| 摘要: | 手術病理檢體的收集送檢是手術室關鍵的醫療作業，手術病理檢體可提供醫師診斷與治療之參考依據，而手術病理檢體之取得為侵入性行為，病人須承受出血、感染甚至死亡等風險。尤其手術病理檢體送檢的完整性攸關病人的安全，如在任何環節有所疏失，將影響病人的診斷、治療。若遺失檢體重複執行檢查，更讓病人面臨再度承受侵入性檢查之風險，當病理檢體送檢不完整也會增加人力處理之浪費。由此可見在醫療照護上，必須嚴加規範，制定與執行正確採集手術病理檢體、保存及運送標準，確保流程之無誤，減少檢體退件率，降低醫療之風險，實為醫療照護上重要課題之一。而現況之手術室作業流程有相當多的風險、浪費和無效率動作，因此需要一套經過驗證的方法論改善目前問題，透過應用在製造業以消除流程浪費、不安全的方法－精實思想（Lean Thinking）導入醫療領域，進而改善當前流程浪費與不安全之問題是刻不容緩之任務。因此本研究之目的是以精實變革之觀點，探討醫院應用智慧科技成功落實手術病理檢體送檢之精實醫療。
本研究以某醫學中心手術病理檢體送檢之精實醫療應用為研究標的，應用深度訪談、實地觀摩和相關次級資料收集方式，從精實醫療之觀點探討其發展手術病理檢體送檢資訊化與應用，以及系統發展之使用效益與障礙；透過內容分析法進行資料分析與探討。研究結果：手術病理檢體送檢之精實醫療應用之資料分析結果，以精實五原則歸納如下：
一、定義價值：手術病理檢體醫療活動價值是病人安全，透過對手術病人病理檢體的送檢作業流程確認及把關，從起始行為與時間之正確性，降低延遲或導致錯誤之風險。
二、確認價值溪流：價值溪流確認包含解決問題任務所進行之手術病理檢體送檢流程資訊化，可以謀合手術團隊合作之任務達成，降低傳統人工流程繁瑣、紙張消耗多等浪費與錯誤發生；在資訊管理任務則是從開單、取下病理檢體到完成送檢之所有作業資訊化後，透過在職教育宣導與系統測試，確認整體手術病理檢體送檢流程中有效的資訊收集、傳送與管理，可改善現有流程之浪費與可能的人為失誤使作業流程的安全提高，將現況不良的處境轉換另一個較理想結果之價值溪流。
三、暢流：落實暢流三個核心步驟包括：第一為對於手術病理檢體送檢流程之特定設計，從開始到完成之整體探討，以確立影響暢流之問題。第二步克服目前遇到執行的問題，實施手術病理檢體送檢流程E化在職教育，並由品管中心進行問題分析與提出改善建議、資訊種子介入克服使用過程所發生問題、確立檢體30分鐘送達檢體室做登錄與掌握檢體動向。設立檢體送檢安全防呆機制為手術病人病理檢體的送檢作業流程把關，使服務線成為連續流。最後第三步，重新思考特定工作之方法與工具以消除各種流程重做、取消等，因此依據病患病理檢體的送檢作業資訊化需求的流程，購置所需科技與專科病理相關設備與作業流程規範修訂，避免分批－等待造成流程浪費。
四、依病患需求的流程：包括配合因不同科別病患之病理報告需求，修改檢體流向權限彈性的調整；以及配合門急診、住院病患需求而調整手術病理帳務處理作業流程，確保檢體送檢批價之勘驗程序正確完整。
五、持續改善病患醫療品質的流程：透過持續手術病理檢體品質指標監測，檢討改善個別單位在病理檢體送檢流程E化問題，並提出解決方案。
本研究之實務應用驗證精實手法確實能有效改善流程上的浪費，而智慧科技的應用亦能為病人的安全把關，藉此成功個案之探討，了解如何應用精實思維在不增加人力資源限制下，消除流程中的浪費，進而提升手術病理檢體送檢品質，研究結果可提供未來或正在發展精實醫療之組織有一參考依據。
The collection and inspection of surgical pathology specimens is a key medical task in the operating room (OR). Such specimens provide physicians with a referential basis for diagnosis and treatment. The collection of surgical pathology specimens is an invasive procedure, during which patients are at risk of bleeding, infection, and even death. The integrity of surgical pathology specimen inspection is crucial to patients’ safety, and any missing links may affect their diagnosis and treatment. Furthermore, reexamination of missing specimens puts patients at greater risks related to invasive examination. The incomplete inspection of pathology specimens increases human resource usage. Thus, medical care requires the introduction of stricter norms; establishment and practice of correct collection, storage, and transportation of surgical pathology specimens; elimination of mistakes in the process; reduction of specimen rejection rates; and reduction of treatment risks. Current OR processes are characterized by multiple risks, a high level of wastage, and ineffective actions. Therefore, a proven method must be used to address existing problems. It is thus necessary for lean thinking—normally used in the manufacturing industry—to be implemented in medical care to address methods that are risky and cause process waste. Accordingly, this study explored the use of lean healthcare in surgical pathology specimen inspection implemented through smart technologies.
The research objective was the use of lean healthcare by a medical center for surgical pathology specimen inspection. In-depth interviews, field observations, and relevant secondary data collection methods were used to explore informatization and the application of surgical pathology specimen inspection from the perspective of lean healthcare, as well as benefits and obstacles in systematic development. Data were analyzed and discussed using the content analysis method.
The data analysis results can be summarized according to five lean principles:
1.Specify value: The value of treatment activities related to surgical pathology specimens is patient safety, which must be ensured and protected in the process of relevant inspection. The correct actions and timing can reduce delay- and mistake-related risks.
2.Identify the value stream: The confirmation of the value stream, including the informatization of the surgical pathology specimen inspection process, can contribute to cooperation within surgical teams and reduce complications related to traditional manual processes, paper waste, and other waste and errors. Information management tasks include the informatization of all operations related to list compilation, pathology specimen collection, and inspection completion. On-the-job education and systematic testing can be provided to ensure the effective collection, delivery, and management of information in the overall process. This can reduce process-related waste and increase the safety of operational processes because of an absence of man-made mistakes, thereby transforming the current unfavorable situation into a more ideal value stream.
3.Flow: Three core steps exist in flow establishment. The first is to perform an overall examination of the design of surgical pathology specimen inspection from beginning to completion in order to determine problems influencing the flow. The second step is to solve current issues and conduct on-the-job education regarding the informatization of the inspection process. A quality management center performs problem analyses, proposes improvement methods and problems occurring in the intervention of information seeds, and determines specimens for 30-minute laboratory registration and inspection. The safety protection mechanism used in specimen inspection includes a careful examination of inspection operations, which transforms the service line into a continuous flow. The final step involves rethinking specific work methods and tools to exclude repetitive and canceled processes. Thus, necessary technologies, special pathology-related facilities, and operational process norms can be established according to relevant informatization needs to avoid process waste.
4.Custom pull: The matching processes to patient needs include the coordination of patients’ pathological reports from various departments and adjustment of the specimen stream. Processing of surgical pathology accounting must be adjusted according to emergency outpatient and inpatient needs to ensure the integrity of the specimen inspection accounting procedures.
5.Continuous improvement: Problems related to the informatization of pathology specimen inspection must be addressed and solved by individual units through continuous monitoring of surgical pathology specimen quality.
The practical application of lean principles in this study effectively reduced process-related waste. Smart technologies were effectively used to monitor patient safety. The use of lean thinking was explored to improve the quality of surgical pathology specimens without increasing the use of human resources as well as to avoid process waste. The results can provide a reference for organizations currently or prospectively engaged in developing lean healthcare. |
