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| 題 名 | 以ECRS手法縮短肝移植術前評估住院時間=Using ECRS to Shorten Hospital Stay for Liver Transplant Preoperative Assessment |
|---|---|
| 作 者 | 黃璇如; 杜敬惟; 杜珠理; 陳香宇; 李玉媚; 林美蓮; 李玲嫻; 孫定平; | 書刊名 | 台灣急重症醫學雜誌 |
| 卷 期 | 8:4 2023.12[民112.12] |
| 頁 次 | 頁112-124 |
| 分類號 | 416.175 |
| 關鍵詞 | 肝移植; 術前評估; 住院時間; ECRS; Liver transplant; Preoperative assessment; Hospital stay; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 背景︰末期肝臟衰竭的受贈者接受肝移植手術前,需先安排一次住院接受移植前評估的經歷。本院肝移植術前評估住院時間平均 5784 分鐘(4.02 天),標竿其他移植醫院設定目標為 4320 分鐘(3 天),故與移植外科、檢查部門組成跨改善團隊。 方法︰受贈者住院檢查項目繁複,本案主要採ECRS手法針對住院檢體採檢流程、住院檢查流程兩部分進行分析及改善。針對18項住院檢體採檢流程進行3項合併、2項剔除、1項重組;82項住院檢查流程進行2項合併、5項剔除、32項重組。另外,擬定1仿靛氰綠代謝試驗(Indocyanine green retention test;ICG test)採血流程進行採血、2.使用24小時尿液收集提醒卡衛教、3.到院前檢查佈署為改善策略。 結果︰改善後,肝移植術前評估住院時間從改善前 5784 分降到 3036 分、目標達成率 187%、進步率 47.5%,不僅增加床位周轉率、也節省健保費用。 結論︰目前,本病房依此改善經驗已制定「肝臟移植評估住院護理指引」標準書,作為臨床護理人員執行肝移植前住院評估照護的基礎。此成果提升檢查效率,也及早讓受贈者完成移植前評估後將檢查結果送至健保局審核,完成器官移植登錄手續。 |
| 英文摘要 | Background: Patients with end-stage liver disease must undergo a comprehensive evaluation prior to liver transplantation. At our hospital, this evaluation process typically takes an average of 5,784 minutes (4.02 days), whereas it takes an average of 4,320 minutes (3 days) at neighboring hospitals. Hence, our goal is to expedite the admission process and establish a cross-functional team. Method: Because of the cumbersome process of examinations, we focused on improving two main parts using ECRS for detailed analysis. After the analysis, the previous 18 steps were streamlined. Two items were combined while 5 items were deleted. However, 32 items were reconstructed. The previous 82 steps were optimized, with 3 items combined, 2 items deleted, and 1 item reconstructed. Our method followed the standardized indocyanine green (ICG) test method to reduce the frequency of blood tests. We used a simple card to record the start and finish timings. Lastly, we deployed troops in anticipation of patient examinations. Result: The total evaluation time was reduced from 5,784 minutes to 3,036 minutes. The target achievement rate was 187%, and the progress rate was 47.5%. Additionally, the health insurance cost was reduced, and patient satisfaction was 100%. Conclusion: In conclusion, we have established a standardized evaluation framework for liver transplantation admission guidelines, providing a more efficient process. The earlier recipients complete the evaluation, the earlier they can be included on the waiting list. |
本系統中英文摘要資訊取自各篇刊載內容。