优化乳腺癌病理学报告交付
背景
Leica Biosystems 采用流程评估，以确定在活检、诊断和报告的整个治疗流程中，乳腺组织管理是否影响了及时诊断的能力。
我们发现设施内部存在孤岛现象，组织收集（空芯针与真空辅助设备）缺乏标准化流程，工作人员调度未达到最佳标准，处理组织涉及过多手工操作，以及过度使用低效的文件记录。 通过对每年进行 16000 - 53000 次手术的学术医学中心进行基准测试，我们找到了改进机会。
方法
由 Leica Biosystems 的临床和流程专家团队对流程进行现场观察，从患者进入活检室开始，直到他们的病理诊断报告交付为止。 我们获得了一些基线指标，包括 300 多个组织处理步骤，14 次科室间/科室内部交接，涉及 3 个不同的 IT 系统。 提交病理报告的周转时间为 4.0 - 10.0 天。
由流程和临床专家组成的一支多学科团队与领导层会面，要求执行以下建议：利用精益处理，调整人员安排，简化设施的物理布局，自动化工作流程，采用标本跟踪系统，并确认监控适当的指标。
结果
他们回访了医院，了解实验室在遵循上述建议后取得以下结果：病理报告交付时间缩短到 1.2 - 3.6 天。 此外，3536 小时的实验室工作量被重新分配，员工个人的生产效率提高 40%，手动标本处理工作减少了 47%。
一位合作伙伴选择不遵照建议，一年后进行重新评估；他们的流程或周转时间没有显著变化。 此外，工作人员口述对工作环境不满意，缺乏流程改进。
结论
通过评估当前的流程，（在适当情况下）应用精益流程原则，采用自动化和系统集成，并建立标准化的工作流程，最终加快乳房组织的病理评估和报告交付时间。 通过对需要额外测试（例如 IHC、ISH）的标本进行优化测试，明显看到时间缩短达到最大程度。 该前导性研究中的观察数据展示了整个综合流程中的流程改进如何帮助加快周转时间，从而为乳腺癌患者提供更可靠的诊断和加速诊疗。
About the presenters
Kimberly Byrwa-Neff is a registered nurse with a background in both clinical nursing and in evidence generation in industry. Her clinical expertise lies in cardiology and oncology, specifically breast cancer. As a nurse, black belt in process excellence, daughter of a breast cancer patient, and survivor of breast cancer herself she brings the full patient experience to her work to improve care for breast cancer patients. Kimberly has authored numerous papers and presented improvement in clinical outcomes as a result of working with breast teams across the country.
Adam Walter at Leica Biosystems is a Certified Six Sigma Master Black Belt and Certified Lean Agent. Adam has worked with over 500 facilities, spanning across the globe, focused on optimizing efficiency, improving quality and integrating automation into clinical workflow processes. His work has traversed a majority of the clinical and anatomic laboratory, as well as hospital departments such as pharmacy, chemotherapy preparation and supply chain. He has multiple publications in the space of workflow and automation as well as authoring industry guidelines relating to laboratory design and architecture.
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