以病人流概念改善人工膝關節置換術照護流程

背景：適當的流程改善可以有效提升醫療照護品質亦可增加病人滿意度。現況調查發現照護流程不完善導致個管師術前收案率低、病人入住時間過長、術前相關衛教認知不足、常規手術取消率高。目的：藉由病人流概念檢視整體照護流程進行改善及對策擬定，提升照護品質。解決方法：為提供完善照護流程，故擬定因應對策：（1）制定骨科個管師標準收案流程，以提高術前收案率；（2）建置關節置換專區將病人集中管理照護，以降低病人入住病室時間；（3）製作膝望護照、拍攝術前須知及居家環境準備影片和拍攝殺菌澡衛教影片，以提升病人術前衛教遵從性及降低手術排程取消率。結果：經改善後，個管師術前收案完成率由27.8%提升至84.6%；入住病室時間由73分鐘縮短至41分鐘；衛教遵從率由83.0%提升至100%；手術排程取消率由11.1%降至0%。結論：本專案運用病人流概念檢視人工膝關節置換術照護流程，藉由專案改善措施落實照護流程標準化，進而提升整體醫療照護品質。

關鍵字

病人流；關節置換；照護流程

並列摘要

Background & Problem: Improving the process of care may effectively improve the quality of medical care and increase patient satisfaction. An investigation found that the process of care used in our unit was imperfect, resulting in a low preoperative enrollment rate of case managers, overly long patient waiting times for ward assignment, insufficient pre-operative knowledge, and high cancellation rates for routine operations. Purpose: The aim of this project was to review the overall process of care using the concept of patient flow to improve and formulate countermeasures to improve quality of care. Resolution: To improve the process of care, the corresponding countermeasures were formulated. 1. Set criteria for enrollment for orthopedic case managers to increase the preoperative enrollment rate; 2. Set up a specialized arthroplasty care area for central case management to reduce the time patients need to wait for the ward; and 3. Improve patient compliance with preoperative education and reduce the operation cancellation rate by distributing patient education pamphlets, filming videos of pre-operative instructions, facilitating home environment preparation, and providing education on sterilization baths. Result: After implementation of the countermeasures, the preoperative case manager enrollment rate increased from 27.8% to 84.6%; the average ward wait time for patients reduced from 73 to 41 minutes; compliance with patient education increased from 83.0% to 100%; and the operation cancellation rate reduced from 11.1% to 0%. Conclusion: This project used the concept of patient flow to review the care process used for total knee arthroplasty. This improvement strategy may be used to standardize care processes and improve the quality of medical care provided.

並列關鍵字

patient flow ； arthroplasty ； care process

參考文獻

洪暐傑、邱姿蓉、洪緯惟、劉美芳、蔡秀慧、鄭暐霖、林季緯、吳至行（2018）．以骨折聯合照護服務建構個案管理網絡系統．台灣醫學，22（2），161–167。[Hung, W.-C., Chiu, T.-J., Hong, W.-W., Liou, M.-F., Tsai, H.-H., Chin, W.-L., Lin, C.-W., & Wu, C.-H. (2018). Implementing the case management network system of fracture liaison services. Formosan Journal of Medicine, 22(2), 161–167.] https://doi.org/10.6320/FJM.201803_22(2).0007

Chan, H. Y., Lo, S. M., Lee, L. L. Y., Lo, W. Y. L., Yu, W. C., Wu, Y. F., Ho, S. T., Yeung, R. S. D., & Chan, J. T. S. (2014). Lean techniques for the improvement of patients’ flow in emergency department. World Journal of Emergency Medicine, 5(1), 24–28. https://doi.org/10.5847/wjem.j.issn.1920-8642.2014.01.004

Delanois, R. E., Mistry, J. B., Gwam, C. U., Mohamed, N. S., Choksi, U. S., & Mont, M. A. (2017). Current epidemiology of revision total knee arthroplasty in the United States. The Journal of Arthroplasty, 32(9), 2663–2668. https://doi.org/10.1016/j.arth.2017.03.066

Hoeffel, D. P., Daly, P. J., Kelly, B. J., & Giveans, M. R. (2019). Outcomes of the first 1,000 total hip and total knee arthroplasties at a same-day surgery center using a rapid-recovery protocol. JAAOS: Global Research and Reviews, 3(3), Article e022. https://doi.org/10.5435/JAAOSGlobal-D-19-00022

Whatley, S. D., Leung, A. K., & Duic, M. (2016). Process improvements to reform patient flow in the emergency department. Healthcare Quarterly, 19(1), 29–35. https://doi.org/10.12927/hcq.2016.24612

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以病人流概念改善人工膝關節置換術照護流程

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