目的探讨缩短危重患者从病房到重症监护室转运时间的护理管理方案。方法2015年11月至12月,实地调研普通病房转运至重症监护室抢救的30例危重患者,运用六西格玛DMAIC五步法,将转运流程细化为7个主流程及22个子流程,确定转运过程中的质量关键点,识别对患者安全转运产生影响的关键因素。提出改进措施为配置多功能危重患者转运车、设计危重患者转运重症监护室前核查表、增加危重患者转运小组、加强低年资护士培训、运用SBAR标准交接模式等。实施系列控制方案后,2016年5月至6月再次调查30例危重患者的转运资料。结果改进后,在不增加转运人员和确保患者安全的前提下,危重患者从病房至重症监护室的总转运时间显著缩短(t=15.052, P<0.001),抢救成功率从91.67%提高至98.01%。结论运用六西格玛DMAIC方法重建了危重患者从病房到重症监护室的转运流程,能有效缩短转运时间,提高抢救成功率。
ObjectiveTo shorten the transfer time of critical inpatients from wards to intensive care unit (ICU). MethodsFrom November to December, 2015, 30 critical inpatients transferred from wards to ICU were investigated, and analyzed with Six Sigma DMAIC five-step method. There were 7 main processes and 22 sub-processes refined in transfer procedure, as well as the key quality points and the factors influencing the safety of transferring. Some improvement advice were recommended, including multifunctional transfer cart, Checklist before Transfer to Intensive Care Unit for Critical Patients, setting up transport group, training for young nurses and application of SBAR communication. Other 30 critical inpatients transferred from wards to ICU, from May to June, 2016, after the series of control programs, were investigated. ResultsAfter improvement, the total transfer time from wards to ICU decreased (t=15.052, P<0.001), without the increase of human power and unsafety issues. The rescue success rate increased from 91.67% to 98.01%. ConclusionThe process transferring patient from wards to ICU has been reengineered based on Six Sigma DMAIC management, that reduces the time and improve the rescue success rate.
[1] 李小寒. 基础护理学[M]. 北京:人民卫生出版社, 2012.
[2] 廖志婕,古妙宁. 危重病人转运的危险因素及防范[J]. 麻醉与监护论坛, 2005, 12(6): 389-391.
[3] Fanara B, Manzon C, Barbot O, et al. Recommendations for the intra-hospital transport of critically ill patients [J]. Crit Care, 2010, 14(3): R87.
[4] Day D. Keeping patients safe during intrahospital transport [J]. Crit Care Nurse, 2010, 30(4): 18-32.
[5] Venkategowda PM, Rao SM, Mutkule DP, et al. Unexpected events occurring during the intra-hospital transport of critically ill ICU patients [J]. Indian J Crit Care Med, 2014, 18(6): 354-357.
[6] 金静芬,陈水红,邵林玲,等. 品质管理圈活动在危重病人转运中的应用[J]. 中华医院管理杂志, 2012, 28(1): 57-59.
[7] 赵伟英,Brendan G, 陈三妹,等. 危重患者安全转运的研究现状和展望[J]. 中华急诊医学杂志, 2013, 22(2): 219-221.
[8] 孙迟,吴洁华. 院内转运风险及其规避措施的研究进展[J]. 中华护理杂志, 2012, 47(11): 981-983.
[9] 牛佳,徐建萍,王乐. 国内外危重症病人院内转运指南比较[J]. 护理研究, 2016, 30(4): 1392-1394.
[10] 万林,施素华,孔悦,等. 危重患者院内转运的研究进展[J]. 中华护理杂志, 2016, 51(8): 975-978.
[11] Thornsett MC. Getting Started in Six Sigma [M]. New York: John Wiley & Sons, 2005.
[12] 张琦,陈兴宝. 六西格玛模式在医院管理中的应用[J]. 中国卫生事业管理, 2004, 20(4): 245-247.
[13] 周睿,李勇,王清涛. 以六西格玛方法提升临床实验室检验效率[J]. 中华检验医学杂志, 2013, 36(5): 457-460.
[14] 徐润琳,罗万军,王文娟,等. 应用六西格玛管理方法控制多药耐药菌医院感染[J]. 中华医院感染学杂志, 2014, 24(2): 495-497.
[15] 王爱卿,刘瑞云,陶左荷. 头脑风暴法在护理质量控制活动中的应用[J]. 护理研究, 2014, 28(5C): 1898-1899.
[16] 王宁. 医疗失效模式与效应分析在急诊危重患者院内转运中的应用[J]. 护理管理杂志, 2013, 12(2): 119-120.
[17] DeRosier J, Stalhandske E, Bagian JP, et al. Using health care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system [J]. Comm J Qual Improv, 2002, 28(5): 248-267,209.
[18] 赵华,耿希华. 无缝隙交接班流程在ICU危重患者中的应用[J]. 齐鲁护理杂志, 2014, 20(7): 44-46.
[19] 王斌,刘婷. 急诊重度颅脑损伤患者院内转运中的无缝隙对接[J]. 中华护理杂志, 2015, 50(2): 246-247.
[20] Ting WH, Peng FS, Lin HH, et al. The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department [J]. Taiwan J Obstet Gynecol, 2017, 56(2): 171-174.
[21] 丁力陆,婷婷,邹婷婷. 标准化沟通方式在神经外科重症监护室患者转出交接中的应用[J]. 中华护理杂志, 2012, 47(7): 627-629.
[22] 余新颖,张妙冉,杨霞. SBAR模式转运交接单在危重患者院内转运中的应用[J]. 护士进修杂志, 2016, 31(8): 1366-1368.
[23] 徐双燕,姚梅琪,周海燕. 标准化沟通方式在医护间沟通中的应用[J]. 中华护理杂志, 2012, 47(1): 48-49.
[24] Rishu AH, Aldawood AS, Haddad SH, et al. Demographics and outcomes of critically ill patients transferred from other hospitals to a tertiary care academic referral center in Saudi Arabia [J]. Ann Intensive Care, 2013, 3(1): 26-34.
[25] 张美,李广罡. 便携式呼吸机在危重患者院内转运中的应用[J]. 中国医学装备, 2012, 9(10): 76-77.
[26] 许晓萍,陈毅文,陈艺延. 急危重症患者院内安全转运路径的建立与实施[J]. 护理学杂志, 2012, 27(7): 11-14.
[27] 朱亚丽,徐琴,孙岚. 便携式呼吸机在危重患者院内安全转运中的应用[J]. 蚌埠医学院学报, 2016, 41(1): 120-122.
[28] Jones HM, Zychowicz ME, Champagne M, et al. Intrahospital transport of the critically ill adult: a standardized evaluation plan [J]. Dimens Crit Care Nurs, 2016, 35(3): 133-146.
