胸痛中心的时间流程

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,胸痛中心的时间流程管理,上海胸科医院 方唯一,如何进行有效监控与改进,完善的流程图,-,并严格按照流程图实施,清晰的组织架构,责任落实到每一位团队成员,为实现时间结点管理需要做的工作,明确有效的、操作性强的流程,明晰流程各个环节的时间分配,压缩不必要的环节、集中和整合相关环节任务,智能信息化管理,便捷的必要检查,-,尽早做出诊断和危险分层,院前传输,明晰全流程的各个时间节点,Creating the Value-added Flowchart,创建包含有意义步骤的流程图,国际先进经验,-,创建有效的流程图,Sign in,登记,2.Wait for triage,等待分诊,3.Triage evaluation,分诊,4.Wait for registration,等待挂号,5.Registration,挂号,6.Wait for exam nurse,等待护士,7.Exam by nurse,护士检查,8.Wait for doctor,等待医生,9.Exam by doctor,医生检查,10.Wait for lab work,等待实验室检查,11.Lab work,实验室检查,12.Wait for diagnosis,等待诊断,13.Diagnosis,诊断,14.Wait for discharge,等待出院,15.Discharge,出院,Step 1:,List all steps in the process from beginning to end.,将流程从进入医院到出院的每一步列举出来,创建有效的流程图,Step 2:,Create a block diagram for every step,in sequence.,创建一个包含每一步的方框图，按顺序排列,创建有意义的流程图,Step 3:,Calculate the,time,currently required to complete each step and add that time to each box.,测出现在每一步所需的时间，并且将每一步所需的时间填写在各方框中,创建有意义的流程图,Step 4:,Add the time from each box to calculate the Total Cycle Time.,将每一方框中的时间加起来得到总的时间,创建有意义的流程图,Step 5:,Identify those steps that do not add value to the process.,确定流程中的哪些步骤是没有价值的或可以替代的,Non-value-added operations include waiting,transferring,documenting,any activity that does not address patient condition throughout the process.,没有价值的步骤包括等待、转移、文案以及任何在整个流程中对于病人的情况判断无意义的工作。,创建有意义的流程图,Step 6,Move the boxes representing non-value-added processes to the right of the value-added steps.,将流程中没有意义的步骤的方框移动到整个流程图的右边,Value-added,Non Value-added,Step 7,Add the time from each of the non-value-added processes to yield the non-value-added cycle time.,(106 minutes),计算整个过程中无意义的步骤耗费的总时间,有意义的（,26,分钟）,无意义的,(106,分钟）,This is the waste that could be eliminated if only value-added steps were performed,.,如果仅履行有意义的步骤，则可以减少不少时间,Step 8,Add the time from each of the value-added processes to yield the value-added cycle time.,(26 minutes),将有意义的步骤所需时间整合为整个流程所需的必要时间,有意义的,(,26,分钟,),无意义的,(106,分钟,),有意义的流程图,Total Cycle Time=132 min.Total Value-added Time 26 minutes=19.7%,Total Non Value-added Time 106 minutes=80.3%,13,Step 9,Calculate the percentage of value-added and non-value-added activities(in relation to total cycle time).,计算有意义的步骤和无意义的步骤所需时间的比例,有意义的流程图,Total Cycle Time=132 min.Total Value-added Time 26 minutes=19.7%,Total Non Value-added Time,106 minutes=80.3%,14,Calculate the percentage of value-added and non-value-added activities(in relation to total cycle time).,计算有意义的步骤和无意义的步骤所需时间的比例,%Value-added is also referred to as the,Process Efficiency,有意义的步骤花费时间的百分比又被称为流程效率,Using the Value-added Flowchart to Improve a Process,用有意义步骤的流程图来对流程进行改善,Analyze the non value-added steps,分析无意义的步骤,Identify actions to reduce or eliminate these operations.,采取行动减少或消除这些操作,Analyze the value-added steps,分析有意义的步骤,Identify improvement opportunities and implement actions to reduce the cycle time.,分析继续改善的可能，并采取行动减少整个流程所耗费的时间,Deployment or Cross-functional Flowchart,跨职能部门流程图,Definition:Shows the detailed steps in a process and who is involved in each step,定义：展示整个流程中的细节和每个细节中包含的职能部门,Adds“swim lanes”to the flowchart,在流程图中加入不同的路线,Each role or functional area is represented in a“swim lane”,每一路线中包含每一个职能角色或职能部门,Vertical“swim lanes”with each role across the top,垂直的路线从顶端开始到底部包含每一个职能角色,Horizontal“swim lanes”with each role down the left side,水平的路线从左到右包含每一个职能角色,跨部门的流程图,Uses:,用途,Helps to understand,improve,and standardize a process that involves more than one person or group,帮助理解、改善和标准化整个流程，尤其是流程中包含不止一个人或一个团体。,Highlights places in a process where work is handed off from one person or department to another,强调流程中工作从一个人或团队被交接到另外一个人或团队的某一节点,Helps all involved understand how their work impacts the work of others,帮助流程中的所有人理解他们的工作将会对其他人的工作产生怎样的影响,Most errors occur during hand-offs or transitions in care.,大部分的错误发生在工作交接的过程当中,Importance of Process Roles,流程中角色的重要性,Do we know whos doing what?,知道谁在做什么,The steps in a process are usually performed by different groups of people acting in a“role”such as:,流程中的每一步都是由不同的角色完成的，比如：,Physician,医生,Pharmacy,药房,Nursing,护理,Patient,病人,Laboratory,检验室,It is important to analyze the roles as well as the steps in the process.,分析不同的角色与分析流程中的步骤具有同等的重要性,Now that you have examined your process and have constructed a flowchart,ask yourself.,审视过流程图后，还要反复问自己：,Are we using the flowchart?,我们是否按流程图操作的？,Is it driving change?,使我们的工作改变了什么？,Example:,Door-to-balloon time is 110 minutes goal is 85 minutes,D2B,时间是,110,分钟，而目标是,85,分钟,How do you know where the breakdown is occurring in your process?,你如何从流程图中问题发生在什么地方？,Outcome Measure:Final goal door-to-balloon time is 85 minutes(actual time 110 min).,结果评估：最终的,D2B,时间是,85,分钟（现在的时间是,110,分钟）,Process Measure:the pieces that make up the“Outcome Measure”,流程评估：构成结果的时间模块,Door to ECG,采集心电图的时间,.20 min,ECG to MD interpretation,急诊医师分析心电图,.15 min,Cath lab call to arrival,启动导管室,.30 min,Call back from cardiologist,召集心内科医生,.20 min,Cath lab time,手术开始时间,.25 min,Go back to your flowchart,回到流程图进行分析,Look at each process and measure each step,衡量流程的每一步如何超过计划的时间？,Drill