失效模式与影响分析在术前流程改进中的应用  

Application of Failure Mode and Effect Analysis in Preoperative Process Improvement

作　　者：史苏霞[1] 毛燕君 鲁敏[2] 费红英[3] 许学国[3] SHI Suxia;MAO Yanjun;LU Min;FEI Hongying;XU Xueguo(Outpatient Department,Shanghai Pulmonary Hospital,Shanghai 200433;Nursing Department,Shanghai Pulmonary Hospital,Shanghai 200433;School of Management,Shanghai University,Shanghai 200444)

机构地区：[1]上海市肺科医院门诊,上海200433 [2]上海市肺科医院护理部,上海200433 [3]上海大学管理学院,上海200444

出　　处：《解放军医院管理杂志》2019年第11期1021-1024,共4页Hospital Administration Journal of Chinese People's Liberation Army

基　　金：上海市护理学会优秀青年人才育苗计划

摘　　要：目的筛查胸外科术前流程的相关风险因素并进行改进,以有效控制外科患者术前住院时间,优化术前服务流程,提高病床周转率。方法采用基于模糊理论的失效模式及效应分析法(FFMEA),根据各风险因素的模糊风险优先度数值(FRPN)进行风险排序,分析外科患者在术前医疗护理服务环节中可能造成时间延误的风险因素,优化流程,比较管理措施改进前后的术前平均住院日、患者满意度、外科医生满意度等。采用FMEA和FFMEA所分析出的风险优先度有差异,失效模块No.5、7、14是两个分析方法得出的共性风险因素,FRPN平均值为3.93,有8项失效模块需要整改。结果整改前后,胸外科某治疗组患者的术前平均住院日从平均2.37天缩短至1.83天,胸外科住院时间从平均5.77天缩短至4.86天,外科医生满意度从90.45%提升至96.67%,差异均有统计学意义,患者、麻醉医生、护士满意度差异无统计学意义。结论FFMEA法减少传统FMEA的限制,风险优化可有助于医疗部门选择明智的整改措施。所以,基于模糊理论的FMEA方法可以用于术前服务流程。Objective To effectively control the preoperative hospital length of stay for surgical patients,optimize the preoperative service process and improve the turnover rate of hospital beds.Methods In this study,the failure mode and effect analysis method based on the fuzzy theory(FFMEA)was used to rank the risks according to the fuzzy risk priority value(FRPN)of each risk factor.The risk factors that may cause time delay in preoperative medical and nursing services of surgical patients were analyzed,the process was optimized,and the preoperative average hospitalization days and patient,nurses,surgeon satisfaction before and after the improvement of management measures were compared.There were differences in risk priority between FMEA and FFMEA.Failure modules No.5,7 and 14 were common risk factors.The average value of FRPN was 3.93.There were eight failure modules that need to be corrected.Results Before and after the improvement,the average hospitalization days of patients in one medical group of thoracic surgery were shortened from 2.37 days to 1.83 days,the average hospitalization time of thoracic surgery was shortened from 5.77 days to 4.86 days,and the satisfaction of surgeons was increased from 90.45%to 96.67%.These differences were statistically significant.There was no significant difference in the satisfaction of patients,anesthesiologists and nurses.Conclusion FFMEA method reduces the limitation of traditional FMEA,and risk optimization can help medical departments to choose wise improvement measures.Therefore,the FMEA method based on fuzzy theory can be used in preoperative service process.

关 键 词：术前流程 故障模式及影响分析(FMEA) 模糊理论 效果评价 

分 类 号：R197.32[医药卫生—卫生事业管理]