Parks Jennifer K, Klein Jorie, Frankel Heidi L, Friese Randall S, Shafi Shahid
Department of Surgery, Division of Burns, Trauma and Critical Care, University of Texas Southwestern Medical School, Dallas, Texas, USA.
J Trauma. 2008 Nov;65(5):1098-104; discussion 1104-5. doi: 10.1097/TA.0b013e318188e8ad.
The Institute of Medicine has identified trauma center overcrowding as a crisis. We applied corporate Lean Six Sigma methodology to reduce overcrowding by quantifying patient dwell times in trauma resuscitation units (TRU) and to identify opportunities for reducing them.
TRU dwell time of all patients treated at a Level I trauma center were measured prospectively during a 3-month period (n = 1,184). Delays were defined as TRU dwell time >6 hours. Using personnel trained in corporate Lean Six Sigma methodology, we created a detailed process map of patient flow through our TRU and measured time spent at each step prospectively during a 24/7 week-long time study (n = 43). Patients with TRU dwell time below the median (3 hours) were compared with those with longer dwell times to identify opportunities for improvement.
TRU delays occurred in 183 of 1,184 trauma patients (15%), and peaked on days with >15 patients or with presence of five simultaneous patients. However, 135 delays (74%) occurred on days when </=15 patients were treated. Six Sigma mapping identified four processes that were related to TRU delays. Reduction of TRU dwell time by 1 hour per patient using interventions targeting these specific processes has the potential to improve our TRU capacity to care for more patients.
Application of corporate Lean Six Sigma methodology identified opportunities for reducing dwell times in our TRU. Such endeavors are vital to maximize operational efficiency and decrease overcrowding in busy trauma centers working at capacity.
医学研究所已将创伤中心人满为患视为一场危机。我们应用企业精益六西格玛方法，通过量化患者在创伤复苏单元（TRU）的停留时间来减少人满为患的情况，并找出缩短停留时间的机会。
前瞻性地测量了一家一级创伤中心在3个月期间（n = 1184）接受治疗的所有患者的TRU停留时间。延迟定义为TRU停留时间>6小时。我们利用接受过企业精益六西格玛方法培训的人员，绘制了患者在我们的TRU中的详细流程地图，并在为期一周、全天24小时的时间研究（n = 43）中前瞻性地测量了在每个步骤所花费的时间。将TRU停留时间低于中位数（3小时）的患者与停留时间较长的患者进行比较，以确定改进的机会。
1184例创伤患者中有183例（15%）出现TRU延迟，在患者人数>15人或同时有5名患者在场的日子达到峰值。然而，135例延迟（74%）发生在治疗≤15例患者的日子。六西格玛映射确定了与TRU延迟相关的四个流程。通过针对这些特定流程的干预措施，将每位患者的TRU停留时间缩短1小时，有可能提高我们的TRU护理更多患者的能力。
企业精益六西格玛方法的应用确定了减少我们的TRU停留时间的机会。此类努力对于在满负荷运转的繁忙创伤中心最大限度地提高运营效率和减少人满为患至关重要。
