Chelvarajah R, Lee J K, Chandrasekaran S, Bavetta S
Department of Neurosurgery, Essex Centre for Neurosciences, Queen's Hospital, Romford, UK.
Br J Neurosurg. 2007 Dec;21(6):610-3; discussion 614-5. doi: 10.1080/02688690701649488.
To investigate inefficiencies during patients' stay in neurosurgical beds.
A prospective audit of neurosurgical inpatients was conducted over approximately 2 months. We recorded the causes and duration of inappropriate delays, defined as actions requiring more that 24 h from initiation until completion.
One-hundred-and-thirty-eight patients were studied (61 elective and 77 emergency admissions). The audited patients were in hospital for a total of 1665 days. Of these, 482 days (29%) were due to delays. 92.5% of these wasted days involved emergency admissions. The main categories of delay were transfer back to referring hospital (46% of all delays), operative (26%) and radiological (19%). Our own hospital was responsible for the longest transfer delays (6.3 days/patient compared with an average of 2.8 for all hospitals). Operative waits arose because of problems with both the timing and capacity of lists. Radiological delays resulted in particular from waits for MRI scans and neuroradiologist-performed procedures. The effect of eliminating all these inappropriate delays would be equivalent to liberating 10.7 of our 37 neurosurgical beds at any one time.
Clinician-led analysis of organizational aspects of patient care has revealed serious structure, process and capacity problems in efficient bed usage, We have made proposals to address the cause of the inappropriate delays.
调查患者在神经外科病床住院期间的低效情况。
对神经外科住院患者进行了为期约2个月的前瞻性审计。我们记录了不适当延误的原因和持续时间，将其定义为从开始到完成需要超过24小时的行动。
共研究了138例患者（61例择期入院和77例急诊入院）。被审计患者的总住院天数为1665天。其中，482天（29%）是由于延误。这些浪费的天数中有92.5%涉及急诊入院。延误的主要类别是转回转诊医院（占所有延误的46%）、手术（26%）和放射检查（19%）。我们自己医院的转诊延误时间最长（平均每位患者6.3天，而所有医院的平均延误时间为2.8天）。手术等待是由于手术安排的时间和容量问题。放射检查延误尤其源于等待磁共振成像扫描和神经放射科医生进行的检查。消除所有这些不适当延误的效果相当于在任何时候腾出我们37张神经外科病床中的10.7张。
由临床医生主导对患者护理组织方面进行分析，揭示了在有效床位使用方面存在严重的结构、流程和容量问题。我们已提出解决不适当延误原因的建议。
