Establish and implement a pre-prescription system for outpatient based on Six Sigma DMAIC model / 中国临床药理学与治疗学

AIM: The pre-prescription system of outpatient was established and implemented based on six sigma DMAIC model to ensure the safety of drug use and promote rational of drug use. METHODS: The rules database was made scientifically and precisely, according to DMAIC model of Six Sigma-define, measure, analyze, improve and control. The pre-prescription system of our hospital was established and improved, through adopting the prescription review mode of interception and Intervention. And the process management was continued to optimize. RESULTS: The rule-making of pre-trial system for outpatient prescription in our hospital was reasonable, and the rate of clinical approval and acceptance was high. After the system audit, the average rate of doctor's revision was 76.32%, and the average rate of Pharmacist's intervention was 63.23%, the effective rate and qualified rate of pharmacist intervention were 97.23% and 96.87%, respectively. CONCLUSION: Based on Six Sigma DMAIC model, the pre-trial system for outpatient prescription was established and implemented, which improved the level of rational drug use, effectively ensured the safety of drug use, and improved the satisfaction of patients.

Analysis of Lean Six Sigma Use in Pharmaceutical Production

Abstract Over the last years, pharmaceutical industries have adopted continuous improvement and operational excellence programs to optimize processes, improve quality and reduce operational costs. Worldwide, Lean Manufacturing (LM) and Six Sigma (SS), as well as the integration of the two methods: Lean Six Sigma (LSS) are the most used approaches in the continuous improvement of industries and services. This work aims to investigate the employment of the Lean Six Sigma methodology in the productive areas of pharmaceutical companies located in Brazil. Interviews were conducted with managers of pharmaceutical industries that apply the approach. The results indicated the greater use of Lean Manufacturing tools compared to Six Sigma and the influence of specific peculiarities of the pharmaceutical industry on the benefits that are achieved with the use of Lean Six Sigma. The approach is considered of great value as it provides substantial benefits to the pharmaceutical industry. It is concluded that the work corroborates to the theoretical and empirical knowledge about the methodology use in the context of Brazilian pharmaceutical industries, as well as contributes to the implementation, reformulation, and improvement of Lean Six Sigma programs in this industrial segment.

Quantification of Pre-analytical Quality Indicators in a Clinical Laboratory and Formulating the Lean Six Sigma DMAIC Strategy

Introduction : Quality control of the laboratory has gained increased importance in the present years. 70 % of the errors in the clinical laboratory occur in the pre-analytical phase. With various guidelines to gauge the quality of the laboratory, Six Sigma Metrics remains by far the most difficult benchmark that a laboratory can achieve. We aimed to quantify the performance of the quality indicators of the routine clinical Biochemistry laboratory in the pre-analytical phase in the form of sigma metrics and devise measures and identify steps to decrease the percentage of errors by defining the DMAIC approach. Materials and Methods : One year retrospective data was collected from January, 2020 to December, 2020 from the data entry register and pre-analytical variables were quantified. Defects Per Million and sigma metric were calculated for each pre-analytical indicator. DMAIC approach was applied and post intervention sigma scores for the month of Jananuary, 2021, February, 2021 and March, 2021 were calculated. Results : Postinterventional analysis was done on a month-to-month basis to monitor the trend and also to ensure corrective action can be taken without delay. Out of 5 quality indicators which were quantified, the pre versus post sigma scores (March’21) are as follows: missing location of the patient (Sigma 4 versus 3.6), missing registration number (Sigma 3.7 versus 4.3) and both registration number and location missing (Sigma 3.6 versus 4.0), Homolysed sample (4.2 versus 4.6), insufficient sample volume (sigma 3.9 versus 4.7). Encouraging results in the form of improved Sigma scores were seen in four of the quality indicators except for the fact that the patient location were still missing in the forms and hence warrants continuous monitoring.

Design of internal quality control program for specific protein testing based on patient risk / 中华检验医学杂志

Objective:Patient risk-based statistical quality control (SQC) program was designed for 9 specific protein projects using Westgard sigma rules with run length.Methods:The cumulative coefficient of variation of immunoglobulin (Ig)G, IgA, IgM, C3, C4, rheumatoid factor (RF), antistreptolysin O (ASO), transferrin (TRF) and prealbumin (PA) from the laboratory department of Beijing Tongren Hospital between December 2018 to May 2019 were used as the estimated value of imprecision. The mean of the absolute value of the percentage difference of 10 batches in the laboratory, which was derived from the results of participating the external quality assessment (EQA), was used as the estimated value of bias. The National Center for Clinical Laboratories EQA evaluation criteria was used as an allowable total error (TEa), and the sigma value of each project (σ) was calculated. Westgard Sigma rule with run length was used to design appropriate SQC program for each project, including quality control rules, number of control measurements (N) and frequency of quality control.Results:The sigma value was larger than 6 for SQC procedure of IgG, IgA, IgM, C4 and TRF. SQC could be established with the use of 1 3s rule, number of control measurements (N)=2, number of runs (R)=1, and a run length of 1 000 patient samples. Combined with the average daily workload, internal quality control could be conducted once every 10 days for IgG, IgA, IgM and C4, every 50 days for TRF. The σ was 5.86 for C3, SQC program could be established with run length of 450 using 1 3S/2 2S/R 4s rule (N=2, R=1), combined with average daily workload, internal quality control could be conducted every 4.5 days. σ was between 3 and 4 for RF, ASO and PA. With the use of 1 3S/2 2S/R 4s/4 1s/6 X rule (N=6, R=1), SQC program with a run length of 45 and higher frequency internal quality control activities. Conclusion:It is feasible to use Westgard sigma rules with run length for the laboratories design of personalized risk-based SQC procedures, the method is very simple and intuitive. This tool is valued to be recommended to be actively applied by all clinical laboratories.

The application of sigma metrics in the laboratory to assess quality control processes in South Africa

Objective: This study aimed to determine the sigma metrics of analytes when using different total allowable error guidelines.Methods: A retrospective analysis was performed on 19 general chemistry analytes at Charlotte Maxeke Johannesburg Academic Hospital in South Africa between January 2017 and December 2017. Sigma metrics were calculated on two identical analysers, using internal quality control data and total allowable error guidelines from the Ricos biological variation database and three alternative sources (the Royal College of Pathologists of Australasia, the Clinical Laboratory Improvements Amendment, and the European Federation of Clinical Chemistry and Laboratory Medicine). Results: The sigma performance was similar on both analysers but varied based on the guideline used, with the Clinical Laboratory Improvements Amendment guidelines resulting in the best sigma metrics (53% of analytes on one analyser and 46% on the other had acceptable sigma metrics) and the Royal College of Pathologists of Australia guidelines being the most stringent (21% and 23%). Sodium and chloride performed poorly across all guidelines (sigma < 3). There were also month-to-month variations that may result in acceptable sigma despite poor performance during certain months.Conclusion: The sigma varies greatly depending on the total allowable error, but could be a valuable tool to save time and decrease costs in high-volume laboratories. Sigma metrics calculations need to be standardised

Satisfacción con el servicio de posortodoncia de la Universidad Santo Tomás según métricas Lean-Six-Sigma / SatisfactionService Post-Orthodontic University Santo Tomas According ToLean-Six-Sigma Metrics

Introducción: La metodología Lean-Six-Sigma es utilizada actualmente en el área de la salud con el objeto de mejorar la calidad y competitividad de los servicios; pero aún no se tienen reportes de su uso en el área de ortodoncia. Objetivo: Determinar la satisfacción posortodoncia por medio de niveles sigma de los pacientes que asisten a una clínica docente-asistencial en Bucaramanga, Colombia. Métodos: Estudio observacional, descriptivo, transversal. La población estuvo constituida por 100 pacientes de ambos sexos, que ya habían concluido el tratamiento de ortodoncia. Se seleccionó toda la población que hubiera finalizado el tratamiento entre julio de 2017 y junio 2018 de acuerdo con criterios de inclusión y exclusión. Se realizó una encuesta telefónica de 17 preguntas y siete dimensiones de satisfacción. La confiabilidad del cuestionario se evaluó con la consistencia interna del cuestionario mediante el alpha de Cronbach en el que se obtuvo 0,87, y para la validez se utilizó el método de Lawshe. Se usó la metodología Lean-Six-Sigma para evaluar la calidad de la satisfacción; se presentan los resultados en porcentaje y niveles sigma. Resultados: La calidad en satisfacción en el servicio fue de 91,27 por ciento (medido convencionalmente) y 1,36 sigmas; en el grupo de 16-19 años fue de 93,6 por ciento y 1,52 sigmas; y para el grupo de más de 27 años, 84,9 por ciento y 1,03 sigmas. El sexo femenino reportó un 88,57 por ciento y 1,2 sigmas, mientras que el masculino, 93,46 por ciento y 1,51 sigmas. Conclusiones: Los resultados de satisfacción en ortodoncia, medidos por métodos convencionales, mostraron porcentajes aceptables, pero mostraron resultados incompetentes al medirse con niveles sigma, lo cual indica que existen problemas ocultos por identificar y que corresponderían a una siguiente investigación(AU)

Introduction: The Lean-Six-Sigma methodology is currently used in the health area in order to improve the quality and competitiveness of services; but there are still no reports of its use in the orthodontic area. Objective : to determine the post-orthodontic satisfaction by means of sigma levels of the patients who attend a teaching-assistance clinic in Bucaramanga, Colombia. Methods: Observational descriptive cross-sectional study. Population: 100 patients (female and male) who finish orthodontic treatment. Sample selection method: the entire population that had completed the treatment between July 2017 and June 2018 was selected according to inclusion and exclusion criteria. A telephone survey of 17 questions and seven dimensions of satisfaction was carried out. The reliability of the questionnaire was evaluated with the internal consistency of the questionnaire by means of the Cronbach's alpha in which 0.87 was obtained, and the Lawshe method was used for validity. The Lean-Six-Sigma methodology was used to assess the quality of satisfaction; Results are presented in percentage and sigma levels. Results: The quality of service satisfaction was 91.27 percent (conventionally measured) and 1.36 sigmas; in the group of 16 to 19 years it was 93.6 percent and 1.52 sigmas; and for the group over 27 years old, 84.9 percent and 1.03 sigma. The female sex reported 88.57 percent and 1.2 sigmas, and the male reported 93.46 percent with 1.51 sigmas. Conclusions: The satisfaction results in orthodontics, measured by conventional methods, showed acceptable percentages, but showed incompetent results when measured with sigma levels, which indicates that there are hidden problems to be identified and that they would correspond to a subsequent investigation(AU)

Six Sigma method to improve the efficacy of red blood cell transfusion in patients with stable hemodynamics / 中国输血杂志

【Objective】 To evaluate the value of Six Sigma quality management method in improving the efficacy of red blood cell transfusion. 【Methods】 The five steps of definition, measurement, analysis, improvement and control in Six Sigma quality management were used to analyze the existing process capability and influencing factors, so as to formulate corresponding optimized measures and control plans for continuous improvement. The transfusion effect of RBCs in hemodynamically stable patients in our hospital from January to November in 2019 were assessed in three phases: January to March(prior to the application of Six Sigma), April to August (tracking the application of Six Sigma), and September to November(determining the effect of Six Sigma). The efficacy and process ability of RBC transfusion in patients with stable hemodynamics before and after the improvement were analyzed and compared. 【Results】 After the improvement, the effective rate of RBC transfusion for hemodynamically stable patients in our hospital increased from 76.9% to 90.5%(P<0.05). The Z value of process capacity increased from 0.408 0 to 1.330 8, with a significant improvement. 【Conclusion】 Application of Six Sigma quality management method can effectively improve the effect of red blood cell transfusion in patients with stable hemodynamics.

Management system and development strategy of quality Chinese medicine / 中国中药杂志

The development of quality Chinese medicine is an important way to improve the quality of Chinese medicine, and ensure the safety and effectiveness of Chinese medicine. This article systematically elaborates the definition, classification, standard and mana-gement certification strategy of quality Chinese medicine. We present the quality Chinese medicine which is higher quality than that of eligible Chinese medicine based on quality control standards. Quality Chinese medicine is strictly in accordance with management procedures, likely GAP and GMP et al, during the productive process, which quality indicators is higher than that of the current relevant national quality standards, such as Chinese Pharmacopoeia(ChP) et al; its limited indicators such as exogenous pollutants and endogenous toxic substances are lower than that of the current relevant national quality standards, likely ChP et al; meanwhile these Chinese herbal medicine, medicinal pieces, patent medicines, and health products and foods with Chinese medicine raw materials are been certificated by quality Chinese medicine. At the same time, this article systematically expounds the five major management systems of quality Chinese medicine, including technical training management for practitioners, productive process management, standard mana-gement, quality inspection and certification management, and product traceability management. And we put forward strategies to improve the supervision and management system, and promote the standardization and development of quality Chinese medicine by improving the technical management system of quality Chinese medicine, strengthening the quality management system and six sigma(6σ) management in the company. These strategies will provide a reliable basis and effective way to improve the quality of Chinese medicine.

Aplicación de Seis Sigma en el Laboratorio Clínico / Six Sigma Application in the Clinical Laboratory

Seis Sigma es un método de mejora de procesos que se focaliza en disminuir la variabilidad de los mismos. El enfoque más común es contar los defectos, determinar el porcentaje, convertirlos a una tasa de defectos por millón y luego usar una tabla para buscar la métrica sigma apropiada. El segundo enfoque consiste en utilizar la medida de la variación del proceso para estimar la métrica sigma. En el laboratorio clínico se pueden aplicar ambos conceptos según la etapa del laboratorio en la cual se pretenda usar la métrica sigma. Para ambos enfoques un proceso de 6 sigmas es considerado un proceso eficiente, de alta calidad. En este trabajo se planteó para la etapa preanalítica una meta mínima de 4 sigmas. Algunos procesos muestran un buen desempeño con indicadores de calidad con sigmas mayores de 4. Sin embargo, varios de ellos tienen sigmas menores que la meta propuesta demostrando ser los más vulnerables. En Química Clínica y Hematología, la elección del requisito de calidad es el punto clave para armonizar la métrica sigma junto a la estrategia para la obtención del error sistemático y aleatorio. En este trabajo se muestran las diferentes estrategias para relacionar el desempeño basado en el sigma del proceso analítico con las reglas de validación de las corridas analíticas.

Six Sigma is a method for improvement of processes that focuses on reducing their variability. The most common approach is to count the defects, determine the percentage, convert them to a defect rate per million and then use a table to find the appropriate sigma metric. The second approach consists of using the process variation measure to estimate the sigma metric. In the clinical laboratory, both concepts can be applied according to the stage of the laboratory in which the sigma metric is intended to be used. For both approaches, a 6 sigma process is considered an efficient, high quality process. In this work, a minimum goal of 4 sigma was raised for the preanalytical stage. Some processes show good performance with quality indicators with sigma greater than 4. However, several of them have sigma lower than the proposed goal proving to be the most vulnerable. In Clinical Chemistry and Hematology, the choice of the quality requirement is the key point to harmonize the Sigma metric together with the strategy to obtain systematic and random error. This paper shows the different strategies to relate the performance based on the sigma of the analytical process with the validation rules of the analytical runs.

Seis Sigma é um método de melhoria de processos focado na redução da sua variabilidade. A abordagem mais comum é contar os defeitos, determinar a porcentagem, convertê-los numa taxa de defeitos por milhão e, depois disso, usar uma tabela para procurar a métrica sigma apropriada. A segunda abordagem consiste em usar a medida da variação do processo para estimar a métrica sigma. No laboratório clínico, podem ser aplicados os dois conceitos de acordo com a fase do laboratório em que se pretenda usar a métrica sigma. Para ambas as abordagens, um processo de 6-sigmas é considerado um processo eficiente e de alta qualidade. Neste trabalho, uma meta mínima de 4 sigmas foi definida para o estágio pré-analítico. Alguns processos mostram bom desempenho com indicadores de qualidade com sigmas maiores que 4. No entanto, vários deles têm sigmas menores que a meta proposta provando ser os mais vulneráveis. Em Química Clínica e Hematologia, a escolha do requisito de qualidade é o ponto chave para harmonizar a métrica sigma juntamente com a estratégia para obter o erro sistemático e aleatório. Este artigo mostra as diferentes estratégias para relacionar o desempenho baseado no sigma do processo analítico com as regras de validação das execuções analíticas.

Lean Six Sigma and anesthesia / Lean Seis Sigma e anestesia

Abstract Background: Demands for health services have been growing sharply. Consequently, the costs of the institutions for their operational maintenance and investments also increase. The challenge of hospital management is to achieve standards of quality and safety for patients, increasing their productivity and minimizing costs. Lean Six Sigma is a well-structured methodology that aims to eliminate waste and activities that do not add value, focused on reducing process variation, eliminating the causes of the defect, and improving performance. As a result, cost reduction, higher quality, and customer satisfaction are observed. Objectives: To define Lean Six Sigma methodology and search references in the literature on its use in Health and specifically in Anesthesiology. Content: How often the waste of medicines, materials and time (rework), as well as the errors that happen in the day-to-day of the anesthesiologist are reported. Anesthesiologists must know the impact of their professional practice, with the purpose of making more appropriate choices, thus reducing the damage to the environment, improving overall health, and reducing costs with health care. The use of the Lean Six Sigma methodology is suggested to make the anesthesia field more sustainable, improving the processes without prejudice to the patient. Conclusion: Lean Six Sigma methodology is a new business management strategy in the health area. It is perfectly inserted in the current context of quality and safety to the patient; therefore, relevant in the practice of anesthesiology.

Resumo Justificativa: As demandas por serviços de saúde têm crescido de forma acentuada. Consequentemente, crescem também os custos das instituições para sua manutenção operacional e investimentos. O desafio da gestão hospitalar é conseguir conquistar padrões de qualidade e segurança para o paciente, aumentar sua produtividade e minimizar os custos. Lean Seis Sigma é uma metodologia bem estruturada que visa a eliminar os desperdícios e atividades que não agregam valor, focada na redução da variação nos processos, elimina as causas do defeito, melhora o desempenho. Como resultado, observa-se redução de custo, maior qualidade e satisfação do consumidor. Objetivos: Definir metodologia Lean Seis Sigma e buscar na literatura referências do uso da metodologia em saúde e especificamente na anestesiologia. Conteúdo: Descreve-se como são frequentes os desperdícios de medicamentos, materiais e tempo (retrabalho), bem como os erros que acontecem no dia a dia do anestesiologista. O anestesiologista deve conhecer o impacto de sua prática profissional, com o objetivo de fazer escolhas mais apropriadas e reduzir assim o dano ao ambiente, melhorar a saúde global e reduzir os custos com assistência à saúde. Sugere-se o uso da metodologia Lean Seis Sigma para tornar a anestesia mais sustentável, com melhoria dos processos, sem prejuízo ao paciente. Conclusão: A metodologia Lean Seis Sigma é uma estratégia de gerenciamento de negócio de fato nova na área da saúde. Insere-se perfeitamente no contexto atual de qualidade e segurança ao paciente, relevante, portanto, na prática da anestesiologia.

Six sigma quality management method on improvement of nurses compliance for standard blood culture specimens in intensive care unit / 中国实用护理杂志

Objective To improve the compliance of nurses in ICU standard specimen collection of blood culture by six sigma quality management method, so as to improve the quality of blood culture sample submission, to ensure the accuracy of inspection results. Methods A total of 158 nurses in ICU from February 2016 to January 2017 were selected as the research objects. The six sigma quality management method was used to analyze the operation of blood culture samples collected by ICU nurses,and the improvement plan was worked out and implemented. The compliance rate of blood culture samples collected by nurses before and after implementation and the feedback information of laboratory about blood culture specimen quality were compared. Results Before the application of six sigma quality management method, the compliance rate of blood culture specimens collected by ICU nurses was 54.1％(152/281), and the compliance rate after improvement was 88.6％(271/306), and the difference was statistically significant (χ2=86.45, P<0.01). Among the factors influencing nurses' blood culture,the importance of blood culture was not enough, the operation process was not mastered, the relevant knowledge of blood culture was not mastered, and the allocation of related consumables was unreasonable. After implementation,the composition ratio was reduced from 50.4％(65/129), 24.0％(31/129), 45.7％(59/129), 21.7％(28/129) to 17.1％(6/35), 8.6％(3/35), 25.7％(9/35), 2.9％(1/35), and the difference was statistically significant (χ2=4.00- 12.39, P<0.01 or 0.05). The contamination rate of blood culture specimens after six sigma management was 6.2％(19/306) and significantly lower than that of 16. 4％(46/281) before implementation,and the difference was statistically significant (χ2=15.36, P<0.01). Conclusions The six sigma quality management method can improve the nurses' attention to the correct collection of blood culture samples, reveal the defects in the operation, and reduce the irregular behavior of blood culture process. Therefore, the compliance of ICU nurses with standardized blood culture samples is improved, and the contamination rate of blood culture specimens is effectively reduced.

Indicadores para mejorar la atención a pacientes según lean-seis-sigma: el caso del hospital Gustavo Fricke (Chile) / Indicators to Improve the Health Care to Patients according to Lean Six Sigma: the Case of the Gustavo Fricke Hospital (Chile) / Indicadores para melhorar o atendimento a pacientes segundo lean-seis-sigma: o caso do hospital Gustavo Fricke (Chile)

Resumen Justificación: ante ciertos desafíos sobre la competitividad de los servicios públicos, resulta crucial mejorar la calidad de la salud. Objetivos: (1) caracterizar el nivel de calidad de servicio en la demanda de urgencias hospitalarias, a partir de la gestión lean seis sigma; y (2) evidenciar la relevancia de ciertos indicadores clave de gestión en la unidad de urgencias de un hospital público. Método: a partir de una propuesta de variables lean-seis-sigma derivadas de la escala SERVQHOS, se aplica una encuesta sobre las percepciones de los usuarios de un servicio de urgencias en un hospital público chileno y se identifican y evalúan sus principales indicadores de gestión. Resultados: enfatizar la importancia de intervenir sobre ciertas variables relevantes en diferentes niveles de actuación de una unidad hospitalaria. Aportación: ilustrar una propuesta para mejorar la atención, enfocándose en la disminución de tiempos y errores en el servicio y agregando valor al paciente.

Abstract Justification: Regarding some challenges of the public services competitiveness, it is crucial to enhance the health quality. Objectives: (1) To characterize the levels of service quality in the emergency rooms based on Lean Six Sigma; and (2) to show the relevance of some key management indicators in the emergency room of a public hospital. Methods: Based on a proposal of Lean- Six-Sigma variables derived from the SERVQHOS scale, a survey was applied to the users regarding their perception about the emergency room services in a Chilean public hospital. The main management indicators thereof were identified and evaluated. Results: To emphasize how it is important to make interventions concerning some relevant variables at different action levels in a hospital Ward. Contribution: To illustrate a proposal to improve the health care, focused on reducing the service times and mistakes and adding values to the patient.

Resumo Justificação: perante certos desafios relacionados com a competitividade dos serviços públicos, resulta crucial melhorar a qualidade da saúde. Objetivos: (1) caracterizar o nível de qualidade do serviço na demanda de urgências hospitalares, a partir da gestão lean- seis-sigma; e (2) evidenciar a relevância de certos indicadores chave de gestão na unidade de urgências de um hospital público. Método: a partir de uma proposta de variáveis lean-seis-sigma derivadas da escala SERVQHOS, aplica-se um inquérito sobre as percepções dos usuários de um serviço de urgências num hospital público chileno e são identificados e avaliados seus principais indicadores de gestão. Resultados: enfatizar a importância de intervir sobre certas variáveis relevantes em diferentes níveis de atuação de uma unidade hospitalar. Contribuição: ilustrar uma proposta para melhorar o atendimento, a focar na diminuição de tempos e erros no serviço e adicionando valor ao paciente.

Efficiency in the operational process: reduction of incorrect entries and guarantee of compliance in the rendering of accounts / Eficiência no processo operacional: redução dos lançamentos incorretos e garantia de compliance na prestação de contas

ABSTRACT Objective To verify the impact of the Lean Six Sigma methodology in reducing incorrect entries of non-appropriated revenues and expenses. Methods Process for the review and application of the Lean Six Sigma methodology between December 2015 and September 2016, in a high-complexity general hospital in the city of São Paulo (SP). Results A total of 3,756,814 (100%) entries were audited between December 2015 and September 2016. The Sigma level evolved over the course of the process and increased from 3.44 Sigma in December 2015 to 5.92 Sigma in September 2016. Entries classified as non-appropriated revenues and expenses were brought down to 0% at the end of the study. Conclusion The use of the Lean Six Sigma methodology was efficient in reducing incorrect entries, calculating costs, ensuring compliance in rendering of accounts and accurately determining cost-outcome ratios.

RESUMO Objetivo Verificar o impacto da metodologia Lean Seis Sigma na redução de lançamentos incorretos de receitas e despesas não apropriadas. Métodos Processo de revisão e aplicação de metodologia Lean Seis Sigma, no período de dezembro de 2015 e setembro de 2016, em um hospital geral de alta complexidade da cidade de São Paulo (SP). Resultados Foram auditados 3.756.814 (100%) lançamentos durante os meses de dezembro de 2015 e setembro de 2016. O nível Sigma foi demonstrado na evolução do processo e aumentou de 3,44 Sigma, em dezembro de 2015, para 5,92 Sigma, em setembro de 2016. Os lançamentos classificados como receitas e despesas não apropriadas chegaram a 0% ao término do estudo. Conclusão O uso da metodologia Lean Seis Sigma foi eficiente na redução de lançamentos incorretos, na apuração correta de custos, na garantia de compliance na prestação de contas e na acurácia no projeto de custos e desfechos.

The application of the Six Sigma theory in the performance evaluation of the four cystatin C reagents / 国际检验医学杂志

Objective To determine the accuracy and accuracy of 4 cystatin C (CysC) reagents,to initially select a suitable detection system according to the Six Sigma parameters for the new development projects,and to evaluate the selected reagents comprehensively.Methods Imprecision (CV％) of 4 kinds of CysC reagents (A,B,C,D) were evaluated with mixed fresh serum of patients,the bias of each kit (Bias％) was evaluated by measuring 5 specimens of the CysC project 2016 Health Planning Commission interventricular quality assessment,the total allowable error (TEa) from Health Planning Commission interventricular quality assessment was used to calculate the Sigma value and quality target index (QGI),sigma verification diagram was rendered,and the results were compared.The linear range verification,interference experiment,clinical reporting range verification and biological reference interval validation were carried out for the highest sigma kit.Results The CV value of four kinds of CysC reagents(A,B,C,D)were 6.11％,5.39％,3.13％ and 3.66％.The value of bias were 4.63％,4.42％,5.38％ and 1.09％.The sigma value were 4.15σ,4.75σ,7.87σ and 7.90σ.The quality target index(QGI) of A and B were 0.50 and 0.55,The sigma performance verification diagrams indicated that the reagent A and B were at good performance level and reagent C and D were at the world class level,D was the best one.The linear range validation,interference test,clinical reportable range validation and biological reference interval validation of D reagent were carried out,which all accorded with the declaration and clinical needs of the instructions.Conclusion The performance verification of Sigma can directly reflect the difference of performance between different reagents,and can be used for the preliminary screening of the kit.

Especificaciones de calidad en base a error total: ¿Cuál es la mejor elección? / Quality specifications based on total error: What's the best choice? / Especificações de qualidade com base em erro total: Qual é a melhor escolha?

El objetivo del trabajo fue evaluar el desempeño anual de los métodos, en términos de error total (ET), las distintas especificaciones de calidad disponibles y el modelo Seis Sigma para calificar desempeño. Se evaluaron analitos con variabilidad biológica (VB), muy baja, baja, media y alta. Se calculó el ET (ETc) y el sigma (s) mensual a dos niveles de control; el ET permitido (ETp) para cada analito se obtuvo de 8 fuentes (metas biológicas y regulatorias). Se consideró desempeño aceptable cuando ETc

The aim of this work was to evaluate the annual performance of the methods in terms of total error (TE), the different quality specifications available, and the Six Sigma model to qualify performance. Analytes with very low, low, medium and high biological variability (BV) were evaluated. TE (TEc) and sigma (s) were calculated monthly at two levels of control; allowable TE (TEa) for each analyte was obtained from 8 sources (biological and regulatory goals). Acceptable performance was considered when TEc

O objetivo do trabalho foi avaliar o desempenho anual dos métodos em termos de erro total (ET), as diferentes especificações de qualidade disponíveis e o modelo Seis Sigma para qualificar desempenho. Foram avaliados analitos com variabilidade biológica (VB) muito baixa, baixa, média e alta. Calculou-se ET (ETc) e o sigma (s) mensal a dois níveis de controle; o ET permitido (ETp) para cada analito foi obtido de 8 fontes (metas biológicas e regulatórias). Levou-se em consideração o desempenho aceitável quando ETc < ETp e s≥3. Foi observada a estabilidade analítica durante o período de avaliação. Não foram alcançadas as metas biológicas para analitos com VB muito baixa, algo semelhante aconteceu para analitos com VB baixa e média; com VB alta alcançaram todas as especificações. O desempenho s e a regra de controle de Westgard dependeram do ETp escolhido; para magnésio, com CLIA (ETp=25%) se obteve s >10 (World Class) e simples regra (13s), com VB mínima s <3 e multirregra. Conclui-se que a aceitação do desemperno do método e as regras de controle dependeram do ETp escolhido, sem disporem nesse meio de metas mínimas a alcançar. O monitoramento mensal do ETc mostrou a estabilidade analítica com variabilidade típica de cada método.

Shortening Transfer Time of Critical Inpatients from Ward to Intensive Care Unit:Based on Six Sigma / 中国康复理论与实践

Objective To shorten the transfer time of critical inpatients from wards to intensive care unit (ICU). Methods From Novem-ber to December, 2015, 30 critical inpatients transferred from wards to ICU were investigated, and analyzed with Six Sigma DMAIC five-step method. There were 7 main processes and 22 sub-processes refined in transfer procedure, as well as the key quality points and the factors influencing the safety of transferring. Some improvement advice were recommended, including multifunctional transfer cart, Check-list before Transfer to Intensive Care Unit for Critical Patients, setting up transport group, training for young nurses and application of SBAR communication. Other 30 critical inpatients transferred from wards to ICU, from May to June, 2016, after the series of control pro-grams, were investigated. Results After improvement, the total transfer time from wards to ICU decreased (t=15.052, P<0.001), without the increase of human power and unsafety issues. The rescue success rate increased from 91.67%to 98.01%. Conclusion The process transfer-ring patient from wards to ICU has been reengineered based on Six Sigma DMAIC management, that reduces the time and improve the res-cue success rate.

Application of Six-Sigma management in prevention of catheter-related bloodstream infection in intensive care unit / 中国感染控制杂志

Objective To explore the effect of Six-Sigma management on prevention and control of catheter-related bloodstream infection(CRBSI) in intensive care unit(ICU).Methods Patients with indwelling central venous catheter in the ICU of a hospital in March-December 2015 were selected,five phases of Six Sigma(define,measure,analyze,improve,and control) were used to find out the key factors that affected CRBSI,targeted improvement measures were taken,incidence of CRBSI before and after adopting Six-Sigma was compared.Results After SixSigma management was adopted,incidence of CRBSI declined from 15.95‰(13/815) to 6.19‰(4/646),difference was significant(P＜0.05).Conclusion Six-Sigma management can reveal the defect in workflow,guide researchers to propose corresponding measures,and effectively reduce the incidence of CRBSI in ICU.

Development of home-based rehabilitation mode for stroke patients based on Lean Six Sigma theory / 中华全科医师杂志

The community rehabilitation model for stroke patients was developed based on the experiences of Quyang Community Health Service Center in Shanghai under the guidance of Lean Six Sigma.The validity of the process and results were evaluated by a expert group according to validity theory.The developed Manual of Home-based Rehabilitation mode for Stroke Patients in Community had good validity,which may provide guidance for stroke patients rehabilitation in the community,and also provide reference for clinical application.

Application of Lean Six Sigma theory in clinical medicine / 中华全科医师杂志

One of the effective methods to resolve the conflict between the ever-increasing medical demands and relatively limited medical resources is to improve the work efficiency of the medical institutions as well as to effectively control their operating cost through continuous reforms and improvements of the management modes in the medical industry.The Lean Management and Six Sigma Management theories which have been applied in manufacturing industry and service industry are now gradually being introduced to clinical medicine.This article systematically describes the Lean Management and Six Sigma Management theories and illustrates some examples of its application in health management renovation and the effects achieved.

Application of six sigma in processing of non-coated surgical instrument / 医疗卫生装备

Objective To apply six sigma management method to optimizing flow,enhancing treatment quality,prolonging service life and decreasing purchase cost of the non-coated surgical instrument.Methods The treatment flow of the noncoated surgical instrument was optimized through five steps of six sigma method including defining,measuring,analyzing,improving and controlling.The treatment results before and after flow optimization were compared,analyzed and evaluated.Results The rates for corrosion and rejection were both decreased significantly after flow optimization,while the quality was increased obviously (P＜0.05).Conclusion Six sigma management method involved in the treatment of the non-coated surgical instrument saves purchase cost,enhances the efficiency of disinfection supply room and facilitates effective supervision and monitoring.