背景:当天手术病例取消消耗资源,扰乱了病人的护理,全球患病率为18%。回顾性分析发现,在利隆韦一家公立三甲医院取消了44%的择期手术,马拉维。为了更好地描述这些取消,这项研究定义了手术病例完成的过程图,并调查了医院工作人员和患者对取消的影响因素和负担的看法。
方法:我们对医院工作人员(n=23)和患者(n=10)进行了参与式过程映射和深入访谈,以详细说明围手术期的过程和对取消的看法。我们使用有目的的抽样来招募按医院角色和手术被取消的患者的工作人员。采访是录音的,翻译,并采用常数比较法和NVivo软件对过程作图精度和专题分析进行转录。
结果:工作人员描述了围手术期过程的具体步骤,生成流程图,以识别效率低下和干预机会。医院工作人员描述了病例取消的不可避免的原因,例如不可靠的供水和材料短缺。与浪费时间和资源相关的可修改原因也很明显,比如慢性迟到,沟通障碍,术前评估不足。对取消的感知影响的主题分析显示,医患关系受损,通信中断,和情绪困扰。工作人员和患者表示沮丧,尴尬,恐惧,计划的手术被取消时士气低落。
结论:我们展示了使用过程映射作为工具来确定实施目标,以降低病例取消率。医院系统可以调整这种方法,以解决特定环境下的手术病例取消问题。
BACKGROUND: Same-day surgical case cancellation consumes resources, disrupts patient care, and has a global prevalence of 18%. A retrospective analysis found that 44% of scheduled elective surgeries were canceled at a public tertiary hospital in Lilongwe, Malawi. To better characterize these cancellations, this study defines a process map for surgical case completion and investigates hospital staff and patient perspectives on contributing factors and burdens of cancellation.
METHODS: We conducted participatory process mapping and in-depth interviews with hospital staff (n = 23) and patients (n = 10) to detail perioperative processes and perspectives on cancellations. We used purposive sampling to recruit staff by hospital role and patients whose surgery had been canceled. Interviews were audio-recorded, translated, and transcribed for process mapping accuracy and thematic analysis using the constant comparative method and NVivo software.
RESULTS: Staff delineated specific steps of the perioperative process, generating a process map that identifies inefficiencies and opportunities for intervention. Hospital staff described unavoidable causes of case cancellation, such as unreliable water supply and material shortages. Modifiable causes linked to wasted time and resources were also evident, such as chronic tardiness, communication barriers, and inadequate preoperative assessment. Thematic analysis of perceived impacts of cancellation revealed compromised provider-patient relationships, communication breakdown, and emotional distress. Staff and patients expressed frustration, embarrassment, fear, and demoralization when planned surgeries were canceled.
CONCLUSIONS: We demonstrate the use of process mapping as a tool to identify implementation targets for reducing case cancellation rates. Hospital systems can adapt this approach to address surgical case cancellation in their specific setting.