Intrahospital Emergency Preoperative Procedure Analysis in Patients with Aneurysmal Subarachnoid Hemorrhage Based on Value Stream Mapping

doi:10.12114/j.issn.1007-9572.2018.00.198

Abstract

Abstract: Objective　To investigate and analyze the intrahospital emergency preoperative procedure in patients with aneurysmal subarachnoid hemorrhage（aSAH），providing a reference for the optimization of this procedure.Methods　We conducted this prospective observational study in a purposive sample of 32 cases of aSAH receiving emergency surgical treatment in Xuanwu Hospital Capital Medical University from October 2017 to February 2018.Our research group followed up the entire intrahospital receiving process which started since the arrival at the emergency triage and ended by entering the operating room or intervention center for receiving procedure，and recorded the duration of each sector of the process，and analyzed the process with a value stream mapping drawn with the standard symbols and the recorded data.Results　The overall serving time，overall waiting time before receiving procedure，duration for the entire intrahospital receiving process were 9-104 min，6-3 658 min，15-3 762 min，respectively.The waiting duration was found to be prolonged for 5 sectors，namely，entering the operating room or intervention center，decision-making involving the patient's family members，preoperative preparation，implementing admission procedures，blood sample collection and submission.Conclusion　There is great room for improving the intrahospital emergency preoperative procedure in aSAH patients.And close multidisciplinary cooperation，intensive management，patient-centered services，and green channel services are the key improvement measures.

Key words: Subarachnoid hemorrhage, Value stream map, Institutional practice

摘要： 目的　通过对动脉瘤性蛛网膜下腔出血（aSAH）患者急诊术前院内流程的调查，分析出血性脑卒中患者院内流程现状，为流程优化提供直接依据。方法　采用目的抽样法，选取2017年10月—2018年2月在首都医科大学宣武医院经急诊入院治疗的aSAH 32例患者为研究对象。从患者到达急诊分诊台开始计时，直至进入手术室或介入中心终止，小组成员跟踪全过程，记录各环节时间。依据价值流程图的通用图标及记录的时间数据绘制患者急诊术前院内流程的价值流程图。结果　aSAH患者急诊术前院内工作时间为9~104 min，等待时间为6~3 658 min，总流程时间为15~3 762 min，入手术室或介入中心、家属参与决策、术前准备、办理入院、抽血送检的等待时间较长。结论　aSAH患者急诊术前院内流程存在较大改进空间，加强多学科合作、精细化管理、人性化服务、启动绿色通道等是优化aSAH患者急诊术前院内流程的关键措施。

关键词: 蛛网膜下腔出血, 价值流程图, 院内诊疗

SHAO Peng,WANG Jun,SUN Xuelian, et al. Intrahospital Emergency Preoperative Procedure Analysis in Patients with Aneurysmal Subarachnoid Hemorrhage Based on Value Stream Mapping[J]. Chinese General Practice, 2018, 21(32): 4018-4021. DOI: 10.12114/j.issn.1007-9572.2018.00.198.
邵鹏,王军,孙雪莲等. 基于价值流程图的动脉瘤性蛛网膜下腔出血患者急诊术前院内流程现状分析[J]. 中国全科医学, 2018, 21(32): 4018-4021. DOI: 10.12114/j.issn.1007-9572.2018.00.198.

References

［1］中华医学会神经外科学分会神经介入学组.颅内动脉瘤血管内介入治疗中国专家共识（2013）［J］．中华医学杂志，2013，93（39）：3093-3103．DOI：10.3760/cma.j.issn.0376-2491.2013.39.003.4021
Neurointerventional Group of Neurosurgery Society，Chinese Medical Association.Chinese expert consensus on endovascular interventional treatment of intracranial aneurysms（2013）［J］．National Medical Journal of China，2013，93（39）：3093-3103．DOI：10.3760/cma.j.issn.0376-2491.2013.39.003.4021
［2］STEINER T，JUVELA S，UNTERBERG A，et al．European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage［J］．Cerebrovasc Dis，2013，35（2）：93-112．DOI：10.1159/000346087.4021
［3］中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国蛛网膜下腔出血诊治指南2015［J］．中华神经科杂志，2016，49（3）：182-191．DOI：10.3760/cma.j.issn.1006-7876.2016.03.003.4021
Neurology Society of the Chinese Medical Association，Cerebrovascular Diseases Group of Neurology Society，Chinese Medical Association.Guidelines for diagnosis and treatment of subarachnoid hemorrhage in China 2015［J］．Chinese Journal of Neurology，2016，49（3）：182-191．DOI：10.3760/cma.j.issn.1006-7876.2016.03.003.doi：10.3760/cma.j.issn.1006-7876.2016.03.003.4021
［4］VAN GIJN J，KERR R S，RINKEL G J.Subarachnoid haemorrhage［J］．Lancet，2007，369（9558）：306-318.4021
［5］CONNOLLY E S Jr，RABINSTEIN A A，CARHUAPOMA J R，等．动脉瘤性蛛网膜下腔出血的治疗指南（ASA/AHA 2012版）（下）［J］．中国脑血管病杂志，2013，4（13）：217-224．DOI：10.3969/j.issn.1672-5921.2013.04.013.4021
CONNOLLY E S Jr，RABINSTEIN A A，CARHUAPOMA J R，et al．Guidelines for the treatment of aneurysmal subarachnoid hemorrhage（ASA/AHA 2012）［J］．Chinese Journal of Cerebrovascular Diseases，2013，4（13）：217-224．DOI：10.3969/j.issn.1672-5921.2013.04.013.4021
［6］HILLMAN J，FRIDRIKSSON S，NILSSON O，et al．Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage：a prospective randomized study［J］．J Neurosurg，2002，97（4）：771-778．DOI：10.3171/jns.2002.97.4.0771.4021
［7］KASSELL N F，TORNER J C.Aneurysmal rebleeding：a preliminary report from the Cooperative Aneurysm Study［J］．Neurosurgery，1983，13（5）：479-481.4021
［8］NAIDECH A M，JANJUA N，KREITER K T，et al．Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage［J］．Arch Neurol，2005，62（3）：410-416．DOI：10.1001/archneur.62.3.410.4021
［9］TANNO Y，HOMMA M，OINUMA M，et al．Rebleeding from ruptured intracranial aneurysms in North Eastern Province of Japan.A cooperative study［J］．J Neurol Sci，2007，258（1/2）：11-16．DOI：10.1016/j.jns.2007.01.074.4021
［10］KASSELL N F，TORNER J C，HALEY E J，et al．The International Cooperative Study on the timing of aneurysm surgery.Part 1：overall management results［J］．J Neurosurg，1990，73（1）：18-36．DOI：10.3171/jns.1990.73.1.0018.4021
［11］CHA K C，KIM J H，KANG H I，et al．Aneurysmal rebleeding：factors associated with clinical outcome in the rebleeding patients［J］．J Korean Neurosurg Soc，2010，47（2）：119-123．DOI：10.3340/jkns.2010.47.2.119.4021
［12］刘承基，凌锋.脑脊髓血管外科学［M］．北京：中国科学技术出版社，2013：199.4021
［13］PARK J，WOO H，KANG D，et al．Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes［J］．J Neurosurg，2015，122（2）：383-391．DOI：10.3171/2014.9.JNS131784.4021
［14］孙娜，王云贵，李亚东.精益六西格玛在基于患者安全流程改造项目的应用研究［J］．西南国防医药，2011，39（11）：1245-1248．DOI：10.3969/j.issn.1004-0188.2011.11.044.4021
SUN N，WANG Y G，LI Y D.Application of Lean Six Sigma in patient safety process reengineering project［J］．Medical Journal of National Defending Forces in Southwest China，2011，39（11）：1245-1248．DOI：10.3969/j.issn.1004-0188.2011.11.044.4021
［15］谢庆红，王小彬，潘志霄.基于价值流图析的复杂产品装配优化研究—以G公司DM3生产装配优化为例［J］．工业工程与管理，2013，18（4）：117-121．DOI：10.3969/j.issn.1007-5429.2013.04.018.4027
XIE Q H，WANG X B，PAN Z X.Optimization study of complex production assembly based on value stream mapping［J］．Industrial Engineering and Management，2013，18（4）：117-121．DOI：10.3969/j.issn.1007-5429.2013.04.018.4027
［16］WORTH J，SHUKER T，KEYTE B，等．精益医疗实践［M］//郦宏，赵自闲，徐远航，译.北京：机械工业出版社，2014.4027
［17］李小宇，梁潇，马青峰，等．医院优势资源整合在急诊医疗服务体系建设的实践［J］．中国医院，2016，20（8）：64-66．DOI：10.3969/j.issn.1671-0592.2016.08.022.4027
LI X Y，LIANG X，MA Q F，et al．Practice on integrating advantage resources in emergency care system building［J］．Chinese Hospitals，2016，20（8）：64-66．DOI：10.3969/j.issn.1671-0592.2016.08.022.4027
［18］张健.精益管理在提升手术室效率中的应用研究［D］．成都：西南交通大学，2013.4027
［19］马春花，王宝珠.急诊分诊过程管理应用研究［J］．护理研究，2006，20（35）：3197-3199．DOI：10.3969/j.issn.1009-6493.2006.35.001.4027
MA C H，WANG B Z.A study on application of triage procedure management in emergency［J］．Chinese Nursing Research，2006，20（35）：3197-3199．DOI：10.3969/j.issn.1009-6493.2006.35.001.4027
［20］苏林霞，杨莘，常红，等．基于价值流程图的缺血性脑卒中患者静脉溶栓院内延迟现状分析［J］．中国护理管理，2015，15（5）：591-594．DOI：10.3969/j.issn.1672-1756.2015.05.022.4027
SU L X，YANG X，CHANG H，et al．The hospital delay analysis of intravenous thrombolysis process among ischemic stroke patients based on value stream mapping［J］．Chinese Nursing Management，2015，15（5）：591-594．DOI：10.3969/j.issn.1672-1756.2015.05.022.4027
［21］FIFI J T，MEYERS P M，LAVINE S D，et al．Complications of modern diagnostic cerebral angiography in an academic medical center［J］．J Vasc Interv Radiol，2009，20（4）：442-447．DOI：10.1016/j.jvir.2009.01.012.4027
［22］向思诗，卢昊，翟晓东，等．改进急诊救治模式对颅内破裂动脉瘤短期效果的影响［J］．中国脑血管病杂志，2016，13（11）：575-578．DOI：10.3969/j.issn.1672-5921.2016.11.003.4027
XIANG S S，LU H，ZHAI X D，et al．Influence of short-term effect of improving emergency managements for the treatment of ruptured intracranial aneurysms［J］．Chinese Journal of Cerebrovascular Diseases，2016，13（11）：575-578．DOI：10.3969/j.issn.1672-5921.2016.11.003.4027

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