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Garcia-Castrillo Riesgo L, Lauwaert D, Cadamuro J, von Meyer A, Dodt C. The preanalytical process in the emergency department, a European survey. Clin Chem Lab Med 2023; 61:93-103. [PMID: 36302372 DOI: 10.1515/cclm-2022-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Clinical decision-making in emergency medicine is under constant pressure from demand and performance requirements, with blood tests being a fundamental part of this. However, the preanalytical process has received little attention. Therefore, this study aimed to investigate the quality of preanalytical phase processes in European emergency departments (EDs) from the perspectives of the three main providers: clinicians, nurses, and laboratory specialists. METHODS This online survey, distributed among European EDs and laboratories, was supported by the European Society for Emergency Nursing (EUSEN), European Society for Emergency Medicine (EuSEM), and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). The size of the centres, the European region, the responder's profession and the country's economic condition were used as co-variables. RESULTS We included 376 responses from all ED-related professions from 306 European centres. In 66.9% of all ED visits, at least one blood test was performed. Tests were requested mostly by nurses (44.6%) using electronic Order/Entry systems (65.4%). Only a minority (19%) reported not using laboratory quality indicators (QIs). Most responders defined the TAT starting point "when the laboratory receives the sample" (66.1%), defining the goal to be "less than 60 min" (69.9%), but only 42.4% of the centres estimated achieving this goal. CONCLUSIONS Our survey illustrates the current situation on preanalytical blood sample processing in European EDs from the clinical and laboratory perspectives. The results emphasise the importance of the IT infrastructure and QI usage in this process and highlight some differences between European regions.
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Affiliation(s)
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Alexander von Meyer
- Institute for Laboratory Medicine and Medical Microbiology, München-Klinik, Munich, Germany
| | - Christoph Dodt
- Emergency Department, München-Klinik Bogenhausen, Munich, Germany
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Singh I, Sarkar S, Dhote S. Turnaround time for the issuing of packed red cells: A retrospective study in a tertiary care hospital. MGM JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/mgmj.mgmj_196_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Becker AS, Das JP, Woo S, Elnajjar P, Chaim J, Erinjeri JP, Hricak H, Vargas HA. Programmatic Implementation of a Custom Subspecialized Oncologic Imaging Workflow Manager at a Tertiary Cancer Center. JCO Clin Cancer Inform 2022; 6:e2200066. [PMID: 36084275 PMCID: PMC9848557 DOI: 10.1200/cci.22.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate whether a custom programmatic workflow manager reduces reporting turnaround times (TATs) from a body oncologic imaging workflow at a tertiary cancer center. METHODS A custom software program was developed and implemented in the programming language R. Other aspects of the workflow were left unchanged. TATs were measured over a 12-month period (June-May). The same prior 12-month period served as a historical control. Median TATs of magnetic resonance imaging (MRI) and computed tomography (CT) examinations were compared with a Wilcoxon test. A chi-square test was used to compare the numbers of examinations reported within 24 hours and after 72 hours as well as the proportions of examinations assigned according to individual radiologist preferences. RESULTS For all MRI and CT examinations (124,507 in 2019/2020 and 138,601 in 2020/2021), the median TAT decreased from 4 (interquartile range: 1-22 hours) to 3 hours (1-17 hours). Reports completed within 24 hours increased from 78% (124,127) to 89% (138,601). For MRI, TAT decreased from 22 (5-49 hours) to 8 hours (2-21 hours), and reports completed within 24 hours increased from 55% (14,211) to 80% (23,744). For CT, TAT decreased from 3 (1-19 hours) to 2 hours (1-13 hours), and reports completed within 24 hours increased from 84% (82,342) to 92% (99,922). Delayed reports (with a TAT > 72 hours) decreased from 17.0% (4,176) to 2.2% (649) for MRI and from 2.5% (2,500) to 0.7% (745) for CT. All differences were statistically significant (P < .001). CONCLUSION The custom workflow management software program significantly decreased MRI and CT report TATs.
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Affiliation(s)
- Anton S. Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeeban P. Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pierre Elnajjar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joshua Chaim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P. Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Mutema L, Chapanduka Z, Musaigwa F, Mashigo N. In-depth investigation of turn-around time of full blood count tests requested from a clinical haematology outpatient department in Cape Town, South Africa. Afr J Lab Med 2021; 10:1318. [PMID: 34007817 PMCID: PMC8111617 DOI: 10.4102/ajlm.v10i1.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background The performance of laboratories can be objectively assessed using the overall turn-around time (TAT). However, TAT is defined differently by the laboratory and clinicians; therefore, it is important to determine the contribution of all the different components making up the laboratory test cycle. Objective We carried out a retrospective analysis of the TAT of full blood count tests requested from the haematology outpatient department at Tygerberg Academic Hospital in Cape Town, South Africa, with an aim to assess laboratory performance and to identify critical steps influencing TAT. Methods A retrospective audit was carried out, focused on the full blood count tests from the haematology outpatient department within a period of 3 months between 01 February and 30 April 2018. Data was extracted from the National Health Laboratory Service laboratory information system. The time intervals of all the phases of the test cycle were determined and total TAT and within-laboratory (intra-lab) TAT were calculated. Results A total of 1176 tests were analysed. The total TAT median was 275 (interquartile range [IQR] 200.0–1537.7) min with the most prolonged phase being from authorisation to review by clinicians (median 114 min; IQR: 37.0–1338.5 min). The median intra-lab TAT was 55 (IQR 40–81) min and 90% of the samples were processed in the laboratory within 134 min of registration. Conclusion Our findings showed that the intra-lab TAT was within the set internal benchmark of 3 h. Operational phases that were independent of the laboratory processes contributed the most to total TAT.
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Affiliation(s)
- Leonard Mutema
- Department of Haematological Pathology, Tygerberg Hospital, National Health Laboratory Service and Stellenbosch University, Cape Town, South Africa.,Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Zivanai Chapanduka
- Department of Haematological Pathology, Tygerberg Hospital, National Health Laboratory Service and Stellenbosch University, Cape Town, South Africa
| | - Fungai Musaigwa
- Department of Haematological Pathology, Tygerberg Hospital, National Health Laboratory Service and Stellenbosch University, Cape Town, South Africa
| | - Nomusa Mashigo
- Department of Haematological Pathology, Tygerberg Hospital, National Health Laboratory Service and Stellenbosch University, Cape Town, South Africa
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Emmanuel I, Abaniwo S, Nzekwe P, Richard SK, Abobarin O, Longwap A, Joseph A. Laboratory Turnaround Time of Surgical Biopsies at a Histopathology Service in Nigeria. Niger Med J 2020; 61:180-183. [PMID: 33284886 PMCID: PMC7688028 DOI: 10.4103/nmj.nmj_173_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Laboratory turnaround time is defined as the time between the receipt of a sample in the laboratory and when the report is ready for collection/dispatch. It is a critical component of the quality assurance of a laboratory and has been identified as a key performance indicator of laboratory performance. This study is aimed at evaluating the turnround time in the histopathology unit of our center and comparing the findings with that of similar studies. Methodology This was a prospective descriptive study of the first 500 consecutive samples of surgical biopsies submitted for analyses at the Histopathology Department of the Jos University Teaching Hospital. The samples were tracked from the reception desk, where they are submitted to the dispatch point where the results are collected by clients. The grossing time (T1), processing time (T2), reporting time (T3), and the transcription time (T4) were recorded for each sample. The data obtained were analyzed using SPSS software and presented as simple frequencies and percentages. Results The mean laboratory turnaround time was 7.5 + 9.7 days with a range of 3-18 days. As much as 20.8% of reports were ready for dispatch by day 3 and 100% by day 18. Overall, the grossing time (T1), processing time (T2), reporting time (T3), and transcription (T4) time consumed 17.5%, 35.5%, 27.7%, and 19.3% of the total time spent, respectively. Conclusion We recommend the development of practicable targets for the histopathology laboratories as regards timeliness. This should be regularly evaluated to ensure compliance and improvement of service quality in this regard.
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Affiliation(s)
- Innocent Emmanuel
- Department of Histopathology, University of Jos, Jos, Nigeria.,Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Samuel Abaniwo
- Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Patrick Nzekwe
- Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Olufunmilayo Abobarin
- Department of Anatomical Pathology, Bingham University Teaching Hospital, Jos, Nigeria
| | - Abdulazis Longwap
- Department of Chemical Pathology, Bingham University Teaching Hospital, Jos, Nigeria
| | - Alhamdu Joseph
- Department of Academy and Cadets Matters, Nigerian Defence Academy, Kaduna, Nigeria
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Verma N, Pacini GS, Torrada JP, de Oliveira DM, Zanon M, Marchiori E, Mohammed TL, Hochhegger B. Subspecialized radiology reporting: productivity and impact on the turnaround times for radiology reports in a middle-income country. Radiol Bras 2020; 53:236-240. [PMID: 32904829 PMCID: PMC7458564 DOI: 10.1590/0100-3984.2019.0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effect that transitioning from a model of general radiology reporting to one of subspecialized radiology reporting has on report turnaround times (TATs) and on productivity in the radiology department of a hospital in a middle-income country. Materials and Methods The reporting workflow in our radiology department was changed from general reporting (any radiologist reporting imaging studies for any specialty) to subspecialized reporting (radiologists exclusively reporting imaging studies that fall within their subspecialty-abdominal, musculoskeletal, cardiothoracic, emergency, or neurological imaging). This was a retrospective study in which we compared general reporting with subspecialized reporting in terms of the following variables: the TAT; the proportions of reports completed within 2 h and within 24 h (TAT-2h and TAT- 24 h, respectively); and productivity. Data were collected over two 24-month periods (2015-2016 for general reporting and 2017-2018 for subspecialized reporting). Results A total of 208,516 reports were generated. The median report TAT decreased from 49.1 h and 52.9 h in 2015 and 2016, respectively, to 16.1 h and 15.2 h in 2017 and 2018, respectively (p < 0.001). The TAT-2h also improved, increasing from 8.7% and 7.9% in 2015 and 2016, respectively, to 52.0% and 61.3% in 2017 and 2018, respectively (p < 0.001), as did the TAT- 24 h, which increased from 12.1% and 14.1% in 2015 and 2016, respectively, to 74.3% and 78.7% in 2017 and 2018, respectively (p < 0.001). Between the two periods, the total number of scans performed increased by 33% (p = 0.001). Conclusion The implementation of a subspecialized reporting system significantly improved the median TAT for radiology reports, as well as increasing the TAT-2h and TAT- 24 h, during a time of increased productivity.
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Affiliation(s)
- Nupur Verma
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Diogo Martins de Oliveira
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Matheus Zanon
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Tan-Lucien Mohammed
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bruno Hochhegger
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.,School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Bhartia S, Wahi P, Goyal R. Reducing delay in laboratory reports for outpatients from 16% to <3% at a non-profit hospital in New Delhi, India. BMJ Open Qual 2019; 8:e000547. [PMID: 31750402 PMCID: PMC6830465 DOI: 10.1136/bmjoq-2018-000547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 09/27/2019] [Accepted: 10/06/2019] [Indexed: 11/03/2022] Open
Abstract
In early 2013, several outpatients at Sitaram Bhartia Institute of Science and Research in New Delhi, India complained that their laboratory results were not ready at the promised time. We reviewed the data for 3 months and learnt that 16% of outpatient results were not ready when patients returned to receive them. We formed a multidisciplinary team to fix the problem. After conducting a time-and-motion study, process mapping and discussions the team identified two key problems: (1) the laboratory consultant did not have a set time to validate the results and (2) the reasons of delay in laboratory reports were not documented; this made it hard to identify and solve specific reasons. The team decided to set a fixed time for the consultant to verify results and to document reasons for delay in each case. The team used Plan-Do-Study-Act (PDSA) cycles to finalise the verification system and to set up the documentation system. Documentation led to the identification of new problems which were also solved using PDSA cycles. Delay in reports reduced significantly from 16% in March 2013 to less than 3% in a period of 4 months. We have sustained these gains for the past 5 years.
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Affiliation(s)
- Saru Bhartia
- Quality, Sitaram Bhartia Institute of Science and Research, Delhi, India
| | - Pradaya Wahi
- Quality, Sitaram Bhartia Institute of Science and Research, Delhi, India
| | - Rinu Goyal
- Laboratory Medicine, Sitaram Bhartia Institute of Science and Research, Delhi, India
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Verbano C, Crema M. Applying lean management to reduce radiology turnaround times for emergency department. Int J Health Plann Manage 2019; 34:e1711-e1722. [PMID: 31397026 DOI: 10.1002/hpm.2884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/18/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
Given the high impact of emergency department (ED) on the quality of care delivered by an hospital, and the many challenges it is facing (eg, overcrowding, excessive waiting time, cost containment, and increasing demand from patients), innovative managerial approaches should be adopted in order to develop safer and more efficient healthcare in this setting. The current study focuses on an application of lean thinking to reduce radiology turnaround times for ED, with the final aim to highlight the key factors enabling the adoption of lean thinking in this context. A research framework has been developed in the literature to analyse lean projects in healthcare and it has been adapted to study the case selected in an Italian hospital. In particular, organizational aspects, phases, and activities of the applied methodology, tools and procedures, and the achieved outcomes have been analysed. The study reports how radiology turnaround times for ED can be significantly reduced applying lean management principles and techniques. The achieved results contribute not only to comply with the regulation, but also to enhance the quality of care delivered to the patient; moreover, staff communication, involvement, and process awareness are favoured by the realization of similar projects promoting the diffusion of a lean culture.
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Affiliation(s)
- Chiara Verbano
- Department of Management and Engineering, University of Padova, Vicenza, Italy
| | - Maria Crema
- Department of Management and Engineering, University of Padova, Vicenza, Italy
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A Business Analytics Software Tool for Monitoring and Predicting Radiology Throughput Performance. J Digit Imaging 2018; 29:645-653. [PMID: 26957292 DOI: 10.1007/s10278-016-9871-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Business analytics (BA) is increasingly being utilised by radiology departments to analyse and present data. It encompasses statistical analysis, forecasting and predictive modelling and is used as an umbrella term for decision support and business intelligence systems. The primary aim of this study was to determine whether utilising BA technologies could contribute towards improved decision support and resource management within radiology departments. A set of information technology requirements were identified with key stakeholders, and a prototype BA software tool was designed, developed and implemented. A qualitative evaluation of the tool was carried out through a series of semi-structured interviews with key stakeholders. Feedback was collated, and emergent themes were identified. The results indicated that BA software applications can provide visibility of radiology performance data across all time horizons. The study demonstrated that the tool could potentially assist with improving operational efficiencies and management of radiology resources.
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Patel V, Sindhwani G, Gupta M, Arora S, Mishra A, Bhatt J, Arora M, Gehani A. A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center. J Clin Diagn Res 2017; 11:TC10-TC16. [PMID: 28969238 DOI: 10.7860/jcdr/2017/29545.10354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION An organization's transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. AIM To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. MATERIALS AND METHODS To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP's), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. RESULTS A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. CONCLUSION Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety.
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Affiliation(s)
- Viral Patel
- Associate Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Geetika Sindhwani
- Assistant Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Monica Gupta
- Professor, Department of Pathology, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Sweta Arora
- Manager QIG, Department of QIG, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Arpita Mishra
- Executive QIG, Department of QIG, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Jayesh Bhatt
- Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Manali Arora
- Senior Resident, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Anisha Gehani
- Resident, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
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Masamba LPL, Mtonga PE, Kalilani Phiri L, Bychkovsky BL. Cancer Pathology Turnaround Time at Queen Elizabeth Central Hospital, the Largest Referral Center in Malawi for Oncology Patients. J Glob Oncol 2017; 3:734-739. [PMID: 29244984 PMCID: PMC5735957 DOI: 10.1200/jgo.2015.000257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose In all settings, a need exists for expedited pathology processing for patients with a suspected cancer diagnosis. In low- and middle-income countries (LMICs) with limited resources, processing pathology samples is particularly challenging, so the measurement of turnaround times (TATs) for pathology results is an important quality metric. We explored the pathology TAT for suspected cancer patients at Queen Elizabeth Central Hospital in Malawi to determine whether a difference exists when patients paid an out-of-pocket fee (paid for [PF] v nonpaid for [NPF]) to facilitate sample processing. Methods and Population This retrospective descriptive study included all patients with suspected cancer (N = 544) who underwent incisional and excisional biopsy in 2010 at Queen Elizabeth Central Hospital, a teaching hospital in Malawi. Data were abstracted from patient charts and administrative forms to build a database and determine the TAT for PF and NPF samples. Results The median TAT for the 544 patients was 71 days (interquartile range [IQR], 31 to 118 days). The median pathology processing time was 31 days (IQR, 15 to 52 days) and was shorter for PF versus NPF samples. The median TAT was 43 days for PF samples (IQR, 27 to 69 days) versus 101 days for NPF samples (IQR, 31 to 118 days), which was significantly different by the Wilcoxon rank sum test (P < .01). Conclusion The TAT for pathology samples among patients with suspected cancer was longer than reported for other African countries during the study period, was longer than considered acceptable in high-income countries, and differed between PF and NPF samples.
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Affiliation(s)
- Leo P L Masamba
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Petani E Mtonga
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Linda Kalilani Phiri
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Brittany L Bychkovsky
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Dolci A, Giavarina D, Pasqualetti S, Szőke D, Panteghini M. Total laboratory automation: Do stat tests still matter? Clin Biochem 2017; 50:605-611. [PMID: 28390779 DOI: 10.1016/j.clinbiochem.2017.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.
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Affiliation(s)
- Alberto Dolci
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Davide Giavarina
- Clinical Chemistry and Hematology Laboratory, "San Bortolo" Hospital, Vicenza, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Dominika Szőke
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan Medical School, Milan, Italy
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Nomdedéu JF, Puigdecanet E, Bussaglia E, Hernández JJ, Carricondo M, Estivill C, Martí-Tutusaus JM, Tormo M, Zamora L, Serrano E, Perea G, de Llano MPQ, García A, Sánchez-Ortega I, Ribera JM, Nonell L, Aventin A, Solé F, Brunet MS, Sierra J. Feasibility of the AML profiler (Skyline™ Array) for patient risk stratification in a multicentre trial: a preliminary comparison with the conventional approach. Hematol Oncol 2016; 35:778-788. [PMID: 27140599 DOI: 10.1002/hon.2304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/15/2016] [Accepted: 03/31/2016] [Indexed: 12/11/2022]
Abstract
Deoxyribonucleic acid microarrays allow researchers to measure mRNA levels of thousands of genes in a single experiment and could be useful for diagnostic purposes in patients with acute myeloid leukaemia (AML). We assessed the feasibility of the AML profiler (Skyline™ Array) in genetic stratification of patients with de novo AML and compared the results with those obtained using the standard cytogenetic and molecular approach. Diagnostic bone marrow from 31 consecutive de novo AML cases was used to test MLL-PTD, FLT3-ITD and TKD, NPM1 and CEBPAdm mutations. Purified RNA was used to assess RUNX1-RUNX1T1, PML-RARα and CBFβ-MYH11 rearrangements. RNA remnants underwent gene expression profiling analysis using the AML profiler, which detects chromosomal aberrations: t(8;21), t(15;17), inv(16), mutations (CEBPAdm, ABD-NPM1) and BAALC and EVI1 expression. Thirty cases were successfully analysed with both methods. Five cases had FLT3-ITD. In one case, a t(8;21) was correctly detected by both methods. Four cases had inv(16); in one, the RNA quality was unsatisfactory and it was not hybridized, and in the other three, the AML profiler detected the genetic lesion - this being a rare type I translocation in one case. Two cases with acute promyelocytic leukaemia were diagnosed by both methods. Results for NPM1 mutations were concordant in all but two cases (2/11, non-ABD mutations). Analysis of costs and turnaround times showed that the AML profiler was no more expensive than the conventional molecular approach. These results suggest that the AML profiler could be useful in multicentre trials to rapidly identify patients with AML with a good prognosis. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Josep F Nomdedéu
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Puigdecanet
- Servei d'Analisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Elena Bussaglia
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Maite Carricondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Camino Estivill
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Mar Tormo
- Hematology Department, Hospital Clínico de Valencia, INCLIVA, Valencia, Spain
| | - Lurdes Zamora
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Elena Serrano
- Bioinformatic Platform, IIB Sant Pau, Barcelona, Spain
| | - Granada Perea
- Laboraotory Service, UDIAT-CD, Parc Taulí Hospital Universitari, Sabadell, Spain
| | | | - Antoni García
- Hematology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Josep Maria Ribera
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Lara Nonell
- Servei d'Analisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Anna Aventin
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc Solé
- Hematology Department, Institut Recerca contra la Leucemia Josep Carreras (IJC), ICO Badalona Hospital Germans Trias i Pujol, Badalona, Spain
| | - Maria Salut Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Luppa PB, Bietenbeck A, Beaudoin C, Giannetti A. Clinically relevant analytical techniques, organizational concepts for application and future perspectives of point-of-care testing. Biotechnol Adv 2016; 34:139-60. [DOI: 10.1016/j.biotechadv.2016.01.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/15/2016] [Accepted: 01/17/2016] [Indexed: 01/19/2023]
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Chan SW, Liew LH, Wong GR, Kallarakkal TG, Abraham MT, Ramanathan A, Zain RB. Audit of Turnaround Time for a Training Oral Histopathology Laboratory in Malaysia. Int J Surg Pathol 2016; 24:401-9. [PMID: 27006298 DOI: 10.1177/1066896916639372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Turnaround time (TAT) is the benchmark to assess the performance of a laboratory, pathologists, and pathology services, but there are few articles on TAT of surgical pathology, particularly in relation to oral or head and neck specimens. This study investigates the TAT for oral histopathology reporting in an academic institution's training laboratory and offers recommendations to achieve better overall quality of diagnostic services. METHODS This study examined data obtained from biopsy request forms for specimens received from the Oro-Maxillofacial Surgery Department of Hospital Tengku Ampuan Rahimah Klang in the Oral Pathology Diagnostic Laboratory of the Faculty of Dentistry, University of Malaya, over a period of 3 years between January 2012 and October 2014. RESULTS TAT for surgical and decalcified specimens were increased significantly compared to biopsies. Additional special handling did not influence TAT, but increased specimen volume resulted in greater TAT. Slide interpretation was the most time-consuming stage during histopathology reporting. Overall, mean TAT was acceptable for most specimens, but the TAT goals were less than satisfactory. CONCLUSION A TAT goal appropriate for this laboratory may hence be established based on this study. Collective efforts to improve the TAT for various specimens are essential for better laboratory performance in the future.
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Wang Y, Coiera E, Gallego B, Concha OP, Ong MS, Tsafnat G, Roffe D, Jones G, Magrabi F. Measuring the effects of computer downtime on hospital pathology processes. J Biomed Inform 2015; 59:308-15. [PMID: 26732996 DOI: 10.1016/j.jbi.2015.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 12/02/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To introduce and evaluate a method that uses electronic medical record (EMR) data to measure the effects of computer system downtime on clinical processes associated with pathology testing and results reporting. MATERIALS AND METHODS A matched case-control design was used to examine the effects of five downtime events over 11-months, ranging from 5 to 300min. Four indicator tests representing different laboratory workflows were selected to measure delays and errors: potassium, haemoglobon, troponin and activated partial thromboplastin time. Tests exposed to a downtime were matched to tests during unaffected control periods by test type, time of day and day of week. Measures included clinician read time (CRT), laboratory turnaround time (LTAT), and rates of missed reads, futile searches, duplicate orders, and missing test results. RESULTS The effects of downtime varied with the type of IT problem. When clinicians could not logon to a results reporting system for 17-min, the CRT for potassium and haemoglobon tests was five (10.3 vs. 2.0days) and six times (13.4 vs. 2.1days) longer than control (p=0.01-0.04; p=0.0001-0.003). Clinician follow-up of tests was also delayed by another downtime involving a power outage with a small effect. In contrast, laboratory processing of troponin tests was unaffected by network services and routing problems. Errors including missed reads, futile searches, duplicate orders and missing test results could not be examined because the sample size of affected tests was not sufficient for statistical testing. CONCLUSION This study demonstrates the feasibility of using routinely collected EMR data with a matched case-control design to measure the effects of downtime on clinical processes. Even brief system downtimes may impact patient care. The methodology has potential to be applied to other clinical processes with established workflows where tasks are pre-defined such as medications management.
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Affiliation(s)
- Ying Wang
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Blanca Gallego
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Oscar Perez Concha
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mei-Sing Ong
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Guy Tsafnat
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - David Roffe
- Information Technology Service Centre, St Vincent's Hospital, Sydney, Australia
| | - Graham Jones
- Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Lean-Agile Adaptations in Clinical Laboratory Accredited ISO 15189. APPLIED SCIENCES-BASEL 2015. [DOI: 10.3390/app5041616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meier FA, Souers RJ, Howanitz PJ, Tworek JA, Perrotta PL, Nakhleh RE, Karcher DS, Bashleben C, Darcy TP, Schifman RB, Jones BA. Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011. Arch Pathol Lab Med 2015; 139:762-75. [PMID: 26030245 DOI: 10.5858/arpa.2014-0090-cp] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring. OBJECTIVE To demonstrate patterns in clinical laboratory testing defect rates and cycle time using 7 College of American Pathologists Q-Tracks program monitors. DESIGN Subscribers measured monthly rates of outpatient order-entry errors, identification band defects, and specimen rejections; median troponin order-to-report cycle times and rates of STAT test receipt-to-report turnaround time outliers; and critical values reporting event defects, and corrected reports. From these submissions Q-Tracks program staff produced quarterly and annual reports. These charted each subscriber's performance relative to other participating laboratories and aggregate and subgroup performance over time, dividing participants into best and median performers and performers with the most room to improve. Each monitor's patterns of change present percentile distributions of subscribers' performance in relation to monitoring durations and numbers of participating subscribers. Changes over time in defect frequencies and the cycle duration quantify effects on performance of monitor participation. RESULTS All monitors showed significant decreases in defect rates as the 7 monitors ran variously for 6, 6, 7, 11, 12, 13, and 13 years. The most striking decreases occurred among performers who initially had the most room to improve and among subscribers who participated the longest. All 7 monitors registered significant improvement. Participation effects improved between 0.85% and 5.1% per quarter of participation. CONCLUSIONS Using statistical quality measures, collecting data monthly, and receiving reports quarterly and yearly, subscribers to a comparative monitoring program documented significant decreases in defect rates and shortening of a cycle time for 6 to 13 years in all 7 ongoing clinical laboratory quality monitors.
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Affiliation(s)
- Frederick A Meier
- From the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Drs Meier and Jones); the Departments of Biostatistics (Ms Souers) and Surveys (Ms Bashleben), College of American Pathologists, Northfield, Illinois; the Department of Pathology, State University of New York, Brooklyn (Dr Howanitz); the Department of Pathology, St Joseph Mercy Hospital, Ypsilanti, Michigan (Dr Tworek); the Department of Pathology, West Virginia University Health Sciences Center, Morgantown (Dr Perrotta); the Department of Pathology, Mayo Clinic, Jacksonville, Florida (Dr Nakhleh); George Washington University Medical Center, Washington, DC (Dr Karcher); Clinical Laboratories, University of Wisconsin Hospitals and Clinics, Madison (Dr Darcy); and Diagnostic Service Line, Southern Arizona Veterans Administration Health Care Systems, Tucson (Dr Schifman)
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Ialongo C, Porzio O, Giambini I, Bernardini S. Total Automation for the Core Laboratory: Improving the Turnaround Time Helps to Reduce the Volume of Ordered STAT Tests. ACTA ACUST UNITED AC 2015; 21:451-8. [PMID: 25882188 DOI: 10.1177/2211068215581488] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Indexed: 11/16/2022]
Abstract
The transition to total automation represents the greatest leap for a clinical laboratory, characterized by a totally new philosophy of process management. We have investigated the impact of total automation on core laboratory efficiency and its effects on the clinical services related to STAT tests. For this purpose, a 47-month retrospective study based on the analysis of 44,212 records of STAT cardiac troponin I (CTNI) tests was performed. The core laboratory reached a new efficiency level 3 months after the implementation of total automation. Median turnaround time (TAT) was reduced by 14.9±1.5 min for the emergency department (p < 0.01), reaching 41.6±1.2 min. In non-emergency departments, median TAT was reduced by 19.8±2.2 min (p < 0.01), reaching 52±1.3 min. There was no change in the volume of ordered STAT CTNI tests by the emergency department (p = 0.811), whereas for non-emergency departments there was a reduction of 115.7±50 monthly requests on average (p = 0.026). The volume of ordered tests decreased only in time frames of the regular shift following the morning round. Thus, total automation significantly improves the core laboratory efficiency in terms of TAT. As a consequence, the volume of STAT tests ordered by hospital departments (except for the emergency department) decreased due to reduced duplicated requests.
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Affiliation(s)
- Cristiano Ialongo
- Department of Laboratory Medicine, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Ottavia Porzio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ilio Giambini
- Department of Laboratory Medicine, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Sergio Bernardini
- Department of Laboratory Medicine, Tor Vergata University Hospital of Rome, Rome, Italy Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Central Laboratory Service and Point-of-Care Testing in Germany—From Conflicting Notions to Complementary Understandings. POINT OF CARE 2015. [DOI: 10.1097/poc.0000000000000043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Angeletti S, De Cesaris M, Hart JG, Urbano M, Vitali MA, Fragliasso F, Dicuonzo G. Laboratory Automation and Intra-Laboratory Turnaround Time: Experience at the University Hospital Campus Bio-Medico of Rome. ACTA ACUST UNITED AC 2015; 20:652-8. [PMID: 25609253 DOI: 10.1177/2211068214566458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Indexed: 11/16/2022]
Abstract
Intra-laboratory turnaround time (TAT) is a key indicator of laboratory performance. Improving TAT is a complex task requiring staff education, equipment acquisition, and adequate TAT monitoring. The aim of the present study was to evaluate the intra-laboratory TAT after laboratory automation implementation (June 2013-June 2014) and to compare it to that in the preautomation period (July 2012-May 2013). Intra-laboratory TAT was evaluated both as the mean TAT registered and the percentage of outlier (OP) exams. The mean TAT was 36, 38, and 34 min during the study periods, respectively. These values respected the goal TAT established at 45 min. The OP, calculated at 45 min as well as at 60 min, decreased from 26 to 21 and from 11 to 5, respectively. From a focused analysis on blood count cell, troponin I, and prothrombin (PT) test, TAT improvement was more evident for tests requiring longer preanalytical process. The follow-up of TAT from June 2013 to June 2014 revealed the reduction of the mean TAT as well as of the OP exams after automation implementation and that automation more strongly affects the test in the preanalytical phase including centrifugation of the sample, such as troponin I and PT.
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Affiliation(s)
- Silvia Angeletti
- Centro Integrato di Ricerche (CIR), Laboratory of Clinical Pathology and Microbiology, University Hospital "Campus Bio-Medico" of Rome, Italy
| | - Marina De Cesaris
- Centro Integrato di Ricerche (CIR), Laboratory of Clinical Pathology and Microbiology, University Hospital "Campus Bio-Medico" of Rome, Italy
| | | | - Michele Urbano
- Hospital Management, University Hospital "Campus Bio-Medico" of Rome, Italy
| | | | - Fulvio Fragliasso
- Information Technology Service, University Hospital "Campus Bio-Medico" of Rome, Italy
| | - Giordano Dicuonzo
- Centro Integrato di Ricerche (CIR), Laboratory of Clinical Pathology and Microbiology, University Hospital "Campus Bio-Medico" of Rome, Italy
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Abstract
This chapter describes the unique challenges of managing reference laboratory utilization. The nature of reference laboratory testing and how it differs from routine hospital clinical laboratory testing is discussed. The vast majority of reference laboratory testing is high complexity, low volume testing to support specialized care. In contrast the hospital clinical laboratory is most effective at performing rapid turn-around, routine, high volume testing. The implication of these differences with respect to identifying utilization issues and interventions to manage utilization is presented along with examples.
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Affiliation(s)
- Patrick M Sluss
- Massachusetts General Hospital, GRB554, 55 Fruit St., Boston, MA 02114, USA.
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Park KS, Heo H, Choi YK. Design and Realization of Integrated Management System for Data Interoperability between Point-of-Care Testing Equipment and Hospital Information System. Healthc Inform Res 2013; 19:222-8. [PMID: 24175121 PMCID: PMC3810530 DOI: 10.4258/hir.2013.19.3.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study was to design an integrated data management system based on the POCT1-A2, LIS2-A, LIS2-A2, and HL7 standard to ensure data interoperability between mobile equipment, such as point-of-care testing equipment and the existing hospital data system, its efficiency was also evaluated. Methods The method of this study was intended to design and realize a data management system which would provide a solution for the problems that occur when point-of-care testing equipment is introduced to existing hospital data, after classifying such problems into connectivity, integration, and interoperability. This study also checked if the data management system plays a sufficient role as a bridge between the point-of-care testing equipment and the hospital information system through connection persistence and reliability testing, as well as data integration and interoperability testing. Results In comparison with the existing system, the data management system facilitated integration by improving the result receiving time, improving the collection rate, and by enabling the integration of disparate types of data into a single system. And it was found out that we can solve the problems related to connectivity, integration and interoperability through generating the message in standardized types. Conclusions It is expected that the proposed data management system, which is designed to improve the integration point-of-care testing equipment with existing systems, will establish a solid foundation on which better medical service may be provided by hospitals by improving the quality of patient service.
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Affiliation(s)
- Ki Sang Park
- Software Team of Diagnosis Business, i-SENS Inc., Seoul, Korea. ; Department of Computer Science, Kwangwoon University, Seoul, Korea
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Kluytmans-van den Bergh MFQ, Vos MC, Diederen BMW, Vandenbroucke-Grauls CMJE, Voss A, Kluytmans JAJW. Dutch guideline on the laboratory detection of methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2013; 33:89-101. [PMID: 23893016 DOI: 10.1007/s10096-013-1933-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/11/2013] [Indexed: 01/25/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has rapidly emerged worldwide, affecting both healthcare and community settings, and intensive livestock industry. The efficient control of MRSA strongly depends on its adequate laboratory detection. This guideline provides recommendations on the appropriate use of currently available diagnostic laboratory methods for the timely and accurate detection of MRSA in patients and healthcare workers. Herewith, it aims to standardise and improve the diagnostic laboratory procedures that are used for the detection of MRSA in Dutch medical microbiology laboratories.
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Georgiou A, Westbrook JI, Braithwaite J. An empirically-derived approach for investigating Health Information Technology: the Elementally Entangled Organisational Communication (EEOC) framework. BMC Med Inform Decis Mak 2012; 12:68. [PMID: 22788698 PMCID: PMC3407796 DOI: 10.1186/1472-6947-12-68] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this paper is to illustrate the Elementally Entangled Organisational Communication (EEOC) framework by drawing on a set of three case studies which assessed the impact of new Health Information Technology (HIT) on a pathology service. The EEOC framework was empirically developed as a tool to tackle organisational communication challenges in the implementation and evaluation of health information systems. METHODS The framework was synthesised from multiple research studies undertaken across a major metropolitan hospital pathology service during the period 2005 to 2008. These studies evaluated the impact of new HIT systems in pathology departments (Laboratory Information System) and an Emergency Department (Computerised Provider Order Entry) located in Sydney, Australia. RESULTS Key dimensions of EEOC are illustrated by the following case studies: 1) the communication infrastructure between the Blood Bank and the ward for the coordination and distribution of blood products; 2) the organisational environment in the Clinical Chemistry and Haematology departments and their attempts to organise, plan and control the processing of laboratory specimens; and 3) the temporal make up of the organisation as revealed in changes to the way the Central Specimen Reception allocated, sequenced and synchronised work tasks. CONCLUSIONS The case studies not only highlight the pre-existing communication architecture within the organisation but also the constitutive role communication plays in the way organisations go about addressing their requirements. HIT implementation involves a mutual transformation of the organisation and the technology. This is a vital consideration because of the dangers associated with poor organisational planning and implementation of HIT, and the potential for unintended adverse consequences, workarounds and risks to the quality and safety of patient care. The EEOC framework aims to account for the complex range of contextual factors and triggers that play a role in the success or otherwise of new HITs, and in the realisation of their innovation potential.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia, 2052
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia, 2052
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia, 2052
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