Koike Daisuke, Nomura Yukihiro, Nagai Motoki, Matsunaga Takashi, Yasuda Ayuko
Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan.
Total Quality Management Center, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan.
Int J Qual Health Care. 2020 Nov 9;32(8):522-530. doi: 10.1093/intqhc/mzaa074.
This study aimed to determine if introducing nontechnical skills to surgical trainees during surgical education can reduce the operation time and contribute to patient safety.
Quality improvement initiatives using the KAIZEN as a problem-solving method.
Department of surgery in a referral and educational hospital.
Surgical team and quality management team.
The KAIZEN was used as a problem-solving method between 2015 and 2018 to reduce the operation time. First, baseline measurement was performed to understand the current situations in our department. To achieve continuous improvement, periodical feedback of the current status was obtained from all staff. Bundles, including nontechnical skills, were established. Briefing and debriefing were performed by the surgical team.
Excessively long operation rates with a standard procedure.
We included 1573 operations in this initiative. Excessively long operation rates were reduced in all types of surgeries, from 27.1% to 15.2% for herniorrhaphy (P = 0.005), 58.3-40.0% for gastrectomy (P = 0.03), 50.0-4.1% for total gastrectomy (P = 0.12), 65.6-45.0% for colectomy (P = 0.004), 67.8-43.2% for high anterior resection (P = 0.02) and 69.6-47.9% for low anterior resection (P = 0.03). The adherence to briefing and debriefing were improved, and majority of the surgeons favored the bundle elements.
The KAIZEN initiative was effective in clinical healthcare settings. In the event of scaling-up this initiative, the educational program for physicians should include project management strategies and leadership skills.
本研究旨在确定在外科培训中向实习医生传授非技术技能是否能缩短手术时间并有助于患者安全。
采用持续改进法（KAIZEN）作为解决问题的方法开展质量改进举措。
一家转诊和教学医院的外科。
手术团队和质量管理团队。
2015年至2018年期间，采用持续改进法（KAIZEN）作为解决问题的方法来缩短手术时间。首先，进行基线测量以了解本部门的当前情况。为实现持续改进，从所有员工处获取当前状态的定期反馈。制定了包括非技术技能在内的一系列措施。手术团队进行术前简报和术后总结。
标准手术流程中过长手术率。
本项目纳入了1573例手术。所有类型手术的过长手术率均有所降低，疝修补术从27.1%降至15.2%（P = 0.005），胃切除术从58.3%降至40.0%（P = 0.03），全胃切除术从50.0%降至4.1%（P = 0.12），结肠切除术从65.6%降至45.0%（P = 0.004），高位前切除术从67.8%降至43.2%（P = 0.02），低位前切除术从69.6%降至47.9%（P = 0.03）。术前简报和术后总结的执行情况得到改善，大多数外科医生对一系列措施表示认可。
持续改进法（KAIZEN）举措在临床医疗环境中有效。在扩大该举措规模时，针对医生的教育项目应包括项目管理策略和领导技能。
