Process improvement for a complex dual medical procedure.
Process improvement for a complex dual medical procedure.
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DOI：
10.1136/bmjoq-2017-000273
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发表时间：
2018
期刊：
影响因子：
1.4
通讯作者：
Blackmore CC
中科院分区：
文献类型：
--
作者：
Weigel WA;Gluck M;Ross AS;Lin OS;Williams BL;Blackmore CC
胰腺体外冲击波碎石术后内镜逆行胰胆管造影是世界范围内公认的治疗大面积、症状性、梗阻性胰腺结石的方法。然而，及时完成合并过程需要来自两个不同复杂程序的设备和人员的协调。我们在为期一周的活动中使用精益管理工具，围绕患者重新设计流程。利用创意生成的“计划、执行、研究、行动”周期来完善流程，从调度到术后恢复，设备和人员都进行了调整，使这两个流程能够立即连续进行。重新设计的过程导致所有患者接受两种程序没有延误。这减少了超过8小时的等待时间。标准工作和新创建的复杂调度程序改进了流程。我们在不延长手术时间的情况下减少了患者使用麻醉剂的次数。
Pancreatic extracorporeal shock wave lithotripsy followed by endoscopic retrograde cholangiopancreatography is accepted worldwide as a treatment for a large, symptomatic, obstructing pancreatic stones. However, timely completion of the combined process requires coordination of equipment and personnel from two different complex procedures. We used Lean management tools in a week-long event to redesign the process around the patient. Using idea-generated Plan Do Study Act cycles to refine the process, from scheduling to postprocedure recovery, equipment and personnel were aligned to allow these two procedures to occur in immediate succession. The redesigned process resulted in all patients receiving both procedures without delay. This eliminated over 8 hours of wait time. Standard work and a newly created complex scheduler improved flow. We reduced the number of anaesthetics for patients without prolonging the procedure length.