Abstract:

Objective　To improve the qualified rate of 24 h urine specimen collection, make clear diagnosis and timely treatment, and improve the patient satisfaction. Methods　In this study, a prospective study was conducted. From January to December 2021, patients who needed to be retained for 24 h urine test were selected from Department of Endocrinology, Fangcun Branch, The Second Clinical Medical College of Guangzhou University of Chinese Medicine. The control group included 50 hospitalized patients from January to May 2021, and the observation group included 53 hospitalized patients from June to December 2021. In the control group, there were 30 males and 20 females, with an age of (57.30±12.88) years old and a disease duration of (5.78±4.82) years; there were 30 males and 23 females in the observation group, with an age of (58.00±12.19) years old and a disease duration of (6.83±5.76) years. The control group was treated with conventional methods; the observation group was treated with Lean Six Sigma management system, the DMAIC cycle was used to define, measure, analyze, improve, and control the process of five stages, the improvement method was used to promote the project, at the same time, the fishbone diagram process improvement tool was used to optimize the retention process of 24 h urine specimens, and the whole process was effectively monitored. The correct rate of retention time, specimen contamination rate, insufficient specimen rate, correct rate of urine volume recording, rate of nurses' standardized education, and satisfaction were compared between the two groups. χ² test, Fisher exact probability test, and independent sample t test were used. Results　The correct rate of retention time was 90.00% (45/50) in the control group and 100.00% (53/53) in the observation group, with a statistically significant difference (P=0.024); the correct rate of urine volume recording was 90.00% (45/50) in the control group and 100.00% (53/53) in the observation group, with a statistically significant difference (P=0.024). The patient satisfaction was investigated, 50 patients were investigated before and after the implementation, and the patients' overall satisfaction score was improved from (3.86±0.57) before the implementation to (4.20±0.45) after the implementation, with a statistically significant difference (t=3.310, P=0.001). Conclusion　Based on Lean Six Sigma management, 24 h urine specimen collection process has achieved good improvement effect, can improve the quality of nursing service and patient satisfaction, and obtains a set of optimized process for 24 h urine specimen collection which is suitable for promotion and reference in hospitals.

Key words: Lean management, Six Sigma management, 24 h urine specimen, Process optimization

摘要： 目的　提高患者24 h尿液标本留取合格率，明确诊断，及时治疗，提高患者满意度。方法　本研究采用前瞻性研究，于2021年1月至12月，在广州中医药大学第二临床医学院芳村医院内分泌科选取需要留取24 h尿液标本检验的患者。对照组为2021年1—5月50例住院患者，观察组为2021年6—12月53例住院患者。对照组男30例，女20例，年龄（57.30±12.88）岁，病程（5.78±4.82）年；观察组男30例，女23例，年龄（58.00±12.19）岁，病程（6.83±5.76）年。对照组采用常规方法，观察组采用精益六西格玛管理体系，使用DMAIC（define， measure， analyze， improve， control）循环，即界定、测量、分析、改进、控制5个阶段构成的过程，改进方法进行项目推进，同时利用鱼骨图工艺改进工具，优化24 h尿液标本的留取流程，并对全过程进行有效监控。比较两组患者留尿时间正确率、标本污染率、标本量不足率、记录尿量正确率、护士规范宣教率、满意度。采用χ²检验、Fisher确切概率法、独立样本t检验。结果　对照组留尿时间正确率为90.00%（45/50），观察组留尿时间正确率为100.00%（53/53），差异有统计学意义（P=0.024）；对照组记录尿量正确率为90.00%（45/50），观察组记录尿量正确率为100.00%（53/53），差异有统计学意义（P=0.024）。调查患者的满意度，实施前后均调查50人，患者总体满意度评分由实施前的（3.86±0.57）分提升为实施后的（4.20±0.45）分，实施前后结果比较，差异有统计学意义（t=3.310，P=0.001）。结论　基于精益六西格玛管理，24 h尿液标本留取流程取得了较好的改进效果，能提升护理服务质量和患者满意度，得出一套适用于医院推广和借鉴的留取24 h尿液标本的优化流程。

关键词: 精益管理, 六西格玛管理, 24 h尿液标本, 流程优化