应用精益六西格玛管理方法优化血培养阳性标本处理流程  

Application of Lean Six Sigma to optimize the process flow of blood culture positive specimen processing flow

作　　者：叶丽艳[1] 马艳宁[1] 马薇[1] 沈跃云[1] 张永轻[1] 杨继勇[1] 张有江[1] 罗燕萍[1] Ye Liyan Ma Yanning Ma Wei Shen Yueyun Zhang Yongqing Yang Jiyong Zhang Youjiang Luo Yanping(Microbial Division, PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院医技部微生物科,北京100853

出　　处：《中华检验医学杂志》2017年第5期383-386,共4页Chinese Journal of Laboratory Medicine

基　　金：军队“十二五”重大课题（AWS11C001）

摘　　要：目的通过优化血培养阳性标本处理流程来缩短阳性血培养检验结果回报时间.方法微生物科于2015年1月26日在细菌室启动了血培养阳性标本处理流程优化项目,将精益六西格玛管理方法应用于微生物学检验流程管理中.收集了项目启动日前后各约两个月中共124份血培养阳性且为肠杆菌科细菌的TAT数据,分析项目启动前的数据的TAT中位数、均值、标准差等数据分布特点及基准Z值、过程性能指数、百万出错机会等流程能力指标,并对TAT进行分解为六个时间段进行分析,找到流程改进的重点及影响因素,针对影响因素提出整改措施,对血培养检验流程实施优化再造.本项目应用MiniTab17.0统计软件进行过程能力分析及双样本t检验.结果项目实施后,血培养平均周转时间由改进前的77.10h缩短至改进后的64.03h,改进后平均周转时间比改进前缩短了13.06h（16.94％）,过程性能指数由0.49提高到0.88;基准Z值由1.48提高到2.63;改进后,除血培养的阳性报警时间外,其余的分解时间段均值在项目实施后均较实施前明显缩短.结论精益六西格玛管理方法的应用节省了人力、物力、财力,减少了等待时间,大大缩短TAT,使得工作效率和流程性能大幅提高,达到了预期的效果.Objective To shorten the turn around time of positive blood culture results by optimizing the blood culture positive specimen processing flow.Methods In January 26,2015,the microbiology department started the blood culture positive specimen processing flow optimization project,and applied the Lean Six Sigma method in the microbiological process management.The TAT data of 124 positive blood cultures containing Enterobacteriaceae were collected before and after the start of the project in about two months.We analyzed the turnaround time median,mean and standard deviation and reference Z value,process performance index,millions of error opportunities.We decompose the turnaround time into six time periods to find the key points of the process improvement and the influencing factors,and then put forward the reform measures to optimize the blood culture inspection process.MiniTab17.0 statistical software was used to process capability analysis and double sample t test.Results After the implementation of the project,the average turnaround time of the blood culture was shortened from 77.10 h to 64.03 h,improved by 13.06 h（16.94%）.Process performance greatly improved in Ppk value increased from 0.49 to 0.88,the benchmark Z value increased from 1.48 to 2.63.After the improvement,except the positive alarm time of blood culture,the mean of the other decomposition time was significantly shorter than before.Conclusions The application of Six Sigma in process management can greatly improve the work efficiency and process performance.This project can save a lot of manpower,material and financial resources,reduce the waiting,shorten turnaround time,that achieve the desired results.

关 键 词：血培养 肠杆菌科 实验室 医院 全面质量管理 时间因素 

分 类 号：R446.5[医药卫生—诊断学]