preconsent and sedation and a 2-room model increased the EQ by 63.3%.Limitations: Findings represent the experience of a single endoscopy unit in a tertiary-referral center and may not be generalizable to ambulatory surgical centers or other hospital-based endoscopy units. Factors other than procedure-time components may impact the efficiency of a 2-rooms-per-endoscopist model.Conclusions: A time-and-motion approach can be used to identify strategies to enhance endoscopic efficiency. The quality of,my aspect of endoscopy performance Should never be compromised in an attempt to enhance efficiency (Gastrointest Endosc 2008;68:1043-50.)