Bridging Care Support and Care Delivery with Engineered Logistics and Technology

摘要 盖辛格诊所的供应链服务已经开发出‘项目帮助’(Healthcare Enabled物流 计划)，该计划基于成功的制造和工程工作流流程，并提出精益 重新设计供应品交付、支持服务操作和住院病房的临床工作流程。项目 Help的目标是将临床医生从支持服务活动中移除，并将这一时间重新投资于患者护理 活动。支持服务被定义为医院内的非临床部门，支持 提供护理(例如，药房、实验室和布草服务)。我们的初步研究估计， 大约16.8%的护士时间(每个住院护士每周40小时6.72小时)浪费在后勤上 他们不应该从事的活动，这在行业中很常见。这导致了 项目假设，通过改进护理提供支持系统，我们可以将护士从支持中移除 服务活动，从而允许临床医生重定向到患者护理活动，并使改进 护理质量。这项研究代表了一种提高医疗保健价值的方法--即减少浪费或 在提高质量的同时，不必要的成本。 Project Help将设计一个积极主动的支持服务系统，以取代目前的医疗保健 行业标准的反应式系统，从而消除了浪费的物流行程和非增值支持 服务活动。新流程将提高支持服务效率，并整合众多 独立的和竖井运作的部门。此外，我们计划设计提供一线服务的工作流程 为临床工作人员提供后勤支持。前线支持将由一名新团队成员协调，该成员将 成为临床工作人员和所有支持服务之间的桥梁。这个人的任务是协调 某一工作领域(如1或2个护理单位)的大部分(如果不是全部)支助服务活动。支持 在这些努力的基础上，我们还将开发一个护理支持信息系统，该系统将捕获护士对 支持准备和实施护理所需的活动。开发的信息系统将指导 通过提供所需信息以主动准备所有资源(即， 设备和用品)，用于规定的临床程序。该系统将包括诸如号码等信息 对护理单元进行的常见程序(如换药)所需的消耗品。 我们建议执行一个为期三年的项目，以设计高效和有效的护理提供支持 减少或消除护理人员对日常后勤活动的介入 离散事件仿真建模和应用已建立的制造和工程实践(AIM 1)，以及开发一个支持新进程的信息系统(目标2)。该项目还将 包括在两个护理单位(一个普通内科/外科单位和一个渐进单位)试行 以及对若干关键业绩指标的执行情况进行评估(目标3)。

Abstract Geisinger Clinic's Supply Chain Services has developed 'Project HELP' (Healthcare Enabled Logistics Program) that is based on successful manufacturing and engineering workflow processes and proposes a lean redesign of supply delivery, support service operations, and the clinical workflow on inpatient units. Project HELP's goal is to remove clinicians from support services activities, and, reinvest this time in patient care activities. Support services are being defined as non-clinical departments in the hospital that support the delivery of care (e.g., pharmacy, lab, and linen services). Our preliminary research has estimated that approximately 16.8% of nurses' time (6.72 hours per 40-hour week per inpatient nurse) is wasted in logistics activities that they should not have to engage in, an amount that is common in the industry. This led to the project hypothesis that by improving the care delivery support system, we can remove nurses from support service activities, thereby allowing redirection of the clinician to patient care activities and enabling improved quality of care. This study represents a way to improve the value of health care - i.e., reduce waste or unnecessary costs while improving quality. Project HELP will engineer a proactive support service system to replace the current, healthcare industry-standard, reactive system, thereby eliminating wasted logistics trips and non-value added support service activities. The new processes will increase support service efficiencies and consolidate the numerous independent and silo-operated departments. In addition, we plan to design workflows which provide frontline logistics support to the clinical staff. The frontline support will be coordinated by a new team member who will be the bridge between the clinical staff and all support services. This person will be tasked with coordinating most, if not all, of the support service activities for a given work area (e.g. 1 or 2 nursing units). To support these efforts, we will also develop a care support information system that captures the nurses' knowledge of support activities required to prepare for and perform care. The information system developed will guide the workflow for the logistics staff by providing the required information to proactively prepare all resources (i.e., equipment and supplies) for defined clinical procedures. This system will include information such as number of consumable supplies needed for common procedures (e.g., dressing change) performed on a nursing unit. We propose to perform a three-year project to engineer efficient and effective care delivery support processes and to reduce or eliminate nursing involvement with routine logistics activities through the use of discrete event simulation modeling and by applying established manufacturing and engineering practices (Aim 1), as well as develop an information system to support the new processes (Aim 2). The project will also include a pilot implementation on two nursing units (one general medical/surgical unit and one progressive care unit) and the evaluation of implementation on several key performance indicators (Aim 3).