医院言语语言病理学的质量改进倡议：精益-敏捷管理模式的开发与评价
A Quality Improvement Initiative in Hospital-Based Speech-Language Pathology: Development and Evaluation of a Lean-Agile Management Model.
文献信息
| PMID | 42922190 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Carina Escudero |
| 作者单位 | Division of Speech-Language Pathology, Central Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo. R. Dr. Ovídeo Pires de Campos, 225 - Cerqueira César, 05403-010, São Paulo, SP, Brazil. |
| 期刊 | International journal for quality in health care : journal of the International Society for Quality in Health Care |
| SCI 分区 | Q2 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 医院言语语言病理学（SLP）在重症患者照护中发挥战略性作用，尤其是在吞咽障碍管理方面。然而，高服务需求和有限资源凸显了对结构化管理办法的需求。本质量改进（QI）研究描述了精益-敏捷管理模式的实施以及临床照护指标基线的建立，以支持高复杂度医院环境中的吞咽障碍管理。
方法： 本质量改进倡议采用回顾性描述性设计，在巴西圣保罗一家高复杂度四级公立医院开展。该模式包括四个阶段：流程映射与价值链构建；使用受看板启发的优先级系统进行临床需求管理；通过预定义的流程和结局指标进行持续监测；以及通过回顾性分析2024年1月至2025年6月期间接受吞咽障碍管理的1,312例成人ICU患者进行评价。经口摄入状态采用功能性经口摄入量表（FOIS）进行分类。使用描述性统计，比例以95%置信区间（Wilson法）报告。
结果： 平均每日服务覆盖率为73%，相当于在100张ICU床位中，平均每日活跃需求为45例患者的情况下，每日接诊33例患者。吞咽障碍（FOIS 1-5）的总体患病率为88.95%（95%CI：87.1-90.5%），初次评估时依赖替代喂养途径（FOIS 1-3）见于54.65%（95%CI：51.9-57.3%）的患者。良好吞咽结局率为80.55%（95%CI：77.8-83.0%；N=869），替代喂养途径脱机率为77.28%（95%CI：73.4-80.8%；N=493）。不良结局主要归因于功能预后差（52.05%）和临床严重程度（30.41%），而流程相关失败仅占总样本的0.5%。
结论： 精益-敏捷管理模式为在高复杂度ICU环境中组织SLP服务提供了结构化方法，并使吞咽障碍照护指标基线的建立成为可能。大多数不良结局归因于患者的基础临床状况而非服务相关因素。这些发现可为类似医院环境中的服务规划和质量监测提供参考，尚待多中心评价。
英文摘要
BACKGROUND: Hospital-based Speech-Language Pathology (SLP) plays a strategic role in the care of critically ill patients, particularly in dysphagia management. However, high service demand and limited resources highlight the need for structured management approaches. This quality improvement (QI) study describes the implementation of a Lean-Agile management model and the establishment of a baseline of clinical care indicators to support dysphagia management in a high-complexity hospital setting.
METHODS: This quality improvement initiative used a retrospective descriptive design and was conducted in a high-complexity quaternary public hospital in São Paulo, Brazil. The model comprised four phases: process mapping and value chain construction; clinical demand management using a Kanban-inspired prioritisation system; continuous monitoring through predefined process and outcome indicators; and evaluation through retrospective analysis of 1,312 adult ICU patients receiving dysphagia management between January 2024 and June 2025. Oral intake status was classified using the Functional Oral Intake Scale (FOIS). Descriptive statistics were used, and proportions are reported with 95% confidence intervals (Wilson method).
RESULTS: The mean daily service coverage rate was 73%, corresponding to 33 patients seen per day out of a mean daily active demand of 45 patients across 100 ICU beds. The overall prevalence of dysphagia (FOIS 1-5) was 88.95% (95%CI: 87.1-90.5%), and dependence on an alternative feeding route at initial assessment (FOIS 1-3) was observed in 54.65% (95%CI: 51.9-57.3%) of patients. The favourable swallowing outcome rate was 80.55% (95%CI: 77.8-83.0%; N = 869), and the alternative feeding route weaning rate was 77.28% (95%CI: 73.4-80.8%; N = 493). Unfavourable outcomes were predominantly attributable to poor functional prognosis (52.05%) and clinical severity (30.41%), whereas process-related failures accounted for only 0.5% of the total sample.
CONCLUSION: The Lean-Agile management model provided a structured approach to organising SLP services in a high-complexity ICU setting and enabled the establishment of a baseline of dysphagia care indicators. Most unfavourable outcomes were attributable to patients' underlying clinical conditions rather than service-related factors. These findings may inform service planning and quality monitoring in similar hospital contexts, pending multicentre evaluation.