运用PDCA循环法优化急性缺血性脑卒中患者静脉溶栓院内流程的效果分析

Application of PDCA cycle to optimize in-hospital process of intravenous thrombolysis in patients with acute ischemic stroke

摘要:

目的 探讨PDCA循环法在优化急性缺血性脑卒中患者院内流程中的实践情况及其对患者到院至用药时间（DNT）的影响。方法 选取2018年6月—2019年12月北京大学第三医院接受静脉溶栓治疗的167例急性缺血性脑卒中患者。其中2018年6月—2019年4月的65例PDCA循环法管理前阶段患者作为对照组；2019年5月—2019年12月的102例PDCA循环法管理后阶段患者作为实验组。分析两组患者DNT及临床各环节用时，针对存在的问题采用PDCA循环法进行管理。结果 两组患者性别比例、年龄比较，差异无统计学意义（P >0.05）。实验组NIHSS评分较对照组低，发病至来诊时间较对照组高（P <0.05）。实验组各环节用时及DNT较对照组低（P <0.05）。对照组DNT≤ 60 min患者15例（23.1%），实验组DNT≤ 60 min患者76例（74.5%）。实验组有64例患者（62.7%）静脉溶栓后NIHSS评分下降≥ 4分或NIHSS评分为0分，较对照组21例（32.3%）明显上升。结论 PDCA循环法可有效改进静脉溶栓院内诊疗流程，显著缩短临床各环节用时。

Abstract:

Objective To investigate the role of Plan-Do-Check-Action (PDCA) cycle in optimizing hospital procedures for patients with acute ischemic stroke (AIS) and its influence on the door-to-needle time (DNT) of these patients.Methods A total of 167 AIS patients undergoing intravenous thrombolysis in our hospital from June 2018 to December 2019 were enrolled. Patientsl treated from June 2018 to April 2019 (65 cases) without the application of PDCA cycle were included in control group, while those treated from May 2019 to December 2019 (102 cases) managed with PDCA cycle for preexisting problems were included in test group. We analyzed the DNT and the time spent on other clinical procedures in the two groups.Results There was no difference in gender and age composition between the two groups (P > 0.05). The National Institutes of Health Stroke Scale (NIHSS) score was lower in the test group than that in the control group (P < 0.05). The onset-to-door time was longer in the test group compared with the control group (P < 0.05). The DNT and time spent on other clinical procedures were all shorter in the test group than those in the control group (P < 0.05). There were 15 cases (23.1%) with DNT≤ 60 min in the control group, while 76 cases (74.5%) with DNT ≤ 60 min in the test group. The proportion of patients with a reduction in NIHSS score ≥ 4 or NIHSS score = 0 after intravenous thrombolysis was 62.7% (64 cases) in the test group, which was higher than 32.3% (21 cases) in the control group.Conclusions The PDCA cycle can effectively improve the in-hospital process of intravenous thrombolysis, and significantly shorten DNT and the time of other key steps in the process.