实施直接从恢复室出院的路径：一项流程改进工作。
Implementation of a direct-from-recovery-room discharge pathway: a process improvement effort.
作者信息
Ehrenfeld Jesse M, Seim Andreas R, Berger David L, Sandberg Warren S
机构信息
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
出版信息
Surg Innov. 2009 Sep;16(3):258-65. doi: 10.1177/1553350609339169. Epub 2009 Jul 3.
BACKGROUND
The authors describe a process improvement effort to achieve direct-from-recovery-room discharge for elective laparoscopic cholecystectomy patients--without prior patient selection.
METHODS
The authors developed and implemented a new pathway, and then measured the learning curve (ie, success rate over time for direct discharge) and compared patients achieving direct discharge with patients admitted after surgery.
RESULTS
The learning curve between the first patient and steady-state performance was 56 patients. A total of 80% of patients achieved direct discharge. Directly discharged patients were younger (P<.001), had lower ASA physical status classifications (P<.005), and left the recovery room earlier in the day (P<.0001). However, elderly patients and those with high ASA scores frequently could be directly discharged from the recovery room.
CONCLUSIONS
Through small team based rapid cycle process improvement, direct-from-recovery-room discharge of laparoscopic cholecystectomy patients can be achieved in an unselected patient population with a short learning curve.
背景
作者描述了一项流程改进措施，旨在实现择期腹腔镜胆囊切除术患者从恢复室直接出院——无需事先进行患者筛选。
方法
作者制定并实施了一条新路径，然后测量学习曲线（即直接出院随时间推移的成功率），并将实现直接出院的患者与术后入院的患者进行比较。
结果
从首例患者到达到稳定状态的学习曲线为56例患者。共有80%的患者实现了直接出院。直接出院的患者更年轻（P<0.001），美国麻醉医师协会（ASA）身体状况分级更低（P<0.005），且在当天更早离开恢复室（P<0.0001）。然而，老年患者和ASA评分高的患者也常常能够从恢复室直接出院。
结论
通过基于小团队的快速循环流程改进，在未筛选的患者群体中，腹腔镜胆囊切除术患者可实现从恢复室直接出院，且学习曲线较短。
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