Alfred Myrtede, Catchpole Ken, Huffer Emily, Taafe Kevin, Fredendall Larry
Adv Health Care Manag. 2019 Oct 24;18. doi: 10.1108/S1474-823120190000018008.
Achieving reliable instrument reprocessing requires finding the right balance among cost, productivity, and safety. However, there have been few attempts to comprehensively examine sterile processing department (SPD) work systems. We considered an SPD as an example of a socio-technical system - where people, tools, technologies, the work environment, and the organization mutually interact - and applied work systems analysis (WSA) to provide a framework for future intervention and improvement. The study was conducted at two SPD facilities at a 700-bed academic medical center servicing 56 onsite clinics, 31 operating rooms (ORs), and nine ambulatory centers. Process maps, task analyses, abstraction hierarchies, and variance matrices were developed through direct observations of reprocessing work and staff interviews and iteratively refined based on feedback from an expert group composed of eight staff from SPD, infection control, performance improvement, quality and safety, and perioperative services. Performance sampling conducted focused on specific challenges observed, interruptions during case cart preparation, and analysis of tray defect data from administrative databases. Across five main sterilization tasks (prepare load, perform double-checks, run sterilizers, place trays in cooling, and test the biological indicator), variance analysis identified 16 failures created by 21 performance shaping factors (PSFs), leading to nine different outcome variations. Case cart preparation involved three main tasks: storing trays, picking cases, and prioritizing trays. Variance analysis for case cart preparation identified 11 different failures, 16 different PSFs, and seven different outcomes. Approximately 1% of cases had a tray with a sterilization or case cart preparation defect and 13.5 interruptions per hour were noted during case cart preparation. While highly dependent upon the individual skills of the sterile processing technicians, making the sterilization process less complex and more visible, managing interruptions during case cart preparation, improving communication with the OR, and improving workspace and technology design could enhance performance in instrument reprocessing.
实现可靠的器械再处理需要在成本、生产率和安全性之间找到恰当的平衡。然而，很少有人尝试全面审视无菌处理部门（SPD）的工作系统。我们将一个SPD视为社会技术系统的一个例子——人员、工具、技术、工作环境和组织相互作用——并应用工作系统分析（WSA）来提供一个未来干预和改进的框架。该研究在一家拥有700张床位的学术医疗中心的两个SPD设施中进行，该中心为56个现场诊所、31个手术室（OR）和9个门诊中心提供服务。通过对再处理工作的直接观察和员工访谈绘制了流程图、进行了任务分析、构建了抽象层次结构并编制了方差矩阵，并根据由来自SPD、感染控制、绩效改进、质量与安全以及围手术期服务的8名员工组成的专家组的反馈进行了反复完善。进行的绩效抽样聚焦于观察到的特定挑战、病例推车准备过程中的中断以及对行政数据库中托盘缺陷数据的分析。在五项主要的灭菌任务（准备装载、进行双重检查、运行灭菌器、将托盘放入冷却区以及测试生物指示剂）中，方差分析确定了由21个绩效塑造因素（PSF）导致的16个故障，从而产生了9种不同的结果变化。病例推车准备涉及三项主要任务：存放托盘、挑选病例以及对托盘进行优先级排序。病例推车准备的方差分析确定了11种不同的故障、16种不同的PSF和7种不同的结果。大约1%的病例存在带有灭菌或病例推车准备缺陷的托盘，并且在病例推车准备过程中每小时会出现13.5次中断。虽然高度依赖无菌处理技术人员的个人技能，但使灭菌过程不那么复杂且更具可视性、管理病例推车准备过程中的中断、改善与手术室的沟通以及改进工作空间和技术设计可以提高器械再处理的绩效。
