Poelaert J, Schuepfer G, Umnus A, Bauer M, Schleppers A
Postoperative Cardiac Surgical ICU - K12 - 5 IE, Ghent University Hospital, De Pintelaan 185, B9000 Gent, Belgien.
Anaesthesist. 2007 Jun;56(6):599-603. doi: 10.1007/s00101-007-1186-9.
The German health care system is currently in a constant state of flux owing to enhanced competition and to the increasing focus on economic aspects. Medical services, especially treatment processes, are being reorganised in an attempt to adapt them to the new economic challenges. Ideally, radical reorganisation and streamlining of medical therapy processes should be accompanied by controlling and quality management systems. The purpose of this is to monitor the intensity of any economic and any patient-related (side)-effects. Business management techniques are needed that allow online and long-term performance reviews of reorganisation measures once initiated.
In industry, the method applied for this purpose is statistical process control (SPC). The present study demonstrates for the first time that use of this monitoring tool can be extended to the medical sector. In an intensive care unit (ICU) the following process parameters were monitored: duration of sedation, time to persisting spontaneous breathing, length of stay in ICU, length of stay in hospital, patient mortality in ICU and in the next 30 days after admission to the ICU. Group 1 was made up of 87 patients examined before and group 2, 93 patients after process optimisation. The main feature of the reorganisation was application of a new analgo-sedation technique and of the weaning concept.
In group 2 duration of sedation, time to spontaneous breathing and length of stay on the ICU were significantly shorter than in group 1. The length of stay in hospital, patient mortality in the ICU and 30 days after the initiation of intensive care did not differ significantly between the two groups.
Economic and patient-related key figures can be evaluated with SPC. It allows online assessment both before and during process optimisation, and especially in the long term afterprocess optimisation.
由于竞争加剧以及对经济方面的日益关注，德国医疗保健系统目前处于不断变化的状态。医疗服务，尤其是治疗流程，正在进行重组，以使其适应新的经济挑战。理想情况下，医疗治疗流程的彻底重组和精简应伴随着控制和质量管理系统。其目的是监测任何经济和任何与患者相关的（副作用）影响的强度。需要商业管理技术，以便在重组措施启动后能够对其进行在线和长期的绩效评估。
在工业领域，为此目的应用的方法是统计过程控制（SPC）。本研究首次证明，这种监测工具的使用可以扩展到医疗领域。在一个重症监护病房（ICU）中，监测了以下过程参数：镇静持续时间、持续自主呼吸时间、ICU住院时间、住院时间、ICU患者死亡率以及入住ICU后接下来30天的死亡率。第1组由87名在流程优化前接受检查的患者组成，第2组由93名在流程优化后接受检查的患者组成。重组的主要特点是应用了一种新的镇痛镇静技术和撤机概念。
第2组的镇静持续时间、自主呼吸时间和在ICU的住院时间明显短于第1组。两组之间的住院时间、ICU患者死亡率以及重症监护开始后30天的死亡率没有显著差异。
经济和与患者相关的关键指标可以通过SPC进行评估。它允许在流程优化之前和期间进行在线评估，尤其是在流程优化后的长期评估。
