Fernandes Darren, Eneje Philip
Basildon and Thurrock University Hospitals NHS Trust, United Kingdom.
BMJ Qual Improv Rep. 2017 Mar 20;6(1). doi: 10.1136/bmjquality.u212969.w5171. eCollection 2017.
The role of a junior doctor involves preparing for the morning ward round. At a time when there are gaps on rotas and doctors' time is more stretched, this can be a source of significant delay and thus a loss of working time. We therefore looked at ways in which we could make the ward round a more efficient place by introducing specific electronic, printed ward round proformas. We used the average time taken to write proformas per patient and the average time taken per patient on the ward round. This would then enable us to make fair comparisons with future changes that were made using the plan, do, study, and act principles of quality improvement. Our baseline measurement found that the average time taken to write up the proforma for each patient was 1 minute 9 seconds and that the average time taken per patient on the ward round was 8 minutes 30 seconds. With the changes we made during our 3 PDSA cycles and the implementation of an electronic, printed ward round proforma, we found that we were able to reduce the average time spent per patient on the ward round to 6 minutes 32 seconds, an improvement of 1 min 58 seconds per patient. The project has thus enabled us to reduce the time taken per patient during the ward round. This improved efficiency will enable patients to be identified earlier for discharge. It will also aid in freeing up the time of junior doctors, allowing them to complete discharge letters sooner, order investigations earlier and enable them to complete their allocated tasks within contracted hours.
初级医生的职责包括为晨间查房做准备。在排班存在空缺且医生时间更为紧张的情况下,这可能会导致严重延误,进而造成工作时间的损失。因此,我们研究了一些方法,通过引入特定的电子和纸质查房模板,使查房变得更高效。我们记录了为每位患者填写模板的平均时间以及查房时每位患者的平均用时。这样就能与未来依据质量改进的计划、执行、研究和行动原则所做的改变进行公平比较。我们的基线测量发现,为每位患者填写模板的平均时间是1分9秒,查房时每位患者的平均用时是8分30秒。通过在3个计划 - 执行 - 研究 - 改进(PDSA)循环中所做的改变以及实施电子和纸质查房模板,我们发现能够将查房时每位患者的平均用时减少到6分32秒,每位患者提高了1分58秒。该项目因此使我们减少了查房时每位患者所花费的时间。这种效率的提高将使患者能更早被确定可以出院。这也有助于腾出初级医生的时间,使他们能更快完成出院小结,更早安排检查,并使他们能够在规定时间内完成分配的任务。