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Objective:Based on the business reengineering theory, to construct the emergency nursing process of acute massive hemoptysis in hospital and explore the effect of it.Methods:According to the order of hospitalization, 200 patients with acute massive hemoptysis admitted to the emergency department in Shanghai Pulmonary Hospital Affilated to Tongji University from January to June in 2020 were selected as the control group, and the original treatment process was adopted. Two hundred patients admitted to the emergency department of this hospital from July to December in 2020 were selected as the experimental group, and the reconstructed in-hospital emergency nursing process for acute massive hemoptysis was applied. In both groups, the researchers recorded the time spent in each sub-process by using the in-hospital treatment time record of acute massive hemoptysis and collected the clinical outcomes of patients through electronic cases. The time-consuming, treatment efficiency and patient outcome of each link of the treatment process in the backyard of the two groups were compared.Results:Finally, 192 patients were enrolled in the control group and the experimental group. The median time from admission to intravenous use of hemostatic drugs and from admission to endovascular treatment in the experimental group were 21.50(20.00, 22.50) and 82.50(79.50, 84.50) min, which were lower than those in the control group which spent 40.87(37.06, 44.43) and 135.50(123.50, 147.00) min, and the differences between the two groups were statistically significant ( Z=-16.84, 16.63, both P<0.01). The incidence of asphyxia caused by acute massive hemoptysis in the experimental group was 4.2%(8/192), which was lower than that in the control group, which was 13.0%(25/192) . There was a statistically significant difference in the incidence of asphyxia between the two groups( χ2=9.58, P<0.01). Conclusions:The emergency nursing process of acute massive hemoptysis effectively shortens the time of in-hospital treatment of acute massive hemoptysis, further promotes the seamless connection of multiple links of in-hospital treatment of acute massive hemoptysis, and improves the overall efficiency of in-hospital treatment of patients with acute massive hemoptysis.
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The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.
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Objective:To explore the effect of the optimized nursing procedure in the conduit room based on Hammer′s theory of process reengineering on the treatment time, anxiety and depression, clinical outcomes of patients undergoing percutaneous coronary intervention (PCI).Methods:A total of 125 PCI patients were received and treated in the conduit room of the Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University. Among them, 63 patients who underwent PCI from April to October 2019 were taken as the control group, and 62 patients who underwent PCI from November 2019 to May 2020 were taken as the observation group. The patients in the control group were treated with the conventional nursing procedure in the conduit room, while those in the observation group were treated with the nursing procedure in the conduit room optimized based on Hammer′s theory of process reengineering. The anticoagulant administration time, transit time, catheterization activation time, door to balloon dilatation time (D to B) and D to B compliance rate of patients were compared between the two groups. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to compare the differences of anxiety and depression between the two groups on the first day after PCI and 1 day before discharge. The incidence of adverse cardiac events during hospitalization, mortality, left ventricular ejection fraction on the 7th day after operation and hospitalization days were recorded.Results:The anticoagulant administration time, transit time, catheterization activation time, D to B time in the observation group were (10.41±1.86), (5.21±0.82), (48.26±6.42), (69.63±11.42) min, respectively, lower than the corresponding data of the control group, which were (17.65±2.94), (7.36±1.32), (57.26±7.61), (82.23±13.58) min. The D to B time compliance rate of patients in the observation group was 87.10% (54/62), which was higher than 69.84% (44/63) in the control group with statistical difference ( χ2 value was 5.49, P<0.05). The SAS and SDS scores of the patients in the observation group within 1 day after PCI were 38.89±5.94, 39.17±5.81, higher than 31.73±5.22, 33.77±5.32 in the control group with statistical difference ( t value was -7.16, -5.42, P<0.05). The incidence of adverse cardiac events during hospitalization, average hospitalization days and left ventricular ejection fraction on the 7th day after operation in the observation group were 8.06%(5/62), (11.26±2.14) d, (55.61±4.31)%, lower than 22.22%(14/63), (13.47±2.76) d, (52.21±3.22)% in the control group with statistical difference ( χ2 value was 4.86, t values were 4.99, 5.00, P<0.05). Conclusions:The nursing procedure in the conduit room optimized based on Hammer′s theory of process reengineering can effectively reduce the PCI patients′ treatment time, alleviate the anxiety and depression, improve the clinical outcome.
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Nowadays hospitals have been at the forefront fighting against novel coronavirus pneumonia, with diagnosing and treating of patients as a top priority. In order to ensure the smooth progress of diagnosis and treatment, and prevent the occurrence of nosocomial infection, logistics support needs to make allowances for the isolation ward in time from the perspectives of logistics, facilities and equipment, and to transform the in-and-out double channels of ward access as required, thus setting up the partition of the three zones. Secondly, logistics support needs to optimize the logistics service workflow, including the medical waste management, the environmental disinfection isolation, and to optimize the catering service within hospitals to reduce the gathering and flow of personnel. Thirdly, logistics support needs to increase personnel training, and to eliminate psychological panic as well as to stabilize the logistics support team by putting logistics management cadres on the front line. Meanwhile, the logistics department needs to take over the hospital access screening work, strictly manage those who enter the hospital, maximize the safety and reliability of the logistics support within the hospital, and ensure the smooth progress of the epidemic prevention work.
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Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.
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Thanks to the process reengineering of appointment registration, outpatient doctor′s advice, payment and mobile Internet application system, multiple payment queues in outpatient service have been replaced by automatic book keeping of the information system. This reform, based on short message reminders and the credit mechanism, has effectively reduced queuing time in convenience of the outpatients.
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Objective To investigate the effect of business process reengineering(BPR)on improving multisectors'participation in management of multidrug-resistant organism(MDRO)infection, and provide methodological guidance for hospital multisectors'collaborative management.Methods Related data about management and disposal of 672 cases of MDRO infection occurred from July 2015 to June 2017 were selected, 370 patients before BPR (from July2015to June 2016)were as control group, 302 patients after BPR(from July2016to June 2017)were as a trial group, BPR was used to improve the process of detection, report, cooperation, and disposal of MDROs in hospital, various quality evaluation indexes of healthcare-associated infection before and after BPR were compared. Results After the BPR was implemented, time of MDRO information transmitted from laboratory to clinical departments shortened from(240±30)minutes to(8±2)minutes;incidence of MDRO HAI decreased from2.39‰to 1.56‰, isolation rate of MDROs decreased from13.42％ to 11.09％, differences were all significant(all P＜ 0.05).Compliance rates and awareness rates of various MDRO prevention and control measures increased from 58.11％-71.89％to 84.11％-92.05％, usage rate of antimicrobial agents decreased from53.18％to 48.45％, defined daily doses(DDDs)of antimicrobial use density decreased from44.76 to 38.26, specimen submission rate before antimicrobial use increased from46.68％to 53.62％.Conclusion BPR can enhance the cooperation between different departments, give full play to the complementary advantages of interdisciplinary, and improve the efficiency of HAI management.
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The standardized management strategy is put into practice of hospital logistics. The standard time management as used in sample delivery service, is cited as an example for analysis of the rationality and efficiency of standard operating practice in hospital logistic services. The purpose is to identify causes of lost operation time and the countermeasures,thus improving working efficiency,performance-based management method,and scoring better operating performance and standard operation process reengineering.
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Based on the analysis of the existing medical service process,the paper takespatient centered as the ultimate objective,and transforms the health service process from the view of informatization including smart hospital,regional health and family health processes.The design includes the health service modes of smart hospital,family health and regional health sub-modules,and provides ideas for the achievement of wisdom medical in the future.
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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.
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Through surveying the hospital′s operation situation and management process of the simple clinic , and outpatient quantity in January to March 2016, we discussed and analyzed the problem of the simple clinic when working , then promoted service process reengineering , so as to the hospital′s simple clinic come into being scientific , reasonable , system management model .
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Objective The study aimed to improve the medication safety of aged patients through the reengineering of the dispense process of discharge medications for elderly cardiac patients.Methods The original dispense process was analyzed to find the existing problems,changing the order of process,increasing or decomposing steps of process in order to redesign,perfect and implement the distribution process of medications.Time and correction rate of drug dispensing for three times a day,mastering degree of related knowledge of oral medication and satisfaction degree with medication instruction were compared before and after reengineering of the process.Results Compared with the original process,patients' ability to understand the drug knowledge,the timing when the patients take three medications per day and the satisfaction degree with the instructions of taking medications all had statistical significance.Conclusions Reengineering of the dispense process of discharge medications for elderly cardiac patients can help to improve patients' understanding of drug knowledge,improve the security of taking medications outside the hospital as well as their satisfaction degree with nursing.
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The business process reengineering is accomplished by setting up at the operation room a pre-op ready room,an anesthesia induction room,and an anesthetic recovery room.With the aid of the computerized management system,a system platform is built to connect anesthetists,blood bank and pathology lab.This can optimize operation room management,shorten turn-over time before operations,improve efficiency,and cut back hospital costs for an all-win outcome.
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The hospital designed a new business process according to the business process reengineering theory and requirement of Diagnosis Related Groups-prospective payment.This new process has scored good outcomes following adjustment of department functions,staffing and equipment installation,as well as process optimization,and policy explanations.
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Objective To optimize physical examination processes,to manage physical examination scientifically in order to meet the needs of medical staff.Methods Medical guidelines were updated by using modern information systems.Meanwhile,the internal structure of medical examination center was rearranged reasonably.The examination process was stuck on the wall which integrated people oriented idea.Results After process reengineering,the return rate of examination menu was 98.55％,project completion rate was 99.16％,one time completion rate was 98.41％,physical examination time was reduced to (1.80±1.50) h.The satisfaction degree of the physical examinees was also increased.All parameters had significant differences compared with the former.Conclusions Scientific process reengineering of health examination plays a scientific and informatization management role.It can improve physical examination quality,increase physical examination capacity,and achieve good social benefit.
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Objective To discuss the practical effect of process reengineering in PICC reengineer-ing management. Methods PICC process was analyzed and the original unreasonable process was reengineered. The number of cases for tube insertion, success rate of paracentesis, incidence rate of compli-cations and patients satisfaction degree with nursing before and after implementing process reengineering were compared nsing χ2 test. Results After the promotion for clinical use of PICC, the numbers of cases for tube insertion, success rate of paracentesis and incidence rate of complication evidently decreased, pa-tients satisfaction degree increased greatly. Conclusions Process reengineering makes the PICC man-agement more standard, safe and highly effective.
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ObjectiveTo explore influence of emergency nursing process reengineering on the satisfac-tion degree of patients, quality of rescue, rescue time and success rate of rescue. MethodsEvidence-based nursing method was used for emergency nursing process reengineering. The first 30 types of acute and sever diseases and the first 6 large emergency events in 2008 were chosen as the rescue objectves, and they received new emergency nursing process. Influence of classic emergency nursing process in 2007 was retrieved and revalued. The satisfaction degree of patients, quality of emergency nursing and success rate of emergency before and after process reengineering were compared and analyzed. ResultsCompared with that before process reengineering, the satisfaction degree of experts, doctors and nurses, and patients was higher, the quality of emergency nursing greatly improved, the rescue time was less, and the success rate of rescue was higher after process reengineering. ConclusionsEmergency nursing process reengineering was more hu-man oriented. It can rescue patients with acute and severe diseases with lest time, reduce disputes between nurses and patients. It is worthy of application in clinic and the process should be reengineered and im-proved constantly in the future.
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ety, reduce the risk of infection and improve the efficiency of nursing service.
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Objective To explore the clinical value of application research in business process reengineering in transferring of inpatients for check-up. Methods We reorganized transferring of inpatients for check-up and service tache by introducing the Systematic Redesign method from the therory of Business Process Reengineering. The reengineered process was adopted and applied in the transferring processes. We randomly selected patients for check-up(126 cases for electrocardiogram,130 cases for Xrayand 128 cases for CT examination)and investigated the time cost for check-up and patients satisfaction rate. The above results were compared with those patients(112 cases for electrocardiogram,112 cases for Xrayand 120 cases for CT examination)before use of reengineered process. Results The time cost for the above mentioned check-up was shorter and patients satisfaction rate were alleviated compared with those before use of reengineered process(U=14.55,12.26,13.57;x2=17.37,14.65,10.75,P＜0.01).Conclusion Application of business process reengineering in the transferring process of inpatients for check-up proved pivotal important in that it could shorten time cost for transferring process and improve patients satisfaction rate.It possessed realistic significance for increasing benefit and competitions for hospitals.
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Based on the analysis of current status of medical service process including the service in out-patient, hospitalization, test, examination, nursing, and so on, the paper describes the bottlenecks and major existing problems of current medical service process. And it further discusses how to make full use of the advanced health information technology, make scientific and reasonable arrangements for all links of medical service, reconstruct medical service process facing the patients, and optimize and reengineer the medical service process.