Kasper J F, Plume S K, O'Connor G T
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03756.
QRB Qual Rev Bull. 1992 Apr;18(4):129-33. doi: 10.1016/s0097-5990(16)30519-x.
This report describes an example of applying comparative process analysis to improve surgical procedures. This approach to health care quality improvement relies on combining techniques from the technical disciplines of systems analysis and systems engineering with concepts embodied in the philosophies of total quality management. Coronary artery bypass grafting (CABG) has been examined in a cooperative observational study involving an engineer, cardiac surgeons, perfusionists, nurses, and an anesthesiologist. A baseline process flow for the CABG procedure was developed, against which interinstitutional variations among the five participating medical centers have been identified. On the basis of analysis of the variations, efforts are under way to develop a strategy for incremental continuous improvement in the CABG procedure in each of the five institutions. On the basis of the perceived success of the first phase of the activity, a second phase, wider in scope, has been undertaken.
本报告描述了一个应用比较过程分析来改进外科手术程序的实例。这种改善医疗保健质量的方法依赖于将系统分析和系统工程等技术学科的技术与全面质量管理理念中所体现的概念相结合。在一项合作观察性研究中，对冠状动脉搭桥术（CABG）进行了研究，该研究涉及一名工程师、心脏外科医生、灌注师、护士和一名麻醉师。制定了CABG手术的基线流程，并据此确定了五个参与医疗中心之间的机构间差异。在对差异进行分析的基础上，正在努力为五个机构中的每个机构制定冠状动脉搭桥术程序逐步持续改进的策略。基于该活动第一阶段取得的显著成效，现已开展范围更广的第二阶段工作。
