某医院影响手术开台时间的三方原因分析

目的探讨量化手术医师、麻醉师和手术室护士三方在9:00以后刀碰皮手术中责任的方法。方法本轮调查开台手术147台,41%在9:00以后刀碰皮,较第一轮有所降低。根据第一轮改进建议的规则,以科室分别计算三方在第二轮9:00以后刀碰皮手术的未完成率,并转换为三方因素的构成比。结果全院9:00以后刀碰皮手术比例较第一轮降低32%。不同科室9:00以后刀碰皮手术中三方构成比不同:手术医师因素在骨科最大,血管外科最小;麻醉师因素在血管外科最大,妇产科最小,疼痛科不受影响;护士因素在疼痛科最大,骨科最小。结论通过成因构成比的分析,可以比较客观地计算出三方在9:00以后开台手术中的责任比例,为该工作持续改进和领导决策奠定了基础。

Cause Analysis of delaying beginning time of Surgery in a Hospital

Objective This article attempt to quantify tripartite responsibility of surgeons, anesthetists and operating room nurses in after- 9 o＇clock actual surgery. Methods This survey included 147 units of the first-operation of the day, of which 41% started later than 9：00, decreased over the first round survey. According to the rules proposed in the first round survey, unfinished rate and conversion constituent ratio of the tripartite factors in different department were calculated. Results The number of surgery started later than 9：00 was decreased than the first round survey by 32%. In different departments, tripartite constitute ratio of the cause was different in later-than- 9：00 surgery, for example, related factor involved surgeon was biggest in orthopaedics operations and smallest in vascular operations. Factor involved anesthetists was biggest in vascular operations and smallest in gynaecology and obstet- rics operations. Factor involved nurses was biggest in pain management operations and smallest in orthopaedics operations. Conclusion a constituent ratio analysis can be more objective to calculate the proportion of the responsibility of the tripartite after 9：00 o＇ clock surgery, meantime, to laid the foundation for continuous improvement and leadership decision-making.