Villarreal Monica C, Rostad Bradley S, Wright Richard, Applegate Kimberly E
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive NW, Atlanta, GA 30332.
Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
Acad Radiol. 2015 Dec;22(12):1579-86. doi: 10.1016/j.acra.2015.08.008. Epub 2015 Sep 28.
To identify and reduce reasons for delays in procedure start times, particularly the first cases of the day, within the interventional radiology (IR) divisions of the Department of Radiology using principles of continuous quality improvement.
An interdisciplinary team representative of the IR and preprocedure/postprocedure care area (PPCA) health care personnel, managers, and data analysts was formed. A standardized form was used to document both inpatient and outpatient progress through the PPCA and IR workflow in six rooms and to document reasons for delays. Data generated were used to identify key problems areas, implement improvement interventions, and monitor their effects. Project duration was 6 months.
The average number of on-time starts for the first case of the day increased from 23% to 56% (P value < .01). The average number of on-time, scheduled outpatients increased from 30% to 45% (P value < .01). Patient wait time to arrive at treatment room once they were ready for their procedure was reduced on average by 10 minutes (P value < .01). Patient care delay duration per 100 patients was reduced from 30.3 to 21.6 hours (29% reduction). Number of patient care delays per 100 patients was reduced from 46.6 to 40.1 (17% reduction). Top reasons for delay included waiting for consent (26% of delays duration) and laboratory tests (12%).
Many complex factors contribute to procedure start time delays within an IR practice. A data-driven and patient-centered, interdisciplinary team approach was effective in reducing delays in IR.
运用持续质量改进原则,识别并减少放射科介入放射学(IR)部门手术开始时间延迟的原因,尤其是当日的首例手术。
组建了一个跨学科团队,成员包括IR以及术前/术后护理区域(PPCA)的医护人员、管理人员和数据分析人员。使用标准化表格记录六个房间内患者在PPCA和IR工作流程中的住院和门诊进展情况,并记录延迟原因。所生成的数据用于识别关键问题领域、实施改进干预措施并监测其效果。项目持续时间为6个月。
当日首例手术按时开始的平均数量从23%增至56%(P值<0.01)。按时安排的门诊患者平均数量从30%增至45%(P值<0.01)。患者准备好接受手术后来到治疗室的等待时间平均减少了10分钟(P值<0.01)。每100名患者的护理延迟时长从30.3小时降至21.6小时(减少了29%)。每100名患者的护理延迟次数从46.6次降至40.1次(减少了17%)。延迟的主要原因包括等待同意(占延迟时长的26%)和实验室检查(占12%)。
IR实践中,手术开始时间延迟由许多复杂因素导致。以数据为驱动、以患者为中心的跨学科团队方法在减少IR延迟方面有效。