条形码技术全程监控血液标本检测过程分析

目的用实验室信息系统(LIS)条形码技术监控血液标本检测全过程,以期实现对标本检验流程的全程监控。方法医院信息系统(HIS)和LIS无缝连接,用条形码技术对以下关键环节进行监控:临床医生开单申请时间、采集标本时间、运送工人接收标本时间、检验人员核收标本时间、检测标本时间、结果审核时间、报告打印时间。通过条形码技术实现全程监控,并通过LIS统计报告回报时间(TAT),比较节点监控过程中实验室内TAT的目标值完成情况。结果不同急诊检验项目实验室外占用时间占总TAT的76.0%~88.9%,实验室内所用时间占TAT的11.10%~24.00%,离群值率下降。生化免疫流水线生化检验时段中位数为30 min,非流水线生化检验时段中位数为48 min。结论条形码技术应用对检验的全过程起到规范和监督作用,实现了检验流程的全程质量监控;条形码管理标本和流水线的结合带来更高效的标本处理。     

检验标本流程中信息节点控制的临床价值

目的在实验室信息系统(LIS)中以标本与数据流向,建立重要环节的节点控制程序,监控检验结果回报时间(TAT),全面提高检验质量。方法在LIS中设置节点控制程序,准确记录条码标本运转过程中的人-人、人-机交接等环节的时间节点,以及校核检测与报告过程中易产生漏项和延误报告的环节。结果通过条码标本流程监控及实时校核,杜绝了标本交接及报告时间的随意性,控制了"复杂标本"检测漏项或漏发报告等现象。结论LIS中建立的节点控制能实时监控TAT,规范各个操作规程,责任明确,对提高检验质量、工作效率及满意度都有极大益处。     

急诊生化检验项目TAT超时情况分析

正随着我国医疗卫生水平的提高,实验室检查成为临床评估病情发展的重要手段。为了及时向临床反馈实验结果,检验结果回报时间(turnaround time,TAT)成为目前反映临床实验室检测效率的最佳指标之一。TAT由3部分组成:开出医嘱到样本收集的时间、样本收集到样本接收的时间、样本接受到结果报告的时间。本研究对新疆医科大学第一附属医院检验科急诊检验组生化检验项目TAT超时标本进行分析,探究TAT超时原因,提出改进意见,合     

实验室生化检验结果的回报时间分析及改进措施

目的探讨实验室生化检验的报告时间,分析延长报告时间的影响因素,制订合理的改进措施,以缩短报告时间。方法选取2015年9~12月在河南科技大学第一附属医院进行生化全项检测的临床住院患者的标本1 000例,从实验室(检验科)信息系统(LIS)上收集所研究标本的相关资料,包括医嘱申请时间、标本采集时间、配送人员接收标本时间、生化室接收标本时间、标本登记时间、上机时间、双审核并报告时间。对研究标本的上述标本周转时间进行统计分析。结果延长报告时间的影响因素主要有:标本运输时间长;标本量大时报告时间延长;标本采集管及离心机质量差导致离心时间延长;部分医生医嘱申请与标本不符导致纠正时间延长;标本复查及危急值反馈临床导致报告时间延长。结论优化标本运输的工作流程,合理利用标本高峰期的配送资源,提高标本采集管、离心机以及检测仪器的质量,进一步完善信息系统,加强与临床的沟通可以有效缩短报告时间。     

利用信息化手段监控和优化检验结果回报时间

目的利用信息化手段进行临床实验室标本检验结果回报时间(TAT)监控,全面提高检验质量。方法通过医院管理系统(HIS)的医技管理模块中现有的医嘱开单时间、采样时间、接收时间、审核时间等数据,设计相关程序,获得各类标本的检验结果回报时间。结果通过对检验结果回报时间的分析找到影响效率的节点加以改进,明显缩短了我院的检验结果回报时间。结论在检验工作日益繁忙的情况下,信息化手段的应用使我院的工作效率和临床满意度得到了有效的提高。     

时间节点监控在检验标本流程管理中的应用

目的在实验室信息系统(LIS)中以检验全过程和标本的流转为主线,对关键环节进行时间节点监控,建立"精确到点、责任到人"的检验标本全过程监控系统。方法 LIS与医院信息系统(HIS)实现无缝连接,设置关键时间节点并加以监控,准确记录以条码为唯一标识的检验标本在临床科室、运送员工、检验科室等各环节、各部门之间交接的时间和责任人。比较节点监控前后标本遗漏率、标本平均流转时间、结果审核及时率、门诊等待抽血的耗时及门诊标本平均结果审核时间。结果对检验标本实现时间节点监控后,减少了标本在交接过程及结果报告等各环节的主观随意性,在对临床科室和患者进行的调查反馈中发现,满意度由96.0%提高为97.6%;检验标本遗漏率由1.34%下降为0.57%;标本平均流转时间由47.2 min缩短为38.6 min;结果审核及时率由97.5%提高为98.6%;门诊患者等待抽血的时间由40~50 min缩短为20~30 min;门诊标本的平均结果审核时间由42.2 min缩短为37.1 min。结论 LIS中建立关键时间节点监控,实现"精确到点、责任到人"的监控,可提高标本周转的效率,保证检验结果的可靠性和及时性,对保障患者安全目标具有重要意义。     

检验条形码的临床应用

[目的]在检验科室使用条形码扫描技术,实现检验工作流程的全自动化,提高临床实验室工作效率,杜绝不必要的人为差错。[方法]在临床医生工作站下医嘱时生成条形码,护士在给病人抽血时打印条形码,并将条形码贴至试管上,送至检验科,检验科室通过扫描条形码同时记费,最后将检验结果传至医生站。比较临床护理人员与检验科工作人员使用传统法与条形码LIS的标本处理时间及错误率。[结果]临床护理人员与检验科工作人员使用条形码LIS的标本处理时间及错误率均优于传统法(P<0.05)。[结论]使用检验条形码技术,实现了检验申请的标准化、检验记费的自动化、检验结果的实时性,提高了工作效率,降低了工作失误。     

临床实验室信息系统对检测流程的管理

目的 建立临床实验室信息系统对实验室内检测流程的实时监控,实现“高品质、高效率、高自动化”管理。方法 在临床实验室信息系统（CLIS）的信息流高效支撑下,根据医嘱条码信息,进行样本核收及前处理,实施室内质控和检测过程,校验标本属性,审核与提交检验报告,进行标本检测完毕的后处理。结果 引入“防呆机制”的实验室检测信息化监控管理系统,实现各种检测流程的节点监控,规范实验室检测管理。结论 CLIS对检测流程的实时监控,建立有效的实验室业务流“防呆机制”,对于规范实验室管理具有重要意义。     

条形码技术在临床实验室信息系统中的作用

目的将条形码技术应用于临床实验室信息系统,提高实验室的自动化程度和工作效率。方法患者在交费或标本采集时生成条形码,并贴在标本容器上。根据条形码信息完成分送标本、传送资料、核实和处理标本、分析仪双向通讯、查询结果、打印报告、保存标本等实验室的常规操作。结果条形码技术在检验信息管理系统中应用后,实现从检验医嘱的生成、收费、标本采集、标本接收、标本检测、结果审核、到网上发报告全过程的高效、准确和严谨。结论条形码技术不仅可以减少差错,极大地提高工作效率,而且还可以优化整个检验流程。条形码技术是实现实验室自动化、信息化的重要途径之一。     

将质量要求融入信息系统,以提高检验前质量控制能力

目的为了提高检验分析前环节的质量,利用信息系统对标本流程中的实验室前过程的质量控制要点进行实时提示、查询与监控。方法改进现有的电子检验申请单模式,实时跟踪、控制标本采集及运送过程中各环节的时间节点,并将标本采集的质量要求及检验项目的相关临床知识要点融入到开单与执行医嘱过程。结果 (1)为临床提供个性化专科或专病种检验申请项目单,如"急诊检验申请项目单",将可供急诊检验的项目集中于此,全院统一,非此单中所开检验申请一律视为非急诊项目;(2)在医生开单界面,随时通过双击鼠标查看检验项目:名称、标本种类、检测方法、标本采集要求、参考区间、临床意义、干扰因素及检验报告出具时间等内容;(3)护士执行医嘱时,每条检验项目行一栏均显示此项目的抗凝管类别或标本杯的条码前缀、采集量、采集要求及检验报告出具时间等内容;(4)所有人员均可通过"标本状态查询"功能,实时了解标本采集、签发、签收、处理、报告发送、报告打印等系列执行状态信息;(5)护士可通过"标本签收、退回"功能,查询本病区退回标本的原因、时间及操作人员信息。结论将检验分析前环节的质量控制要求融入信息系统,不仅方便临床医护实时了解检验相关知识的要求,而且完善了实验室对临床医护的培训、沟通体系,受到检验人员及临床医护的高度认可。     

Evaluation of the turnaround time of an integrated preanalytical and analytical automated modular system in a medium-sized laboratory

OBJECTIVES: Evaluation of an integrated Modular Preanalytics (MPA) and Modular Analytics SWA (MA) system (Roche Diagnostics) during continuous batch processing. DESIGN AND METHODS: A total of 1000 blood specimen tubes was processed and tested in a batch-wise fashion, according to two different specimen input conditions (Study 1 and Study 2). The resulting turnaround time of the system was assessed. RESULTS: Study 1 tubes were centrifuged in the MPA. The preanalytical time rose steadily from 14 to 28 min, and after sample 315, it showed minimal variation. The analytical time remained almost constant. In Study 2, tubes were centrifuged before being processed in the MPA. The preanalytical time increased from 4 to 19 min, and the analytical time increased similarly. The turnaround time in Study 1 was 132 min and in Study 2 was 108 min. CONCLUSION: Centrifugation in the MPA slightly increased the turnaround time. Nevertheless, the labor associated with specimen processing was reduced and the efficiency of the laboratory was improved.     

陕西省临床实验室标本周转时间调查

目的调查陕西省临床实验室检验标本周转时间(TAT),为实验室质量改进提供依据。方法实验室在线填报4个专业(生化、免疫、血尿粪常规、凝血)急诊和住院标本的检验前和实验室内TAT的第90百分位数;用Excel 2007和SPSS 17.0软件对回报数据进行统计分析;两组数据比较用Mann-Whitney U检验,多组数据比较用Kruskal-Wallis H检验。结果共发放调查表267份,实验室填报率91.0%;其中,完整填写标本TAT的实验室138家。4个专业急诊标本检验前TAT差异无统计学意义(P0.05),大于85%实验室集中在45 min内;4个专业住院标本检验前TAT差异有统计学意义(P0.05),80%实验室集中在120 min内,血尿粪常规标本的TAT较免疫稍短;无论急诊还是住院标本,二级医院实验室的4个专业检验前TAT均小于三级医院(P0.05)。无论是急诊还是住院标本,4个专业的实验室内TAT差异均有统计学意义(P0.05);血尿粪常规标本最短,其次是凝血,生化和免疫标本最长;80%实验室的生化、免疫、血尿粪常规、凝血的急诊标本实验室内TAT依次集中在30～120 min、30～180 min、60 min、15～120 min;80%实验室的血尿粪常规和凝血的住院标本实验室内TAT分别集中在120 min和180 min内,而20%实验室的生化和免疫的住院标本实验室内TAT分别≥240 min和≥300 min;无论急诊还是住院标本,两个等级医院实验室内标本TAT之间差异均无统计学意义(P0.05)。结论陕西省临床实验室检验标本TAT差异较大,部分实验室需要优化标本周转环节,缩短标本TAT。     

Experimental fusion of different versions of the total laboratory automation system and improvement of laboratory turnaround time

Background

Use of total laboratory automation (TLA) system has expanded to microbiology and hemostasis and upgraded to second and third generations. We herein report the first successful upgrades and fusion of different versions of the TLA system, thus improving laboratory turnaround time (TAT).

Methods

A 21‐day schedule was planned from the time of pre‐meeting to installation and clinical sample application. We analyzed the monthly TAT in each menu, distribution of the “out of range for acceptable TAT” samples, and “prolonged time out of acceptable TAT,” before and after the upgrade and fusion.

Results

We installed and customized hardware, middleware, and software. The one‐way CliniLog 2.0 version track, 50.0‐m long, was changed to a 23.2‐m long one‐way 2.0 version and an 18.7‐m long two‐way 4.0 version. The monthly TAT in the outpatient samples, before and after upgrading the TLA system, were uniformly satisfactory in the chemistry and viral marker menus. However, in the tumor marker menu, the target TAT (98.0% of samples ≤60 minutes) was not satisfied during the familiarization period. There was no significant difference in the proportion of “out of acceptable TAT” samples, before and after the TLA system upgrades (7.4 ‰ and 8.5 ‰) . However, the mean “prolonged time out of acceptable TAT” in the chemistry samples was significantly shortened to 17.4 (±24.0) minutes after the fusion, from 34.5 (±43.4) minutes.

Conclusions

Despite experimental challenges, a fusion of the TLA system shortened the “prolonged time out of acceptable TAT,” indicating a distribution change in overall TAT.

     

2台血凝分析仪的性能比较及临床应用评价

目的：对 LG-PABER-1型和 Sysmex CA510型2台血凝分析仪进行性能评价,并在临床应用上进行比较。方法对2台仪器进行 PT、APTT、TT 和 FIB 测试,并对线性、精密度、相关性进行比较评价。结果2台仪器检测项目 FIB 线性良好,分别为：仪器1为Y ＝0．931X ＋0．114,r＝0．9998;仪器2为Y ＝0．868X ＋0．242,r＝0．9993。相对偏差在-8．83％～28．1％之间,分析误差均在允许误差范围内。精密度分析：日内 CV％在0．84～3．19之间,日间 CV％在2．14～7．36之间。对43例临床样本进行分析,2台仪器各项目均数比较,差异无统计学意义（P ＞0．05）,PT、APTT、TT、FIB 相关性良好（r 分别为0．9716、0．9368、0．8391和0．9715）。结论2台仪器在对临床标本进行检测的结果之间相关性良好,检测结果之间具有良好的一致性和可比性,可以满足临床检测需要。     

Emergency Department Patient Volume and Troponin Laboratory Turnaround Time

Objectives: Increases in emergency department (ED) visits may place a substantial burden on both the ED and hospital‐based laboratories. Studies have identified laboratory turnaround time (TAT) as a barrier to patient process times and lengths of stay. Prolonged laboratory study results may also result in delayed recognition of critically ill patients and initiation of appropriate therapies. The objective of this study was to determine how ED patient volume itself is associated with laboratory TAT. Methods: This was a retrospective cohort review of patients at five academic, tertiary care EDs in the United States. Data were collected on all adult patients seen in each ED with troponin laboratory testing during the months of January, April, July, and October 2007. Primary predictor variables were two ED patient volume measures at the time the troponin test was ordered: 1) number of all patients in the ED/number of beds (occupancy) and 2) number of admitted patients waiting for beds/beds (boarder occupancy). The outcome variable was troponin turnaround time (TTAT). Adjusted covariates included patient characteristics, triage severity, season (month of the laboratory test), and site. Multivariable adjusted quantile regression was carried out to assess the association of ED volume measures with TTAT. Results: At total of 9,492 troponin tests were reviewed. Median TTAT for this cohort was 107 minutes (interquartile range [IQR] = 73–148 minutes). Median occupancy for this cohort was 1.05 patients (IQR = 0.78–1.38 patients) and median boarder occupancy was 0.21 (IQR = 0.11–0.32). Adjusted quantile regression demonstrated a significant association between increased ED patient volume and longer times to TTAT. For every 100% increase in census, or number of boarders over the number of ED beds, respectively, there was a 12 (95% confidence interval [CI] = 9 to 14) or 33 (95% CI = 24 to 42)‐minute increase in TTAT. Conclusions: Increased ED patient volume is associated with longer hospital laboratory processing times. Prolonged laboratory TAT may delay recognition of conditions in the acutely ill, potentially affecting clinician decision‐making and the initiation of timely treatment. Use of laboratory TAT as a patient throughput measure and the study of factors associated with its prolonging should be further investigated. ACADEMIC EMERGENCY MEDICINE 2010; 17:501–507 © 2010 by the Society for Academic Emergency Medicine     

急诊住院血常规标本实验室内周转时间调查与分析

目的调查分析急诊住院血常规标本的实验室内周转时间(TAT)。方法回顾性分析2012年1月1日至2014年5月31日解放军第四七七医院检验科检测的急诊住院血常规标本的实验室内TAT,比较分析800i五分类血液分析仪(简称800i)和HMX五分类血液分析仪(简称HMX)所检测标本的实验室内TAT合格率。结果 800i所测急诊标本的实验室内TAT合格率(90.05%)高于HMX(57.98%),组间比较差异有统计学意义(P0.05);不同工作日800i所测标本的实验室内TAT合格率比较差异有统计学意义(P0.05),且周六的合格率最高(93.86%)、周日最低(86.77%);不同工作日HMX所测标本的实验室内TAT合格率比较差异有统计学意义(P0.05),且除周一外,其余工作日的合格率均小于60%。结论建议实验室合理应用实验室信息系统(LIS)定期调查和分析标本TAT,尤其为急诊患者赢取更多的抢救时间。     

To bleed or not to bleed? is that the question for the PTT?

Summary. The activated partial thromboplastin time (PTT) is the grandchild of the Lee‐White whole blood clot time (WBCT). Both tests were developed to assist the diagnostic process for patients who exhibited features consistent with hemophilia, i.e., the pretest probability was extremely high. Probably <0.1%–1.0% of PTTs ordered in current medical practice fit that indication with the most common indication now being routine admission order; i.e., a pretest probability that is extremely low. The question asked of the PTT has evolved from ‘why does this patient bleed?’ to ‘will this patient bleed?’ As the PTT was never intended to answer that question, one must be careful regarding interpretation of results of that test. As many situations not related to hemorrhage are associated with perturbations of the PTT, a prolonged PTT is not strongly predictive of hemorrhage nor does a normal PTT provide shelter against hemorrhagic risk.