運用精實理論提升某醫學中心急診室檢體送檢達成率

The Application of Lean Production Theory to Improve Success Rates of Emergency Room Specimens Delivery in a Medical Center

10.6320/FJM.202105_25(3).0012

葉佩萱(Pei-Hsuan Yeh)；劉玉香(Yu-Hsiang Liu)；廖秋萍(Chiu-Ping Liao)；張志華(Chee Fah Chong)

精實理論 ； 檢體送檢達成率 ； 急診室 ； lean theory ； success rates of delivery specimens ； emergency room

台灣醫學

25卷3期（2021 / 05 / 25）

394 - 402

繁體中文

本急診室於2017年11月1日至2018年2月28日檢體採檢至檢驗報告完成時間為100分鐘15秒，較本院標準作業流程規定時間延遲40分鐘15秒，檢驗報告60分鐘時效達成率為63.8％。運用精實理論導入檢體檢驗作業流程，分析歸納送檢逾時原因，擬定出解決方案，安排專責檢體傳送員並製作背心、製作急診專用顏色檢體傳送袋、推動檢驗單張無紙化、檢體改為每15分鐘送檢、設置超高遠離心機，有效提升檢體20分鐘內送檢時效達成率由46.90％提升至91.2％，急件檢體40分鐘檢驗時效達成率由86.2％提升至100％，檢驗報告60分鐘達成率由63.8％提升至95.2％，有效縮短病人檢驗報告時效，提升病人就醫品質及安全性。

The average time from collecting the samples to completion of laboratory reports in our emergency room (ER) was 100 min. 15 sec. between November 1^(st), 2017 to February 28th, 2018. It was 40 min. 15 sec. longer than standard time allowance compared to our protocol. The timely report rate within 60 minutes was 63.8%. By introducing lean production theory into specimen examination workflow, we analyzed the cause of delaying specimen delivery, formulated solutions which included assigning specific staff wearing special uniform vest to deliver the specimen, making specimen delivery pouches with ER-specific color, promoting paperless laboratory services, increasing the frequency of ER-to-laboratory specimen delivery to every 15 minutes, and installing ultracentrifuge in the clinical laboratory. The achievement rate to deliver the specimen within 20 minutes from collection improved from 46.9% to 91.2%. The laboratory could complete the examination within 40 minutes after receiving the specimen in 100% of cases, compared to 86.2% previously. In 95.2% of the cases, the laboratory examination could be completed within 60 minutes from ER specimen collection, which was 63.8% before the modification of workflow. We shortened the waiting time of laboratory examination and improved the quality and safety of medical care.

1. Rees GH, Gauld R. Can lean contribute to work intensification in healthcare? J Health Organ Manag 2017;31:369-84.
   連結：
2. 劉憲義：從5S到目視化管理提升公司管理效能。品質月刊2012;48:43-52。
   連結：
3. Charles Kenney. Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience, America, Productivity Press, 2014:297-313.
4. 高智雄、許琳偵、嚴雯馨：以精實原則與時間動作研究，改善急件檢驗報告時效。生物醫學暨檢驗雜誌2015;27:48-60。
5. 胡瑋珊(譯)(2011)。精實醫療 Lean Hospitals : Improving Quality, Patient Safety, and Employee Satisfaction, CRC Press(原作者：Graban, M.)。台北市：財團法人中衛發展中心。(原著出版年：2009年)