Roberts Simon, Saithna Adnan, Bethune Rob
George Eliot Hospital.
BMJ Qual Improv Rep. 2015 Feb 27;4(1). doi: 10.1136/bmjquality.u206641.w2670. eCollection 2015.
Surgical departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. At a district general hospital in the west-midlands we approached the challenge of improving efficiency and optimising the services available in our orthopaedic theatres. Data was collected on: anaesthetic start times, operation start and finish times, and reasons for delay in our trauma theatre over a period from October 2014 to January 2015. During this period a change was implemented to improve the start time of the first operation of each day in the trauma theatre. Through adaptation of a method developed by Javed S et al, a patient was pre-selected by the on-call team and given the name the "golden patient" the day before they were due to be operated upon. This nominated patient would then be fixed at the start of the trauma theatre list the following day. The list would only then change if a "life or limb threatening" case was admitted overnight. The on-call team would prioritise that this patient was optimised for theatre and the theatre staff would ensure the surgical instruments were prepared. A PDSA cycle method was used, collecting data on 80 orthopaedic trauma cases during the period, and demonstrated a 59 minute (95% CI 45-72) improvement in start times from 10:49 AM to 9:50 AM with a p-value of 0.00024 with the intervention of early allocation of the first patient on the trauma list. A relatively simple intervention tool designed to improve communication within and between health-care teams can have a significant impact on the efficiency of a complex environment such as a trauma theatre.
外科科室面临着越来越大的压力，需要改善服务、缩短等候名单、提高效率并节省资金。在西米德兰兹郡的一家地区综合医院，我们着手应对提高骨科手术室效率和优化可用服务的挑战。收集了以下数据：2014年10月至2015年1月期间，创伤手术室的麻醉开始时间、手术开始和结束时间以及延迟原因。在此期间，实施了一项变革，以改善创伤手术室每天第一台手术的开始时间。通过采用Javed S等人开发的一种方法，值班团队预先选择一名患者，并在其预定手术前一天将其命名为“黄金患者”。然后，这名被提名的患者将被固定在次日创伤手术室手术名单的首位。只有在夜间有“危及生命或肢体”的病例入院时，名单才会更改。值班团队将优先确保该患者为手术做好充分准备，手术室工作人员将确保手术器械准备就绪。采用了计划-实施-检查-处理（PDSA）循环方法，在此期间收集了80例骨科创伤病例的数据，结果显示，通过提前分配创伤手术名单上的第一名患者，手术开始时间从上午10:49提前至上午9:50，改善了59分钟（95%置信区间45-72），p值为0.00024。一个旨在改善医疗团队内部及之间沟通的相对简单的干预工具，可能会对创伤手术室等复杂环境的效率产生重大影响。
