Baumgart André, Denz Christof, Bender Hans-Joachim, Schleppers Alexander
Department of Anesthesiology and Intensive Care, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Qual Manag Health Care. 2009 Oct-Dec;18(4):305-14. doi: 10.1097/QMH.0b013e3181bee2c6.
The complexity of the operating room (OR) requires that both structural (eg, department layout) and behavioral (eg, staff interactions) patterns of work be considered when developing quality improvement strategies. In our study, we investigated how these contextual factors influence outpatient OR processes and the quality of care delivered. The study setting was a German university-affiliated hospital performing approximately 6000 outpatient surgeries annually. During the 3-year-study period, the hospital significantly changed its outpatient OR facility layout from a decentralized (ie, ORs in adjacent areas of the building) to a centralized (ie, ORs in immediate vicinity of each other) design. To study the impact of the facility change on OR processes, we used a mixed methods approach, including process analysis, process modeling, and social network analysis of staff interactions. The change in facility layout was seen to influence OR processes in ways that could substantially affect patient outcomes. For example, we found a potential for more errors during handovers in the new centralized design due to greater interdependency between tasks and staff. Utilization of the mixed methods approach in our analysis, as compared with that of a single assessment method, enabled a deeper understanding of the OR work context and its influence on outpatient OR processes.
手术室的复杂性要求在制定质量改进策略时，既要考虑工作的结构模式（如科室布局），也要考虑行为模式（如工作人员的互动）。在我们的研究中，我们调查了这些背景因素如何影响门诊手术室的流程以及所提供护理的质量。研究地点是一家德国大学附属医院，每年进行约6000例门诊手术。在为期3年的研究期间，该医院将其门诊手术室设施布局从分散式（即手术室分布在大楼相邻区域）显著改为集中式（即手术室彼此紧邻）设计。为了研究设施变更对手术室流程的影响，我们采用了混合方法，包括流程分析、流程建模以及对工作人员互动的社会网络分析。设施布局的变更被认为会以可能对患者结局产生重大影响的方式影响手术室流程。例如，我们发现，由于新的集中式设计中任务和工作人员之间的相互依赖性更强，在交接过程中出现更多错误的可能性增加。与单一评估方法相比，我们在分析中使用混合方法能够更深入地了解手术室的工作环境及其对门诊手术室流程的影响。
