Comparative Study On Lean Management Between Orthopedic Surgery Based On Time-motion Study

【Objective】By constructing a scientific and objective nursing staff behavior classification system,observing the workflow of nursing staff in orthopaedic surgery rooms,analyzing the problems and influencing factors in the operation of orthopedic surgery,using lean management methods for optimization and improvement,and verifying the improved results,Provide a reference for the implementation of lean management in specialty operating rooms.【Method】1 Through literature review,focus group discussion and on-site observation method,the nursing activity behavior classification system suitable for the orthopedic surgery equipment nurses and itinerant nurses in this study was constructed.2 The time-action method was used to collect the working data of nursing staff in the orthopaedic surgery room from March 2019 to April 2019 and obtain the surgical procedure.3 Use lean management method to analyze the problems in orthopaedic surgery process and analyze its influencing factors,combined with the Lean management tools such as Sifang diagram,value flow diagram,fish bone diagram,5S and so on to build an improvement plan.4 The time-action method was used again to collect the data from September 2019 to October 2019 after the lean management was improved,and compared with the data from March 2019 to April 2019 before the improvement to verify the implementation effect of the lean program.【Result】1 In this study,a literature review,on-site observations and three special panel discussions were used to construct a list of behavioral activities for nursing staff in orthopedic surgery rooms suitable for this study,a total of 106 items,including 42 nursing activities for device nurses and 83 nursing activities for roving nurses(device nurses)19 nursing activities are repeated with itinerant nurses),and all nursing activities are divided into 8 behavior categories according to the research purpose: direct nursing,indirect nursing,infection control,nursing documents,standing and walking between behaviors,language communication,Personal errands,other.2 On-site observation before lean management shows that the three types of device nursesthat spend the most time are indirect care,direct care,and infection control.The three types of tour nurses that spend the most time are indirect care,direct care,and behavior.Standing and walking;the opening time of the first operation of the orthopaedic surgery room is after 9:00,the average opening time of the first operation of the joint surgery is the latest,(9: 38 ± 1.58),and the average first of the spine surgery The operation time of the first operation is(9: 15 ±2.30);the preparation time of the first operation exceeds 70 minutes,of which the preparation time of the first operation of the traumatology orthopedics department is the longest(80.4 ±7.16)min.The shortest preparation time of the operation is(70.2 ± 6.42)min;the shortest pure operation time is hip replacement(49.6 ± 5.73)min,and the longest time is intramedullary needle closed reduction and internal fixation(125.2 ± 10.64)min;The self-cleaning time of the operating room is too long,which exceeds the self-cleaning time of the indirect table of the level of surgery in accordance with its own operation level;the interval between the operations of the specialty surgery of the heart is too long,and the orthopedic trauma reached(83.2 ± 4.09)min.3 Drawing a lean management value flow chart and discovering the key nodes that can be improved in the orthopedic surgery process are: the opening time of the first operation,the time during the operation,and the interval time between the operations.According to the analysis of the fishbone diagram of the lean management tool,the improvement subjects targeted by the above three key nodes are: personnel,equipment,environment and process.From the above perspectives,an improved plan for lean management of orthopedic surgery suitable for this study was constructed.4 The on-site observation after lean management showed that the indirect nursing time of device nurses was shortened by an average of 5 minutes.Among them,7 kinds of surgical methods before and after improvement were P≤0.01,the difference was very significant,and1 kind of surgical method was 0.01<P≤0.05;Standing and walking were shortened by an average of 3 minutes.Among them,5 surgical methods were compared before and after P≤0.01,1 surgical method 0.01<P≤0.05,2 surgical methods P>0.05,no statistical significance;longitudinal comparison of equipment nurse lean management The changes of nursing work time before and after improvement were all reduced,and the time changes of 6 surgicalmethods were statistically significant.The time change of nursing paperwork of itinerant nurses was P≤0.01 in 7 kinds of surgical methods before and after comparison,the difference was extremely significant,1 kind of surgical method was 0.01<P ≤ 0.05;the change of standing and walking between behaviors was compared before and after 2 kinds of surgical methods P≤0.01,3 surgical methods 0.01<P≤0.05,2 surgical methods P>0.05;although the time of indirect nursing decreased,but the difference was not significant;longitudinal comparison of changes in time before and after the improvement of lean management of itinerant nurses,P≤0.01,All have statistical significance.The average opening time of the first operation in the orthopaedic operation room is advanced,and the preparation time of the first operation is shortened,P ≤ 0.01,the improvement effect is obvious;the cleaning self-purification time is shortened(within the self-purification time range specified in the tiered operation room),of which trauma orthopedics 、Spine surgery P≤0.01,joint surgery,sports medicine department 0.01<P ≤0.05,the improvement effect is obvious;the interval time between consecutive stages is shortened,compared with P ≤ 0.01 before and after,shortened the patient turnaround time,improved the turnover efficiency of consecutive stages,improved The effect is obvious.【Conclusion】1 The list of nursing staff behavior activities between orthopedic surgery was constructed with subjective and objective evaluation items comprehensively considered,which covered comprehensive contents and was highly operable and of great practical guiding significance.2 Conclusion of the observational study in the orthopedic surgery room before lean management: Device nurses spend more time in indirect care and infection control,and itinerant nurses spend more time in direct care,nursing documents,standing and walking between behaviors,the same During working hours,the nursing workload of the traveling nurses is greater;the preparation time of each department of the orthopedic center is longer,and the first operation is opened later;the pure operation time of the 8 orthopedic operations selected in this study has obvious differences;The time between room cleaning and self-cleaning is longer than the interval between tables.There is much room for improvement in the efficiency of orthopedic surgery rooms.3 Conclusion of the observational study of the orthopaedic surgery room after lean management: By implementing lean management programs for personnel,environment,equipment,and processes,the opening time of the first operation of the orthopedic surgery,the operation preparation time,the cleaning and self-cleaning time of the operation room,The interval between consecutive stages improves the efficiency of the orthopaedic surgery room.