Ajdari Ali, Boyle Linda Ng, Kannan Nithya, Rowhani-Rahbar Ali, Wang Jin, Mink Richard, Ries Benjamin, Wainwright Mark, Groner Jonathan I, Bell Michael J, Giza Chris, Zatzick Douglas F, Ellenbogen Richard G, Mitchell Pamela H, Rivara Frederick P, Vavilala Monica S
J Healthc Qual. 2017 Nov/Dec;39(6):334-344. doi: 10.1097/JHQ.0000000000000052.
In the treatment of pediatric traumatic brain injury (TBI), timely treatment of patients can affect the outcome. Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.
Data for 136 pediatric trauma patients (age < 18 years) with severe TBI from 2 trauma centers in the United States were collected. A process flow and value stream map identified NVATs and their sources in the treatment process. Cluster and regression analysis were used to examine the relationship between NVAT, as a percentage of the patient's length of stay (LOS), and the patient outcome, measured by their corresponding Glasgow outcome scale.
There were 14 distinct sources of NVAT identified. A regression analysis showed that increased NVAT was associated with less favorable outcomes (relative ratio = 1.015, confidence interval = [1.002-1.029]). Specifically, 1% increase in the NVAT-to-LOS ratio was associated with a 1.5% increase in the chance of a less favorable outcome (i.e., death or vegetative state).
The NVAT has a significant impact on the outcome of pediatric TBI, and every minute spent on performing non-value-added processes can lead to an increase in the likelihood of less favorable outcomes.
在小儿创伤性脑损伤（TBI）的治疗中，及时治疗患者会影响治疗结果。我们的目标是研究急性小儿TBI的治疗过程以及非增值时间（NVAT）对患者治疗结果的影响。
收集了来自美国2个创伤中心的136例年龄小于18岁的重度TBI小儿创伤患者的数据。通过流程和价值流图确定了治疗过程中的NVAT及其来源。采用聚类和回归分析来研究NVAT（占患者住院时间（LOS）的百分比）与患者治疗结果之间的关系，治疗结果通过相应的格拉斯哥预后量表来衡量。
共确定了14个不同的NVAT来源。回归分析表明，NVAT增加与较差的治疗结果相关（相对比率=1.015，置信区间=[1.002 - 1.029]）。具体而言，NVAT与LOS的比率每增加1%，较差治疗结果（即死亡或植物状态）的几率增加1.5%。
NVAT对小儿TBI的治疗结果有显著影响，在执行非增值流程上花费的每一分钟都会导致较差治疗结果的可能性增加。
