运用丰田生产方式缩短急性缺血性卒中静脉溶栓时间临床研究

目的 研究丰田生产方式（Toyota production system，TPS）缩短急性缺血性卒中患者入院至溶栓时间（door to needle time，DNT）和提高DNT≤60 min的比例。方法 收集2012年6月-2013年12月重组组织型纤溶酶原激活剂（recombinant tissue plasminogenactivator，rt-PA）静脉溶栓的急性缺血性卒中患者为对照组，2014年1月-2015年6月启用TPS改善溶栓流程后rt-PA静脉溶栓的急性缺血性卒中患者为实验组，比较两组患者DNT时间及DNT≤60 min比例。结果 研究共纳入对照组68例，实验组87例。对照组DNT平均（92.27±16.98）min，实验组DNT平均（63.52±11.86）mi n，两组有显著差异（P =0.002）。改善流程后DNT≤60 min的比例由对照组的6.11%提高到实验组的51.09%（P =0.001）。结论 通过组建TPS团队多学科合作进行溶栓流程改造，能够显著降低急性缺血性卒中rt-PA静脉溶栓的院内延误时间，缩短DNT，提高DNT≤60 min的比例。

Clinical Study of Using Toyota Production System to Shorten the Door-to-needle Time for Acute Ischemic Stroke

Objective To investigate using Toyota Production System (TPS) to shorten patients' door-to-needle time (DNT) and increase the proportion of patients with DNT≤60 minutes. Methods The patients with acute ischemic stroke who underwent recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis from June 2012 to December 2013 were taken as the control group, and the patients who were admitted from January 2014 to June 2015 via TPS formula were taken as the study group. The DNT time and the proportion of patients with DNT≤60 minutes were compared. Results The study included 68 patients in the control group and 87 patients in the study group. There was a significant statistical difference on the average DNT between the control group and the study group (P=0.002), and the average DNT in the control group and the study group were (92.27±16.98) minutes and (63.52±11.86) minutes respectively. The proportion of patients with DNT≤60 minutes was significantly increased from 6.11% to 51.09% (P=0.001). Conclusion Multi-discipline TPS team was helpful for optimizing process of administering thrombolytic therapy on acute ischemic stroke, reducing the delay time of rt-PA intravenous thrombolysis in the hospital, shortening DNT, and increasing the proportion of patients with DNT ≤60 minutes.