Divisions of Pediatric Gastroenterology, Hepatology and Nutrition and.
Pediatrics. 2014 Feb;133(2):e428-33. doi: 10.1542/peds.2013-2316. Epub 2014 Jan 20.
Pediatric endoscopic procedures are essential in the evaluation and treatment of gastrointestinal diseases in children. Although pediatric endoscopists are greatly interested in increasing efficiency and through-put in pediatric endoscopy units, there is scarcely any literature on this critical process. The goal of this study was to improve the timeliness of pediatric endoscopy procedures at Children's Hospital at Montefiore.
In June 2010, a pediatric endoscopy quality improvement initiative was formed at Children's Hospital at Montefiore. We identified patient-, equipment-, and physician-related causes for case delays. Pareto charts, cause and effect diagrams, process flow mapping, and statistical process control charts were used for analysis.
From June 2010 to December 2012, we were able to significantly decrease the first case endoscopy delay from an average of 17 to 10 minutes (P < .001), second case delay from 39 to 25 minutes (P = .01), third case delay from 61 to 45 minutes (P = .05), and fourth case delay from 79 to 51 minutes (P = .05). Total delay time decreased from 196 to 131 minutes, resulting in a reduction of 65 minutes (P = .02). From June 2010 to August 2011 (preintervention period), an average of 36% of first endoscopy cases started within 5 minutes, 51% within 10 minutes, and 61% within 15 minutes of the scheduled time. From September 2011 to December 2012 (postintervention period), the percentage of cases starting within 5 minutes, 10 minutes, and 15 minutes increased to 47% (P = .07), 61% (P = .04), and 79% (P = .01), respectively.
Applying quality improvement methods and tools helped improve pediatric endoscopy timeliness and significantly decreased total delays.
儿科内镜检查在儿童胃肠道疾病的评估和治疗中至关重要。尽管儿科内镜医生非常关注提高儿科内镜检查单位的效率和吞吐量，但几乎没有关于这一关键过程的文献。本研究的目的是提高蒙特菲奥雷儿童医院的儿科内镜检查的及时性。
2010 年 6 月，在蒙特菲奥雷儿童医院成立了一个儿科内镜质量改进倡议。我们确定了导致病例延迟的患者、设备和医生相关原因。我们使用帕累托图、因果图、流程映射和统计过程控制图进行分析。
从 2010 年 6 月至 2012 年 12 月，我们能够显著减少首例内镜检查的延迟，从平均 17 分钟减少到 10 分钟（P<.001），第二例延迟从 39 分钟减少到 25 分钟（P=.01），第三例延迟从 61 分钟减少到 45 分钟（P=.05），第四例延迟从 79 分钟减少到 51 分钟（P=.05）。总延迟时间从 196 分钟减少到 131 分钟，减少了 65 分钟（P=.02）。从 2010 年 6 月至 2011 年 8 月（干预前），平均有 36%的首例内镜检查在预定时间的 5 分钟内开始，51%在 10 分钟内开始，61%在 15 分钟内开始。从 2011 年 9 月至 2012 年 12 月（干预后），5 分钟、10 分钟和 15 分钟内开始的病例比例分别增加到 47%（P=.07）、61%（P=.04）和 79%（P=.01）。
应用质量改进方法和工具有助于提高儿科内镜检查的及时性，并显著减少总延迟。
