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运用质量改进降低输液诊所等候时间。

Reducing Infusion Clinic Wait Times Using Quality Improvement.

机构信息

Birmingham VA Medical Center, Birmingham, AL.

出版信息

JCO Oncol Pract. 2020 Aug;16(8):e807-e813. doi: 10.1200/JOP.19.00643. Epub 2020 Mar 6.

Abstract

PURPOSE

Long wait times are a common occurrence for chemotherapy infusion patients and are a source of decreased patient satisfaction. Our facility sought to decrease outpatient infusion clinic wait times by 20% using the Model for Improvement, quality improvement tools, and Plan-Do-Study-Act cycles.

METHODS

A multidisciplinary team was formed to address clinic wait times. Patient interviews, time studies, process mapping, brainstorming sessions, affinity diagrams, fishbone diagrams, and surveys were used to define the problem and to develop an intervention. Wait times from check-in until medication administration were analyzed using statistical process control charts. Our Plan-Do-Study-Act cycle led to the addition of a "fast-track" clinic title for patients not waiting for laboratory results on the day of treatment and changes in clinic communication. The fast-track clinic signaled for those patients to have priority for vital sign collection and earlier notification to pharmacy to begin preparing medications.

RESULTS

Baseline wait times for patients not requiring laboratories on the day of treatment averaged 1 hour and 33 minutes. After intervention, using statistical process control charts, a shift was observed with a new average wait time of 1 hour and 12 minutes (a 23% decrease). Wait times for patients requiring laboratories on the day of treatment did not change significantly.

CONCLUSION

Implementation of a fast-track clinic title and improving communication resulted in a significant reduction in wait times for patients not requiring laboratories on the day of treatment. Future efforts will focus on sustainment and improving wait times for all patients.

摘要

目的

化疗输注患者经常需要长时间等待,这导致患者满意度降低。我们的机构旨在使用改进模型、质量改进工具和计划-执行-研究-行动循环将门诊输注诊所的等待时间缩短 20%。

方法

成立了一个多学科团队来解决门诊等待时间的问题。患者访谈、时间研究、流程映射、头脑风暴会议、亲和图、鱼骨图和调查用于定义问题并制定干预措施。使用统计过程控制图分析从登记到给药的等待时间。我们的计划-执行-研究-行动循环导致为当天不需要实验室结果的患者添加了“快速通道”诊所名称,并改变了诊所沟通方式。快速通道诊所表示这些患者优先进行生命体征采集,并提前通知药剂师开始准备药物。

结果

当天不需要实验室的患者的基线等待时间平均为 1 小时 33 分钟。干预后,使用统计过程控制图观察到一个新的平均等待时间为 1 小时 12 分钟(减少 23%)的转变。当天需要实验室的患者的等待时间没有明显变化。

结论

实施快速通道诊所名称并改善沟通,显著缩短了当天不需要实验室的患者的等待时间。未来的工作重点将放在维持和缩短所有患者的等待时间上。

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