背景:精益方法已在工业和医疗保健中成功使用,以减少浪费。手术室(OR)和中央供应部(CSD)是与高医院费用相关的区域。这项研究的目的是采用精益方法来支持儿科腹股沟阴囊手术中手术托盘的合理化,以减少器械浪费。欧洲环境中的处理时间和总成本。
方法:这是一个前瞻性的,使用包括DMAIC(定义,Measure,分析,改进和控制)周期。相关的托盘设置包括接受开放式选择性腹股沟手术的年龄≥12个月的男孩的托盘。两个阶段的比较分析,然后就操作时间进行了标准化前和标准化后,仪器设置时间,托盘重量,和成本。使用时间<40%的器械从手术托盘中取出。
结果:腹股沟腹盘的合理化导致托盘尺寸减少了34.7%,伴随着每个病例>2分钟的时间减少。用户的平均整体仪器利用率从56%增加到80%。根据目前的变化,预计每年节省5380.40欧元。手术时间没有差异,或不良后果。
结论:在医院层面,变异的减少,和合理化这个单一的手术托盘可以导致操作(托盘组装过程;手术室;人体工程学功能)以及经济(消毒;仪器维修;购买)财务和人体工程学的医疗保健系统的改进。计数和消毒仪器所需时间的减少可以导致潜在的人力节省,包括将活动重新分配到可能需要它们的其他区域。
结论:外科托盘合理化是新兴的精益概念,在许多专业中重叠,代表了一种管理成本的技术,并提高供应链效率,而不会对患者的医疗保健结果产生任何不利影响。
Lean methodologies have been used successfully in both industry and healthcare to reduce waste. The operating room (OR) and central supplies department (CSD) are areas associated with high hospital costs. The aim of this study was to employ
Lean methodologies to support the rationalisation of surgical trays in paediatric inguinoscrotal surgery in order to reduce instrument wastage, processing times and overall costs in a European setting.
This was a prospective, pilot observation and implementation study using
Lean methodology including DMAIC (Define, Measure, Analyse, Improve and Control) cycles. Relevant tray set-up included trays for boys ≥12 months age undergoing open elective inguinoscrotal surgery. A comparative analysis of two phases, pre and post-standardization was then carried out with respect to operating times, instrument set-up times, tray weights, and costs. Instruments that were used <40% of the time were eliminated from the surgical tray.
Rationalization of the inguinoscrotal tray led to a 34.7% reduction in tray size, with a concomitant time-reduction of >2 min per
case. The average overall instrument utilisation rate increased from 56% to 80% across users. Cost savings were projected at €5380.40 per annum based on current changes. There were no differences in operative time, or adverse outcomes.
At the hospital level, the reduction in variation, and rationalisation of this single surgical tray could lead to both operational (Tray assembly process; Operating rooms; Ergonomic functionality) as well as economic (Sterilisation; Instrument repair; Purchases) financial and ergonomic improvements for the healthcare system. The reduction in time taken to count and sterilise instruments can lead to a potential manpower saving involving a redistribution of activities to other areas which may require them.
Surgical tray rationalisation is emerging
Lean concept with overlap across a number of specialities, and represents a technique by which to manage costs, and improve supply chain efficiency without any adverse effect in patient healthcare outcomes.