Division of Transfusion Medicine, Department of Pathology, the Center for Innovation in Quality Patient Care, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Transfusion. 2010 Sep;50(9):1887-96. doi: 10.1111/j.1537-2995.2010.02679.x.
Red blood cell (RBC) product wastage in hospitals is reported to range from 0.1% to 6.7%. Wastage at our institution averaged 4.4% of 63,000 issued RBC products. Data indicated that approximately 87% of wasted RBC units were either individual units that were out of blood bank for more than 30 minutes (dispensed but not administered) or units packed in transport containers that had temperature indicators affixed to each unit. We hypothesized that Lean Sigma methodology could be used to reduce RBC wastage by 50%.
An interdisciplinary hospital team (transfusion medicine, nursing, and anesthesiology) used Lean Sigma methodology as a tool to reduce RBC product wastage, with a focus on container wastage, which was determined to yield the largest impact. Using the five-part Lean Sigma process-define, measure, analyze, improve, and control-the team collected baseline wastage data, identified major factors affecting RBC product wastage, and implemented interventions to reduce amount of wastage.
Factors identified as contributors to RBC wastage most amenable to improvement were lack of awareness and training of staff ordering and handling RBC products, management of temperature-validated containers, inconsistent interpretation of RBC temperature indicators, and need for accountability when ordering blood products. Overall RBC product wastage decreased from 4.4% to a sustained rate of less than 2%. This reduction decreased the number of RBC units wasted by approximately 4300 per year, savings approximately $800,000 over the 4-year period of the study.
Lean Sigma methodology was an effective tool for reducing RBC wastage in a large academic hospital.
据报道，医院的红细胞（RBC）产品浪费率在 0.1%至 6.7%之间。我们机构的浪费率平均占发放的 63000 个 RBC 产品的 4.4%。数据表明，大约 87%的浪费 RBC 单位要么是在血库外超过 30 分钟的单个单位（已分发但未使用），要么是包装在运输容器中的单位，每个单位都附有温度指示器。我们假设精益西格玛方法可以将 RBC 浪费减少 50%。
一个跨学科的医院团队（输血医学、护理和麻醉学）使用精益西格玛方法作为工具来减少 RBC 产品的浪费，重点是容器浪费，这被确定为产生最大影响的因素。该团队使用精益西格玛的五个部分流程-定义、测量、分析、改进和控制-收集了基线浪费数据，确定了影响 RBC 产品浪费的主要因素，并实施了干预措施来减少浪费量。
确定为 RBC 浪费的促成因素最适合改进的因素是员工对 RBC 产品的订购和处理缺乏意识和培训、温度验证容器的管理、对 RBC 温度指示器的不一致解释以及在订购血液制品时需要问责制。总体 RBC 产品浪费从 4.4%降至持续低于 2%的水平。这一减少使每年浪费的 RBC 单位数量减少了约 4300 个，在研究的 4 年期间节省了约 80 万美元。
精益西格玛方法是减少大型学术医院 RBC 浪费的有效工具。
