基于价值流程图的动脉瘤性蛛网膜下腔出血患者急诊术前院内流程现状分析

目的　通过对动脉瘤性蛛网膜下腔出血（aSAH）患者急诊术前院内流程的调查，分析出血性脑卒中患者院内流程现状，为流程优化提供直接依据。方法　采用目的抽样法，选取2017年10月—2018年2月在首都医科大学宣武医院经急诊入院治疗的aSAH 32例患者为研究对象。从患者到达急诊分诊台开始计时，直至进入手术室或介入中心终止，小组成员跟踪全过程，记录各环节时间。依据价值流程图的通用图标及记录的时间数据绘制患者急诊术前院内流程的价值流程图。结果　aSAH患者急诊术前院内工作时间为9~104 min，等待时间为6~3 658 min，总流程时间为15~3 762 min，入手术室或介入中心、家属参与决策、术前准备、办理入院、抽血送检的等待时间较长。结论　aSAH患者急诊术前院内流程存在较大改进空间，加强多学科合作、精细化管理、人性化服务、启动绿色通道等是优化aSAH患者急诊术前院内流程的关键措施。

Intrahospital Emergency Preoperative Procedure Analysis in Patients with Aneurysmal Subarachnoid Hemorrhage Based on Value Stream Mapping

Objective　To investigate and analyze the intrahospital emergency preoperative procedure in patients with aneurysmal subarachnoid hemorrhage（aSAH），providing a reference for the optimization of this procedure.Methods　We conducted this prospective observational study in a purposive sample of 32 cases of aSAH receiving emergency surgical treatment in Xuanwu Hospital Capital Medical University from October 2017 to February 2018.Our research group followed up the entire intrahospital receiving process which started since the arrival at the emergency triage and ended by entering the operating room or intervention center for receiving procedure，and recorded the duration of each sector of the process，and analyzed the process with a value stream mapping drawn with the standard symbols and the recorded data.Results　The overall serving time，overall waiting time before receiving procedure，duration for the entire intrahospital receiving process were 9-104 min，6-3 658 min，15-3 762 min，respectively.The waiting duration was found to be prolonged for 5 sectors，namely，entering the operating room or intervention center，decision-making involving the patient's family members，preoperative preparation，implementing admission procedures，blood sample collection and submission.Conclusion　There is great room for improving the intrahospital emergency preoperative procedure in aSAH patients.And close multidisciplinary cooperation，intensive management，patient-centered services，and green channel services are the key improvement measures.