精益六西格玛方法在实验室样本周转时间管理中的应用效果评价

Application Effect Evaluation of Lean Six Sigma Management in Laboratory Sample Turnaround Time Management

摘要: 目的：统计实验室样本周转时间(TAT)，探索应用精益六西格玛(LSS)方法缩短TAT的方法，提高医患满意度。方法：应用LSS方法改进中国人民解放军971医院门急诊检验室内TAT管理流程，选择2020年2月至5月(改进前)和8月至11月(改进后)在门急诊检验的室内TAT数据作为研究对象，改进前35,468人次，改进后37,266人次。分别比较改进前后临床检验、生化免疫检验和急诊检验平均室内TAT、TAT超时率；对比改进前后σ值。分别在改进前和改进后随机选取100例患者和50名门急诊临床医师，调查其对门急诊检验TAT的满意情况。结果：改进后，临检项目、生化免疫检验及急诊检验室内TAT均较改进前显著降低，差异有统计学意义(P < 0.05)。改进前室内TAT平均超时率5.94% (3.1σ)，改进后室内TAT平均超时率0.30% (4.3σ)，改进后室内TAT符合率显著高于改进前，差异有统计学意义(P < 0.05)。改进前4个月(2~5月) σ值依次是3.1、3.1、3.2和3.1，改进后4个月(8~11月) σ值依次是4.2、4.3、4.3和4.3。改进后患者对室内TAT满意率提高，但差异无统计学意义(P > 0.05)，而临床医师室内TAT满意率显著高于改进前满意率(P < 0.05)。结论：LSS在门急诊检验室工作流程优化、缩短室内TAT、医患满意率提升等方面，是行之有效的。

Abstract: Objective: To investigate the application of Lean Six Sigma (LSS) to shorten the sample turnaround time (TAT) and improve the satisfaction of doctors and patients. Methods: The LSS methodologies were applied to improve the TAT management process in the outpatient and emergency laboratory of 971 Hospital of PLA. The data of TAT in the outpatient and emergency laboratory from Feb. to May (pre-improvement) and Aug. to Nov. (post-improvement) in 2020 were selected as the research objects, 35,468 person times pre-improvement and 37,266 person times post-improvement. The average indoor TAT and TAT overtime rate of clinical test, biochemical immune test and emergency test were compared, and the σ value before and after the improvement was compared. Before and after the improvement, 100 patients and 50 outpatient and emergency clinicians were randomly selected to investigate their satisfaction with TAT. Results: After the improvement, the clinical examination items, biochemical immune test and TAT in the emergency laboratory were significantly lower than before (P < 0.05). The average overtime rate of indoor TAT before and post-improvement was 5.94% (3.1σ) and 0.30% (4.3σ), respectively. The coincidence rate of indoor TAT post-improvement was significantly higher than that pre-improvement (P < 0.05). In the four months pre-improvement (Feb. to May), the σ values were 3.1, 3.1, 3.2 and 3.1, and in the four months post-improvement (Aug. to Nov.), the σ values were 4.2, 4.3, 4.3 and 4.3. After the improvement, the satisfaction rate of patients with indoor TAT increased, but the difference was not statistically significant (P > 0.05), while the satisfaction rate of clinicians with indoor TAT was significantly higher than that before the improvement (P < 0.05). Conclusion: LSS methodologies are effective in optimizing the work process of outpatient and emergency laboratory, shortening the indoor TAT and improving the satisfaction rate of doctors and patients.