提高围手术期绩效：运用运营管理和电子健康记录。
Improving perioperative performance: the use of operations management and the electronic health record.
机构信息
Children's Medical Center Dallas, Department of Pediatric Surgery, University of Texas Southwestern, Dallas, TX 75235, USA.
出版信息
J Pediatr Surg. 2013 Jan;48(1):95-8. doi: 10.1016/j.jpedsurg.2012.10.022.
PURPOSE
Perioperative services require the orchestration of multiple staff, space and equipment. Our aim was to identify whether the implementation of operations management and an electronic health record (EHR) improved perioperative performance.
METHODS
We compared 2006, pre operations management and EHR implementation, to 2010, post implementation. Operations management consisted of: communication to staff of perioperative vision and metrics, obtaining credible data and analysis, and the implementation of performance improvement processes. The EHR allows: identification of delays and the accountable service or person, collection and collation of data for analysis in multiple venues, including operational, financial, and quality. Metrics assessed included: operative cases, first case on time starts; reason for delay, and operating revenue.
RESULTS
In 2006, 19,148 operations were performed (13,545 in the Main Operating Room (OR) area, and 5603, at satellite locations); first case on time starts were 12%; reasons for first case delay were not identifiable; and operating revenue was $115.8M overall, with $78.1M in the Main OR area. In 2010, cases increased to 25,856 (+35%); Main OR area increased to 13,986 (+3%); first case on time starts improved to 46%; operations outside the Main OR area increased to 11,870 (112%); case delays were ascribed to nurses 7%, anesthesiologists 22%, surgeons 33%, and other (patient, hospital) 38%. Five surgeons (7%) accounted for 29% of surgical delays and 4 anesthesiologists (8%) for 45% of anesthesiology delays; operating revenue increased to $177.3M (+53%) overall, and in the Main OR area rose to $101.5M (+30%).
CONCLUSIONS
The use of operations management and EHR resulted in improved processes, credible data, promptly sharing the metrics, and pinpointing individual provider performance. Implementation of these strategies allowed us to shift cases between facilities, reallocate OR blocks, increase first case on time starts four fold and operative cases by 35%, and these changes were associated with a 53% increase in operating revenue. The fact that revenue increase was greater than case volume (53% vs. 35%) speaks for improved performance.
目的
围手术期服务需要协调多个人员、空间和设备。我们的目的是确定是否实施运营管理和电子病历（EHR）可以改善围手术期的绩效。
方法
我们比较了 2006 年（运营管理和 EHR 实施前）和 2010 年（实施后）的数据。运营管理包括：向工作人员传达围手术期愿景和指标，获取可信数据和分析结果，并实施绩效改进流程。EHR 允许：识别延迟的原因和负责的服务或人员，收集和整理多个场所（包括运营、财务和质量）的数据进行分析。评估的指标包括：手术例数、第一例按时开始；延迟原因，以及手术收入。
结果
2006 年，共进行了 19148 例手术（主手术室（OR）区域 13545 例，卫星地点 5603 例）；第一例按时开始的比例为 12%；无法确定第一例延迟的原因；手术总收入为 11.58 亿美元，主 OR 区域为 7.81 亿美元。2010 年，手术例数增加到 25856 例（增加 35%）；主 OR 区域增加到 13986 例（增加 3%）；第一例按时开始的比例提高到 46%；主 OR 区域以外的手术增加到 11870 例（增加 112%）；手术延迟归因于护士 7%、麻醉师 22%、外科医生 33%和其他（患者、医院）38%。5 名外科医生（7%）占手术延迟的 29%，4 名麻醉师（8%）占麻醉延迟的 45%；手术总收入增加到 17.73 亿美元（增加 53%），主 OR 区域增加到 10.15 亿美元（增加 30%）。
结论
使用运营管理和 EHR 可改善流程、获取可信数据、及时共享指标，并确定个体提供者的绩效。实施这些策略使我们能够在设施之间转移病例、重新分配 OR 块、将第一例按时开始的比例提高四倍并增加手术例数 35%，这些变化与手术收入增加 53%相关。收入增长大于病例量（53% 与 35%）的事实表明绩效得到了改善。
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