2020—2022年某医院住院患者科间会诊现状分析

目的 探讨住院患者科间会诊现状及管理对策。方法 收集某医院2020—2022年住院患者科间会诊数据,分析科间会诊的影响因素。结果 2020—2022年全院住院患者共申请院内普通会诊201 058例,日均183.45例。申请数量最多的科室为急诊科、普外分中心、消化分中心、神经内科、心脏中心,且每年内科系统占比均高于外科系统。应邀院内普通会诊179 876例,日均164.12例。应邀数量最多的科室为心脏中心、消化分中心、内分泌科、普外分中心、内科教研室,且每年内科系统占比均高于外科系统。3年内全院会诊申请应答率和会诊及时率逐年提高,且每年内科系统会诊及时率均高于外科系统。结论 系统分析医疗机构会诊数据,掌握不同学科住院患者科间会诊的实际需求以及对会诊的态度,可为优化会诊服务流程、提升会诊服务效率和质量提供参考依据。     

应用六西格玛方法减少病人会诊等待时间

我院是台州市唯一一家三级甲等综合性医院，床位1100张，实际住院人数达1300人／天，平均住院日为13天。缩短平均住院日，提高工作效率，解决目前加床多、住院难的问题迫在眉睫。住院病人中，因患二种以上慢性病需要他科会诊的病人每日可达50人次，经初步调研统计，我院目前部分病人等待会诊时间超过10小时，延误了及时诊疗，严重影响了病人满意度。通过开展六西格玛项目，从优化工作流程出发，持续不断地改进，大大改善了会诊的及时性。     

完善院内会诊流程 提高临床医疗质量

随着医疗科学技术的飞快发展,临床专业越分越细,为促进医院进一步规范医疗行为,改善医疗服务,提高医疗质量,保障医疗安全,医院必须切实有效地提高会诊质量及会诊效率,优化会诊流程。医院利用工程学方法,精益管理,通过头脑风暴绘制鱼骨图,对原有手工流程进行缺陷分析,并针对各个环节,采用6σ方法进行优化流程设计,利用医院电子病历数字化平台,建立院内科间电子会诊系统,提高会诊及时性,提高会诊单的填写质量,加强了医院的动态监测和决策支持。     

六西格玛法在优化病理流程中的应用

目的缩短病理报告发放时间,降低医院平均住院日,提高患者满意度。方法采用六西格玛管理方法定义、统计、分析、改进、控制5个步骤优化病理报告收送流程,对流程前后再造前后效果进行评价。结果流程优化前后4个工作日内病理报告发出的比例由原来的67.0%提高到目前的91.2%,达到了预期目标。结论应用六西格玛管理方法缩短了病理报告发放时间,优化了病理报告发送流程,更新了医院管理理念。     

应用六西格玛管理缩短出院病人结算时间

六西格玛是以顾客需求为导向,以数据为基础改进的管理方法。护理人员应用六西格玛管理体系对病人出院流程进行定义、测量、分析、改进、控制,从而畅通出院流程,缩短出院病人结算时间,提高病人对医院满意度。     

精益六西格玛方法在患者TPR测量中的应用

目的：探讨应用精益六西格玛对 TPR 测量流程改造的效果研究。方法应用精益六西格玛 DMAIC 模型进行 TPR 测量流程改造,观察试点科室改进前后 TPR 测量时间、准确率、差错率等指标验证效果。结果改进前后 TPR 测量时间、准确率、差错率均有显著统计学差异（P ＜0．01）。结论运用精益六西格玛方法可有效提高 TPR 测量的效率和质量。     

基于精益六西格玛的医用耗材供配流程改造

目的:通过应用精益六西格玛管理理论改进医院医用耗材的流程,使医院的耗材成本、服务质量、服务效率达到最优状态.方法:应用改进的DMAIC Ⅱ法(定义—测量—分析—改进—控制)改造医院当前的耗材管理流程.结果:医院耗材管理流程改造成功实施,达到了预期目的.结论:精益六西格玛方法对手流程改造具有重大的指导性作用,可以考虑加以推广.     

综合性医院联络精神会诊291例分析

目的　对综合性医院联络精神会诊进行分析研究。方法　对一所综合性医院 2 91例住院病人联络精神会诊进行回顾分析 ,以了解联络精神会诊于综合性医院的应用情况。结果　邀请会诊的科室以内科最多 (4 3 3% ) ,会诊形式以普通会诊为主 (6 9 4 % ) ,躯体疾病伴发精神障碍要求协助诊治是会诊的主要原因 (4 4 3% )。非精神科医生对精神疾病普遍认识不够 ,对精神障碍的实际诊断率和诊断符合率偏低 ,分别为 5 1 9%和 35 6 % ,能于会诊前使用精神药物者仅 2 2 7%。结论　在综合性医院应大力开展联络精神会诊 ,这有利于提高精神科与非精神科医生的业务水平 ,全方位提高医院诊治病人的能力。     

运用六西格玛缩短扁桃体炎患者待术时间

目的:缩短慢性扁桃体炎手术的平均待术时间,加快床位周转,在一定程度上缓解病人住院难问题,同时提高医院及科室的经济效益和社会效益。方法:运用六西格玛管理工具中的定义、测量、分析、改进和控制5个步骤,对慢性扁桃体炎手术的待术时间进行分析,找出主要的影响因素,通过群策群力方法进行流程改进。结果:通过改进和控制,使慢性扁桃体炎手术的平均待术时间从原来的79.34小时下降到45.40小时。结论:六西格玛管理方法在医院的应用,体现了以病人为中心、着力解决病人住院难的问题;同时提高医疗服务质量、经济效益和社会效益。     

基于精细化管理理念的院内会诊及时性监管实践

会诊特别是院内会诊在日常医疗工作中的重要性日益凸显,及时有效的院内会诊,能减少临床误诊误治的发生,确保患者安全,真正意义上提升医疗服务水平。本文从提高会诊及时性出发,基于精细化管理理念,以所在医院2017年第四季度会诊原始数据为基础,通过数据收集和原因分析,提出了相应的改进措施。     

Integrating Six Sigma with total quality management: a case example for measuring medication errors

Six Sigma is a new management philosophy that seeks a nonexistent error rate. It is ripe for healthcare because many healthcare processes require a near-zero tolerance for mistakes. For most organizations, establishing a Six Sigma program requires significant resources and produces considerable stress. However, in healthcare, management can piggyback Six Sigma onto current total quality management (TQM) efforts so that minimal disruption occurs in the organization. Six Sigma is an extension of the Failure Mode and Effects Analysis that is required by JCAHO; it can easily be integrated into existing quality management efforts. Integrating Six Sigma into the existing TQM program facilitates process improvement through detailed data analysis. A drilled-down approach to root-cause analysis greatly enhances the existing TQM approach. Using the Six Sigma metrics, internal project comparisons facilitate resource allocation while external project comparisons allow for benchmarking. Thus, the application of Six Sigma makes TQM efforts more successful. This article presents a framework for including Six Sigma in an organization's TQM plan while providing a concrete example using medication errors. Using the process defined in this article, healthcare executives can integrate Six Sigma into all of their TQM projects.     

Ancillary services in the health care industry: is Six Sigma reasonable?

Within the naval medical center construct, the disparate disciplines encompassed within ancillary services lend themselves to formal quality analysis and process improvement. This analysis uses the Six Sigma approach. Error rates were investigated and calculated for various processes within ancillary services at Naval Medical Center, San Diego. These were translated into the common metric of defects per million opportunities (DPMO). DPMO rates vary between 21.5 and 420,000. These correspond to Sigma values from 1.7 to approaching 6. Rates vary with biological complexity of the system and the degree of automation available. Some ancillary services translate well into a Six Sigma schema. Systems with high potential patient risk if performed poorly and those amenable to second checking and computer oversight may be candidates for such optimization. This should be undertaken in a local environment conducive to individual error reporting, and in a corporate environment with the will and funding to support the transition.     

Six Sigma arises from the ashes of TQM with a twist

PURPOSE: This paper sets out to analyse the use of the Six Sigma methodology to improve quality in healthcare. It looks at how Six Sigma grew out of the concept of Total Quality Management (TQM). DESIGN/METHODOLOGY/APPROACH: Six Sigma is a quality improvement methodology that has been widely adopted by companies since the early 1990s and has grown exponentially in the healthcare industry during the past five years. Some of the main tenets of Six Sigma have emerged from the principles of TQM, including the notion that the entire organization must support the quality effort; that there should be a vigorous education effort; and that a quality improvement process should emphasize root cause analysis. FINDINGS: In spite of its early success, TQM "crashed and burned" for several reasons including the fact that financial benefits were difficult to assign to TQM efforts, root cause was not always determined resulting in recurring errors, there was no common metric to measure the level of quality attained, and quality efforts were sometimes aimed at processes or operations that were not critical to the customer. Six Sigma filled the vacuums created by these TQM failures in several ways. Under the Six Sigma methodology, quality improvement projects are carefully defined so that they can be successfully completed within a relatively short time frame. Financials are applied to each completed project so that management knows how much the project saves the institution. ORIGINALITY/VALUE: On each project, intense study is used to determine root cause analysis; and in the end, a metric known as "sigma level" can be assigned to signify the level of quality. Six Sigma has a "critical to quality" dimension that keeps the quality effort focused on improving only those things that really matter to the customer.     

六西格玛管理方法在医院管理中的应用

目的：通过有效的设备配件采购管理，在保证临床使用的前提下，既合理控制库存，又缩短设备配件采购时间。方法：通过六西格玛管理方法，对医院目前的医疗设备配件采购流程进行改进，找到设备配件采购的最佳方法。结果：设备配件采购时间平均缩短了10．5d。结论：改进前后两组医疗设备配件采购时间存在显著性差异，说明六西格玛管理方法对医院配件采购管理的流程改进非常有效。     

精益六西格玛在优化手术标本处理流程中的应用

目的优化手术标本处理流程。方法运用精益六西格玛,采用DMAIC改进模式,对影响手术标本处理流程的原因进行价值流图、鱼骨图、因果矩阵分析,找出10个关键因素,从流程再造、信息化管理、处理标准、规范化培训、监督管理等方面进行针对性改进。结果标本从离体到固定时间均值由213min缩短为3.1min,手术标本处理合格率由90.7%提高到96.0%。结论精益六西格玛的应用显著增强了医院质量管理的科学性,有效地优化了手术标本处理流程,促进了医院质量管理的标准化和规范化。     

精益六西格玛法在医疗废物管理中的应用

目的评价精益六西格玛法对某院医疗废物管理进行干预的效果。方法调查某三级甲等医院住院病区和手术室的医疗废物处理相关情况,并随机抽取13个住院病区作为试点。2014年12月—2015年3月为干预前,了解医疗废物管理现状的基线数据,2015年4—7月为干预后,利用精益六西格玛法规范医疗废物的分类、处置流程,并对改进效果进行评价。结果医疗废物处理费用影响因素分析结果表明,共有7项影响因素且呈4级递进结构,管理部门间职责不明确为根源层,从而导致医疗废物分类标准不统一,最终影响医疗废物处理的费用。试点病区和手术室的医疗废物分类合格率分别由干预前的69.22%、71.88%上升至干预后的80.42%、81.00%,差异均有统计学意义（均P＜0.01）;医疗废物重量试点病区由（1.11±0.14）kg/床日下降至（0.91±0.18）kg/床日,手术室由（10.77±0.33）kg/床日下降至（7.26±1.04）kg/床日,差异均有统计学意义（均P＜0.05）。效益成本比为6.09,即医院投入1元可以节省6.09元。结论通过精益六西格玛管理方法,可以有效降低每床日医疗废物重量和花费,具有一定的卫生经济学价值。     

三级医院科室综合评价指标体系的构建

目的构建基于岗位管理的三级医院临床科室综合评价指标体系。方法采用德尔菲法,对32名专家进行两轮有效函询,获得专家一致性意见,确立临床科室综合评价指标。结果两轮函询问卷有效回收率分别为94.12%、100%,最终构建的指标体系包含8个一级指标,64个二级指标。结论基于岗位管理的临床科室综合评价指标体系构建方法具有科学性,可为提升护理工作,实现目标化管理提供依据。     

六西格玛的发展及其应用

介绍了质量管理的发展之路,六西格玛与传统的质量管理方法的区别及通用电气公司在推广六西格玛中的作用.     

Six Sigma scale as a quality criterion for aggregation of food property measures

The EuroFIR (European Food Information Resource) quality management framework is a recent development to process standardization in data compilation for European Food Composition Data Banks. Data aggregation procedures taken from scientific literature as well as from analytical laboratory reports are still under discussion; however, the Six Sigma concept may be a useful approach, and therefore this work evaluates the concept. The Six Sigma approach was applied directly to analytical data taken from both laboratory reports and scientific literature. Sigma levels are calculated as indicators of laboratory test performance and the approach for data and laboratory selection is discussed. The results provide additional information on the quality of analytical data, allowing compilers and users to assess bias and imprecision for single and aggregate values. The Six Sigma approach is a complementary methodology to the quality methodologies already in use for data compilation processes and can be applied to further improve data quality.