術前麻醉評估門診流程改善之行動研究 -以中部某醫學中心為例

根據中部某醫學中心麻醉前訪視門診資料顯示，2007年至2012年每日平均病患訪視量由約75人次增至約120人次。因每個病患麻醉方式不同，麻醉風險分級與醫師解說時間也不相同，又因麻醉前訪視門診並非採預約掛號模式，而以隨到抽取號碼牌看診，若同一時間門診病人與住院病人大量湧入，易造成作業延宕。在人力資源有限之下，為確保病人安全與服務品質，故本行動研究藉PDCA等品管手法，將工作內容重整並標準化，以改善作業流程及降低前台作業時間。希望縮短病患等候時間與維持手術室運作順暢，以提升病人滿意度及病人安全。研究目的有三：（一）報到櫃台作業流程精實；（二）落實衛教影片觀賞；（三）避免因未麻醉訪視影響手術室排程。本研究於流程改善前、中與效果維持期，以行動研究方法探討麻醉訪視中心從病人報到開始至簽署麻醉同意書之各作業流程，完整記錄麻醉前訪視的流程改善，並記錄每個病人所花時間。分析各項影響手術作業原因並歸納總結，針對問題與可改善方向制定策略改善。結果顯示，經由行動研究改善作業包含:登記報到流程、自我健康評估、觀看衛教影片及麻醉風險評估。整體麻醉前訪視作業流程時間由1561.4秒(約26分鐘)減少為1263.6秒(約21分鐘)，節省時間297.8秒(約5分鐘)。透過行動研究以品管手法審視流程步，不僅提升術前作業流暢性。在目前有限人力下，跨部門整合以及麻醉全期資訊系統的執行，更可促進病人安全與病人滿意度，提升手術室的行政效率。

關鍵字

麻醉前訪視門診；麻醉同意書； PDCA ；行動研究； ASA

並列摘要

According to pre-anesthesia clinic data of a medical center in central Taiwan, the average interview patients have increased from 75 to 120 per day during 2007 to 2012. Due to the differences of anesthesia methods, an-esthesia risk classifications and explanation times of physician to each patient, it somehow causes to delay of operation process. Other problems like the pre-anesthesia interview clinic does not have pre-registration function and patient enters freely to visit the clinic had caused the clinic have too many outpatients and inpatients in the same time. This action research was used PDCA related quality control methods to reorganize and standardize the work contents for improving the operation process under the limited per-sonnel and ensured patient safety and service quality. The other action pur-poses were to reduce the front desk working time and waiting time of pa-tients in order to keep maintain the process smoothly in operating room and improve patient satisfaction and safety. The purposes of this study were: 1) to lean the front desk working process. 2) to implement the anesthesia video watch program. 3) to avoid any postpone of operating schedule. The action research methods were used to explore each operation procedures of the anesthesia interview clinic from the beginning of patient registration to sign an anesthesia consent form during pre-, mid- and post- of the process improvements in this study. We recorded all the process im-provements of the pre-anesthesia interviews and the time spent by each pa-tient. Besides, the causes of delay surgical operations were analyzed and summarized to develop strategies of improvement for better operations. The results showed that the improvements through action research in-clude: registration process, self-health assessment, viewing of pre-anesthesia educational videos, and anesthesia risk assessment. The overall time of pre-anesthesia visit workflow was reduced from 1561.4 seconds (approxi-mately 26 minutes) to 1263.6 seconds (approximately 21 minutes), saving 297.8 seconds (approximately 5 minutes). In conclusion, through quality control methods of action research to evaluate the process steps were not only improved the fluency of pre-surgical operations. But also the cross-sectoral integration and the im-plementation of the full-time anesthesia information system were promoted the patient safety and satisfaction, and improved the administrative efficiency of the operating room under the current limited personnel.