一种综合性基于单元的安全计划，旨在提高青少年特发性脊柱侧凸围手术期效率。
A Comprehensive Unit-based Safety Program to Improve Perioperative Efficiency in Adolescent Idiopathic Scoliosis.
机构信息
NewYork-Presbyterian Hospital.
Department of Orthopedics, Columbia University Irving Medical Center, New York, NY.
出版信息
J Pediatr Orthop. 2022 Mar 1;42(3):123-130. doi: 10.1097/BPO.0000000000001992.
BACKGROUND
Addressing operational inefficiencies in operating rooms (ORs) enhances patient access to care, reduces delays, and improves employee and patient satisfaction. The Comprehensive Unit-based Safety Program (CUSP) promotes patient safety through increased teamwork, empowerment of frontline staff, and utilization of science of safety principles. CUSP has demonstrated success in outpatient and inpatient settings to decrease complication rates and establish a culture of safety but has been used minimally in the perioperative setting. In this study, the CUSP methodology was utilized to improve perioperative efficiency in pediatric spine surgery, and preimplementation and postimplementation efficiency were compared, using the rate of first case on-time starts (FCOTS) as the primary metric.
METHODS
A CUSP quality improvement workgroup including nurses, technicians, surgeons, anesthesiologists, and administrators sought feedback on opportunities for improvement and tracked key performance metrics in the OR from 2015 to 2020. Key interventions developed in response to feedback included standardizing and streamlining room setup and adjusting staffing models for greater efficiency. Univariate analysis was conducted to compare time periods pre-CUSP and post-CUSP implementation.
RESULTS
First case on-time starts increased from 38% to a high of 81% after implementation. For more complex cases, the average patient in the room to anesthesia ready time improved by 31% with decreased variance over time, and average closure to patient out of room time improved by 45%. Improvements were sustained through Year 3, while CUSP remained a primary focus for the team.
CONCLUSIONS
CUSP is effective in enhancing perioperative efficiency, demonstrating strong improvement in on-time starts over 5 years. The results indicate that process improvement in ORs requires consistent attention to sustain gains over time. Engaging frontline staff in quality improvement fosters collaboration and provides employee buy-in to promoting a culture of safety and improving value in patient care.
LEVEL OF EVIDENCE
Level III-retrospective comparative study.
背景
提高手术室（OR）的运营效率可以增加患者获得护理的机会，减少延迟，并提高员工和患者的满意度。综合单位基础安全计划（CUSP）通过增强团队合作、赋予一线员工权力以及利用安全科学原则来促进患者安全。CUSP 已在外科门诊和住院环境中取得成功，以降低并发症发生率并建立安全文化，但在围手术期环境中使用较少。在这项研究中，CUSP 方法学被用于提高小儿脊柱手术的围手术期效率，并比较了实施前和实施后的效率，使用第一例手术按时开始（FCOTS）率作为主要指标。
方法
一个包括护士、技术人员、外科医生、麻醉师和管理人员的 CUSP 质量改进工作组征求了有关改进机会的反馈意见，并在 2015 年至 2020 年期间跟踪了 OR 中的关键绩效指标。针对反馈意见制定的关键干预措施包括标准化和简化房间设置以及调整人员配备模式以提高效率。进行了单变量分析以比较 CUSP 实施前后的时间段。
结果
实施后，第一例手术按时开始的比例从 38%提高到了 81%的高峰。对于更复杂的病例，房间到麻醉准备时间的平均患者时间提高了 31%，并且随着时间的推移方差减小，平均关闭到患者离开房间的时间提高了 45%。这些改进在第 3 年得以维持，而 CUSP 仍然是团队的主要关注点。
结论
CUSP 可有效提高围手术期效率，在 5 年内显著提高按时开始率。结果表明，手术室的流程改进需要持续关注，以保持随着时间的推移取得的收益。让一线员工参与质量改进可以促进协作，并使员工认同促进安全文化和改善患者护理价值的理念。
证据水平
三级-回顾性比较研究。
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