| Objective Basing on Lean Six Sigma Theory to implement the project of quality improvement in intra-hospital transport of critically ill patients from ward to ICU.Through measuring and analyzing the status of transport,to put forward the improvement measures and improve the efficiency and safety of transport.Methods The first part:using the five-steps method of Lean Six Sigma management system as define,measure,analyze,improve and control,to set up project team,to setgoals of quality improvement for intra-hospital transportfrom ward to ICU,and investigate the transport processfrom ward to ICUwhich mainly includes six links as evaluating condition before the transport,personnel allocation,coordination and communication,preparation for the transport,monitoring and emergency and handover after the transport.To discuss the risk of each link in the transport by the method of brainstorming and draw the fishbone diagram,using the method of Failure Mode And Effects Analysis to measure the Risk Priority Number of these risks which its values of RPN higher than 125 points were as a key factor for affecting the quality of transport.Then proposing the improvementmeasures by organizing team discussion and expert consultation according to each key factor,and finally establishing the program of graded management under early warning.The second part:123 critically ill patients who were transported during June 2015 to November 2015 were selected as a control group,and other 111 critically ill patients who were transported during Jan 2016 to June2016 were perceived as an observation group.The control group was transported using conventional method,while the observation group was transported utilizing a transporting receipt of early warning graded to implement the early warning graded management.Using the general information questionnaire,APACHE II score,MEWS score to comparewhether there have any differences in the aspects of gender,age,disease distribution and condition between two groups of patients,and the rates of adverse events,transport time and nurse-nurse collaboration level were compared between the two groups.Results The key factors affecting the quality of transport including 3 risk problems as patients condition(the disease is severe,unstable,restlessness or conscious disorder,mechanical ventilation),transport equipment failure(dysfunction,insufficient power supply and oxygen),inadequate qualifications of transport personnel(lack of experience,professional skills unskilled,lack of system training,guardianship ability insufficiency,using the equipment undeserved).To establish the program of graded management under early warning as using the MEWS score to evaluate the severity of patients' condition,according to the score is below 5 points,5 to 9 points,9 points and the above listed as?,?,? level,transport personnel be held by the primary nurse in the?level transport,transport personnel be held by the primary nurse with more than 3 years working experience in the ?level transport,if the primary nurse lack of the qualification,assigned the other high qualification nurse with more than 3 years working experience by the head nurse or the nurse on duty,in the ? level transport or transporting mechanical ventilation patients the primary nurse reported the competent physician to determine 1 doctor accompanying the transport on the basis of ?level transport.According to the RPN value of the transport equipment failure is above 125,60 to 125 points,below 60 to divide three level of high,medium and low to manage.Organizing warning grading management training for transport nuses.In the control group,its incidence of adverse events was 13.8%,the mean transport time was (19.5±8.4),and the mean score for nurse-nurse collaboration level was(101.87±7.13).In the observation group,its incidence of adverse events was 5.4%,the mean transport time was(13.5±5.4),and the mean score for nurse-nurse collaboration level was(106.15± 8.86).After implementing warning grading management,the incidence of adverse events is reduced(X2=3.959,P<0.05),the transport time has shortened significantly(t=3.833,P<0.01),and the level of nurse-nurse cooperation has improved significantly(t=-4.261,P<0.05).Conclusions Implementing the early warning grading management in intra-hospital transport of critically ill patients,to assign transport personnel in graded form according to the severity of patients' condition,which made the quantity and the structure of transport personnel be reasonable and orderly distribution,reduced the safety problems related to transport personnel because these patients whose condition were heavier is responsible for the higher level of medical staff to transport,improved the early warning sensitivity for observing any changes of patients' condition by nurse,as a key point to strengthen the monitoring for patients whose the score were on high alert value(MEWS > 5 points),implementing the training of the early warning graded management for transport personnel and taking the management to transport equipment be focused and hierarchical,which have reduced the risk of transport effectively,improved the transport safety of the critically ill patient,improved the level of cooperation between the nurses and improve the efficiency of the transport,is worth be applied during the other transport process like from ED to ICU or critically ill patients to check out. |
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