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Abstract：
In Ireland, the extent of outpatient orthopedic waiting lists results in long waiting times for patients, delays in processing referrals, and variation in the consultant caseload. At the study site, the Define, Measure, Analyze, Improve, and Control (DMAIC) Lean Six Sigma framework was applied to evaluate sources of Non-Value-Added (NVA) activity in the process of registering and triaging patients referred to the trauma orthopedic service from the Emergency Department. A pre- (October-December 2021)/post- (April-August 2022) intervention design was employed, utilizing Gemba, Process Mapping, and the TIMWOODS tool. Embracing a person-centered approach, stakeholder Voice of Customer feedback was sought at each stage of the improvement process. Following data collection and analysis, a co-designed pilot intervention (March 2022) was implemented, consisting of a new triage template, dedicated trauma clinic slots, a consultant triage roster, and a new option to refer directly to physiotherapy services. This resulted in the total wait time of patients for review being reduced by 34%, a 51% reduction in the process steps required for registering, and an increase in orthopedic consultant clinic capacity of 22%. The reduction in NVA activities in the process and the increase in management options for triaging consultants have delivered a more efficient trauma and orthopedic pathway.
摘要：
在爱尔兰,门诊骨科等候名单的范围导致患者等待时间长，处理转介的延迟，和顾问案件量的变化。在研究现场，定义，Measure,分析,改善,和控制（DMAIC）精益六西格玛框架被用于评估非增值（NVA）活动的来源，在注册和分诊急诊创伤骨科服务的患者的过程中。采用了前(2021年10月至12月)/后(2022年4月至8月)干预设计，利用Gemba,进程映射,和TIMWODS工具。拥抱以人为本的方法，利益相关者在改进过程的每个阶段都寻求客户反馈意见。在数据收集和分析之后，实施了一项共同设计的试点干预措施(2022年3月)，由一个新的分诊模板组成，专门的创伤诊所插槽，顾问分诊名册，以及直接参考物理治疗服务的新选择。这导致患者等待复查的总时间减少了34%，注册所需的流程步骤减少51%，骨科顾问诊所的能力增加了22%。在此过程中，NVA活动的减少和分类顾问管理选择的增加提供了更有效的创伤和骨科途径。
