Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
Ann Thorac Surg. 2019 Apr;107(4):1011-1016. doi: 10.1016/j.athoracsur.2018.11.071. Epub 2019 Jan 7.
Prolonged operating room turnover time erodes patient and employee satisfaction and value.
Lean and value stream mapping was applied to three operating room teams at an academic health center in New York City, and a solution called Performance Improvement Team (PIT Crew) was piloted.
Overall, 10% of operating room turnover steps were considered nonvalued and were eliminated, and 25% of previously sequential steps were performed synchronously. Seven institutional dogmas were eliminated, and three hospital policies were changed. After 35 pilot turnovers, median operating room turnover time improved from 37 minutes (range, 26 to 167 minutes) in historic matched controls to 14 minutes (range, 10 to 45 minutes, p < 0.0001) for the PIT Crew. Cost of the PIT Crew was $1,298 daily, and estimated return on investment was $19,500 per day.
Lean and value stream mapping identifies nonvalued steps in operating room turnover and affords opportunities for efficiency. Once institutional rules and dogma are changed, culture and workflow improve and turnover time substantially improves. This process adds cost but is profitable. Scalability and sustainability are under further study, as is the "halo effect" on the culture in other non-PIT Crew operating rooms.
手术室交接时间延长会降低患者和员工的满意度和价值。
在纽约市一家学术医疗中心的三个手术室团队中应用精益和价值流映射，并试行名为“绩效改进团队（PIT Crew）”的解决方案。
总体而言，10%的手术室交接步骤被认为是无价值的，并被删除，25%的先前顺序步骤被同步执行。消除了 7 个医院传统观念，改变了 3 项医院政策。在 35 次试点交接后，PIT Crew 的手术室交接时间中位数从历史匹配对照组的 37 分钟（范围，26 至 167 分钟）改善至 14 分钟（范围，10 至 45 分钟，p<0.0001）。PIT Crew 的每日成本为 1298 美元，估计投资回报率为每天 19500 美元。
精益和价值流映射可识别手术室交接中的无价值步骤，并提供提高效率的机会。一旦改变了医院的规则和传统观念，文化和工作流程就会得到改善，交接时间也会大大缩短。这个过程会增加成本，但却是盈利的。正在进一步研究可扩展性和可持续性，以及对其他非 PIT Crew 手术室的“光环效应”。
