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Cherie N, Teketelew BB, Tamir M, Angelo AA, Terekegne AM, Chane E, Nigus M, Berta DM. Performances and determinants of proficiency testing in clinical laboratory services at comprehensive specialized hospitals, northwest Ethiopia. Sci Rep 2024; 14:7745. [PMID: 38565637 PMCID: PMC10987491 DOI: 10.1038/s41598-024-58525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/01/2024] [Indexed: 04/04/2024] Open
Abstract
Proficiency testing (PT) is an impartial laboratory performance-evaluating system using an independent body. It is a mandatory accreditation requirement and means for improving the laboratory's performance. The study aimed to evaluate the performance of PT, with a focus on identifying and discussing determinants that influence PT performance at comprehensive specialized hospitals in northwest Ethiopia. A retrospective cross-sectional study was carried out from 2020 to 2022. Using a convenient sampling technique, laboratory tests with recorded PT results in each hospital laboratory were included. A data collection template and customized checklists were used to collect the data. Epi Data Version 3.1 for data entry and STATA Version 14.1 for cleaning and analysis were used. Binary logistic regression analyses were used. Variables with p < 0.05 in the multivariable logistic regression were considered to be statistically significant. Over nine cycles, 3807 PT challenges were distributed. The total failure rate of the laboratories was 32.4%, with a peak failure rate of 40.3% in 2020, after which the failure rate was decline to 20.6% in 2022. Among the five laboratory sections, molecular biology had the lowest failure rate (22.2%), while microbiology had the highest failure rate (56.5%). Multivariate logistic regression revealed that PT results reported without appropriate unit of measurement (AOR 7.5), lack of corrective action for PT nonconformance (AOR 7.1), and reagent unavailability (AOR 6.1) had significant effects on PT performance (p < 0.001). The results of this study showed that the overall performance of the laboratory was lower. Reporting PT results without appropriate units of measurement and not taking corrective action for PT nonconformance were the major aggravating factors for high failure rates.
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Affiliation(s)
- Negesse Cherie
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Bisrat Birke Teketelew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mebratu Tamir
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abiy Ayele Angelo
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Mekuanint Terekegne
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elias Chane
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mesele Nigus
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Mengesha Berta
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Liana P, Patricia V, Shofiarani M, Umar TP. The Level of Internal Customer Satisfaction with the Android-based Laboratory Result Application in an Indonesian Tertiary Hospital. JOURNAL OF HEALTH MANAGEMENT 2024. [DOI: 10.1177/09720634231216071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
To perform its function of providing health services, the clinical laboratory faces several challenges, especially in the speediness and accuracy of result delivery. Some issues frequently arise during the execution. An approach to overcoming obstacles and improving service quality is to use online applications delivered via the Android system to distribute the laboratory results. This study assessed internal customer satisfaction with the use of this online application. This study employs a quantitative approach with a cross-sectional approach. The customer was given a questionnaire with 15 questions covering five aspects of service quality (tangibility, reliability, responsiveness, assurance and empathy). The questionnaire’s validity and reliability were evaluated, and the Cartesian diagram analysis was used to determine the service improvement strategy. The empathy dimension has the highest satisfaction figure, with an average of 95.39%, while the assurance dimension has the lowest, with an average of 84.62%. The majority of the quality subdimensions are found in quadrants II and III of the Cartesian diagram (five parameters each). Most subdimension quality is found in quadrant II, with as many as five subdimension quality, indicating a high level of importance and satisfaction.
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Affiliation(s)
- Phey Liana
- Department of Clinical Pathology, Faculty of Medicine, Universitas Sriwijaya – Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
- Biomedicine Doctoral Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Venny Patricia
- Banten Ministry of Health Polytechnic, Tangerang, Indonesia
| | - Meika Shofiarani
- Department of Clinical Pathology, Faculty of Medicine, Universitas Sriwijaya – Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Tungki Pratama Umar
- Medical Profession Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Swetha N, Kusuma K, Sahana K, Shobha C, Abhijith D, Akila P, Suma M. Sigma metric analysis of quality indicators across the testing process as an effective tool for the evaluation of laboratory performance. Med J Armed Forces India 2023; 79:S150-S155. [PMID: 38144620 PMCID: PMC10746809 DOI: 10.1016/j.mjafi.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/15/2022] [Indexed: 10/18/2022] Open
Abstract
Background Laboratories across the world are successfully using quality indicators (QIs) to monitor their performance. We aimed to analyze the effectiveness of using the peer group comparison and statistical tools such as sigma metrics for periodic evaluation of QIs and identify potential errors in the preanalytical, analytical, and postanalytical phases. Methods We evaluated the monthly QIs for 1 year. A total of 11 QIs were evaluated across the three phases of the total testing process, using percentage variance, and sigma metric analysis. Results Our study observed that based on sigma metric analysis, the performance was good for all the QIs except for the number of samples with the inappropriate specimen hemolyzed samples, clotted samples, and turnaround time (Sigma value < 3). The percentage variance of QIs in all the phases was plotted in a Pareto chart, which helped us in identifying turnaround time and internal quality control performance are the key areas that contribute to almost 80% of the errors among all the QIs. Conclusion Laboratory performance evaluation using QIs and sigma metric analysis helped us in identifying and prioritizing the corrective actions in the key areas of the total testing process.
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Affiliation(s)
- N.K. Swetha
- Assistant Professor (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
| | - K.S. Kusuma
- Assistant Professor (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
| | - K.R. Sahana
- Assistant Professor (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
| | - C.R. Shobha
- Assistant Professor (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
| | - D. Abhijith
- Assistant Professor (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
| | - P. Akila
- Professor (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
| | - M.N. Suma
- Professor & Head, (Biochemistry), JSS Medical College, JSSAHER, Shivarathreeshwaranagar, Mysore, India
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Kidanemariam G, Gebrekidan H, Dagnazgi EA, Asfaw K. Improving Patient Satisfaction and Associated Factors at Outpatient Department in General Hospitals of Central Zone, Tigray, Northern Ethiopia, June 2018-August 2019: Pre- and Postinterventional Study. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6685598. [PMID: 38027041 PMCID: PMC10665098 DOI: 10.1155/2023/6685598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/16/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
Background Typically, the idea of patient satisfaction is employed to evaluate quality. When patients enter hospitals, they have certain demands for treatment. However, patients may become dissatisfied if their requirements or expectations are not met. There is increasing agreement that evaluating hospital services should be based in part on patients' assessments of the quality of treatment they received overall. The aim of this study was to improve patient satisfaction at outpatient department. Objective To assess improving of patient satisfaction and associated factors at outpatient department in general hospitals of central zone, Northern Ethiopia, 2019. Methods Pre- and post-intervention study was conducted to assess the patient satisfaction at outpatient department in general hospitals of central zone, between June 2018 and April 2019 using systematic random sampling method. Two hundred seventy-five (275) participants were investigated in the preintervention and postintervention study. Data were entered to SPSS version 20. Binary logistic regression was done to test association of factors with the outcome variable with consideration of p value of less than 0.05. Result In the preintervention period, the patient satisfaction was 54.2%; after providing intervention, the patient satisfaction was increased to 77% in postinterventional study. Respondents who paid for the medical service were 41% less likely satisfied than those who had gotten free services. Participants whose age of 18-27 years were 22% more likely satisfied than whose age were 58 and greater. Conclusion The result in this study shows that the patient satisfaction is higher than other studies done in our country. Sex, age, and those who make payment were significantly associated with patient satisfaction. Despite the result, much things are left to be covered to increase satisfaction, so the concerned bodies, including the regional health bureau, woreda health office, and management committee and board, should mobilize the community and give training to the health professionals to make the environment smoother and more comfortable for patients.
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Affiliation(s)
| | | | - Ebud Ayele Dagnazgi
- Department of Public Health Nutrition, School of Public Health, Aksum University, Aksum, Ethiopia
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Sciacovelli L, Padoan A, Aita A, Basso D, Plebani M. Quality indicators in laboratory medicine: state-of-the-art, quality specifications and future strategies. Clin Chem Lab Med 2023; 61:688-695. [PMID: 36660807 DOI: 10.1515/cclm-2022-1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
In the last few decades, quality in laboratory medicine has evolved in concert with the transformation and the changes (technological, scientific and organizational) in this sector. Laboratory professionals have faced great challenges, at times being overwhelmed, yet also involved in this progress. Worldwide, laboratory professionals and scientific societies involved in laboratory medicine have raised awareness concerning the need to identify new quality assurance tools that are effective in reducing the error rate and enhancing patient safety, in addition to Internal Quality Control (IQC) procedures and the participation in the External Quality Assessment Schemes (EQAS). The use of Quality Indicators (QIs), specifically designed for laboratory medicine are effective in assessing and monitoring all critical events occurring in the different phases of Total Testing Process (TTP), in particular, in the extra-analytical phases. The Model of Quality Indicators (MQI), proposed by the Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and validated by experts in consensus conferences, is an important window of opportunity for the medical laboratory to demonstrate the use of an effective quality assurance tool fit for this purpose. Aim of this paper is to provide an update of the state-of-the-art concerning the most used QIs data collected in 2021 and the Quality Specifications (QSs) proposed for their evaluation. Moreover, a strategy for the future is proposed in order to improve the MQI and encourage its use in medical laboratories throughout the world.
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Affiliation(s)
- Laura Sciacovelli
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Ada Aita
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Daniela Basso
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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Patryn R, Zagaja A, Drozd M. Donor Safety, Discrepancies Between Practice and Theory: Analysis of the Polish Supreme Audit Office's Report. Appl Clin Genet 2023; 16:1-10. [PMID: 36713959 PMCID: PMC9880020 DOI: 10.2147/tacg.s376251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/21/2022] [Indexed: 01/21/2023] Open
Abstract
The introduction and development of genetic testing has caused the emergence of numerous dilemmas, which pertain to the performed tests, their results, and the influence they have on an individual person. To minimize potential doubts, it is crucial to ensure compliance with established procedures and to fulfill all test-associated formalities. In 2018, a report of the Polish Supreme Audit's Office (a governmental control agency) on the quality of genetic tests revealed that there is much to be done in the field of laboratory diagnostics in Poland. The inspection of six selected laboratories performing genetic tests identified shortcomings in terms of formalities accompanying the process of performing laboratory tests, keeping patient documentation and personal data protection. Although the observed shortcomings pertained to legal aspects of genetic tests, and not the quality of the tests themselves, the aforementioned may be detrimental to the individual person and the society (eg, lack of consent undermines the concept of biological material ownership), may cause legal liability to the laboratory personnel and even undermine public trust in genetic testing.
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Affiliation(s)
- Rafał Patryn
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland
| | - Anna Zagaja
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland
| | - Mariola Drozd
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland,Correspondence: Mariola Drozd, Department of Humanities and Social Medicine, Medical University of Lublin, 1, Raclawickie str 20-059, Lublin, Poland, Tel +48 448 68 50, Email
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Onyenekwu CP, Czaja RC, Norui R, Hunt BC, Miller J, Jorns JM. Assessment of Quality of Frozen Section Services at a Large Academic Hospital Before and After Relocation. Am J Clin Pathol 2022; 158:655-663. [PMID: 36208148 DOI: 10.1093/ajcp/aqac109] [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: 05/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine outcomes following relocation of frozen section services (FSS) and the implementation of a dedicated gastrointestinal frozen service. METHODS We reviewed our FSS 6 months prior to and following FSS relocation. Satisfaction surveys were sent to surgeons and pathologists. Survey feedback resulted in a pilot of gastrointestinal subspecialist frozen section coverage. RESULTS There were 1,607 and 1,472 specimens from 667 and 602 patients pre- and post-FSS relocation, respectively. There was a decline in median specimen delivery time to pathology (12 vs 10 minutes, P < .001) and an increase in median time from receipt in pathology to intraoperative diagnosis (20 vs 22 minutes, P = .008) in cases with intrapathology consultation but no change without consultation (median, 19 minutes). Intrapathology consultation decreased from 19.7% (317/1,607) to 11.5% (169/1,472) (P < .001). Discordance rates between frozen section and permanent section remained low and similar (2.0% [33/1,607] vs 2.7% [40/1,472], P = .24). There was no significant change in discordance with dedicated gastrointestinal subspecialty frozen section interpretation. CONCLUSIONS Relocation of FSS and dedicated subspecialty interpretation may improve surgeon satisfaction but can also create workflow challenges. Pathology departments need to achieve a balance between satisfaction and adequacy to establish best frozen section coverage models.
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Affiliation(s)
| | - Rebecca C Czaja
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rashda Norui
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bryan C Hunt
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James Miller
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julie M Jorns
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
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Shcolnik W, da Silva Duarte AJ. Assessment of Culture and Laboratory Practices Related to Patient Safety in Brazilian Laboratories. J Patient Saf 2022; 18:674-679. [PMID: 36170586 DOI: 10.1097/pts.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed at the simultaneous assessment of culture and laboratory practices related to patient safety in Brazilian laboratories, and validation of the proposed questionnaire. METHODS The questionnaire was based on the Hospital Survey on Patient Safety Culture, used by the 1.0 version of the Agency of Healthcare Research and Quality and other bibliographical references. The sample consisted of 1414 professionals from 51 different Brazilian clinical laboratories. Agency of Healthcare Research and Quality criteria were used to define "strengths and weaknesses" related to patient safety. The psychometric evaluation of the questionnaire included the analysis of reliability and validity. RESULTS Patient safety in the laboratories was considered "excellent" (35.22%), "very good" (53.14%), "regular" (10.11%), "bad" (0.92%), and "very bad" (0.61%). The only dimension of culture with positivity less than 50% was "nonpunitive responses to errors" (30.74%). The dimensions on laboratory practices related to patient safety revealed positivity greater than 60%, with the "analytical" dimension (76.47%) being the highest. The psychometric evaluation revealed the reliability of the questionnaire, the applicability of 12 dimensions to assess culture, and 4 or 5 dimensions to assess laboratory practices related to patient safety. CONCLUSIONS The culture and practices related to patient safety in Brazilian laboratories were evaluated as good, although a punitive culture against the occurrence of errors was identified. The psychometric evaluation of the questionnaire confirmed its reliability and validity. Studies performed in a larger and more diverse sample of clinical laboratories are needed to confirm the results obtained.
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Paulino A, Pedro AR, Roque R, Dias S. Quality and performance indicators in Portuguese anatomical pathology laboratories: a panel validation by qualitative Delphi technique. BMJ Open Qual 2022. [PMCID: PMC9362786 DOI: 10.1136/bmjoq-2021-001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In laboratory medicine, quality and performance indicators (QPIs) are essential tools to ensure the quality of healthcare services and patient safety. QPIs allow comparison of outcomes, favouring accountability and transparency. Internationally, there are some QPI evaluation models, but the fact that they are paid limits their dissemination in smaller/poorer laboratories. In Portugal, each laboratory defines its own QPIs, with no uniformity between institutions. The development of a free QPI panel suitable for anatomical pathology laboratories (APLs) would allow for quality assessment and improvement. Objective To develop a consensual and validated QPI panel suitable for Portuguese APLs. Methods The study was developed in two stages. First, a bibliographic review was carried out, selecting the adequate QPIs. Afterwards, these QPIs were evaluated by experts through the Delphi method, where they could also suggest other pertinent QPIs. Results By the end of the Delphi method, there was a consensus on 64 QPIs (31 for ‘structure’, 30 for ‘process’ and 3 for ‘result’). The consensual QPIs covered all phases of the total test cycle. The lack of specific anatomical pathology QPIs in the bibliography was noticeable. There was greater consensus on ‘process’ and ‘result’ QPIs than on ‘structure’. This was supported by the bibliography, where the first ones were more valued. Nevertheless, it is important to monitor all the main laboratory processes, prioritising the evaluation of QPIs with greater impact on healthcare quality and patient safety. These results should allow APLs to identify the causes behind poor performance and improve their services. Conclusions This panel is a valuable tool for APLs, contributing to quality awareness. It can be the first step towards the development of a free benchmarking quality programme in Portugal, encouraging competitiveness and cost-efficiency.
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Affiliation(s)
- Ana Paulino
- Anatomical Pathology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ruben Roque
- Anatomical Pathology Department, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
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Barnes T, Fontaine T, Bautista C, Lee J, Stanley R. Developing and Aligning a Safety Event Taxonomy for Inpatient Psychiatry. J Patient Saf 2022; 18:e704-e713. [PMID: 35617595 DOI: 10.1097/pts.0000000000000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this project was to develop and align an inpatient psychiatric safety event taxonomy that would blend well-established safety events with psychiatry-specific concerns. METHODS A hybrid inductive-deductive thematic analysis was used to generate novel descriptive safety event categories for inpatient psychiatry and align these categories with an established taxonomic framework. In the inductive phase, an initial taxonomy was developed by describing the semantic subject and context of reported safety concerns. In the deductive phase, existing literature, national standards, and local content experts were used to align our taxonomy with the safety event measurement system at our institution. RESULTS A total of 2291 events were extracted and 483 were analyzed. After thorough review, the data was divided into 4 domains: (1) Provision of care, (2) patient actions, (3) environment/equipment, and (4) safety culture. Each domain reflects a mutually exclusive typology of events and provides a parsimonious view of safety concerns in inpatient psychiatry. Each domain was further divided into categories, subcategories, and subcategory details. CONCLUSIONS Safety events on inpatient psychiatric units are understudied and lack the measurement infrastructure to identify care processes that result in exposure to harm. We develop and align an inpatient psychiatric safety taxonomy based on real-world data, existing literature, and measurement standards. This taxonomy can be used by psychiatric hospitals to improve their patient safety measurement systems-and ultimately-the safety of their patients and communities.
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Affiliation(s)
- Todd Barnes
- From the Yale New Haven Psychiatric Hospital, New Haven, Connecticut
| | - Thomas Fontaine
- From the Yale New Haven Psychiatric Hospital, New Haven, Connecticut
| | | | - Jaeyeon Lee
- From the Yale New Haven Psychiatric Hospital, New Haven, Connecticut
| | - Rebecca Stanley
- From the Yale New Haven Psychiatric Hospital, New Haven, Connecticut
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Peck Palmer OM, Dasgupta A. Review of the Preanalytical Errors That Impact Therapeutic Drug Monitoring. Ther Drug Monit 2021; 43:595-608. [PMID: 33928931 DOI: 10.1097/ftd.0000000000000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Preanalytical errors comprise the majority of testing errors experienced by clinical laboratories and significantly impact the accuracy of therapeutic drug monitoring (TDM). METHODS Specific preanalytical factors in sample timing, collection, transport, processing, and storage that lead to errors in TDM were reviewed. We performed a literature search using several scientific databases including PubMed, ScienceDirect, Scopus, Web of Science, and ResearchGate for human studies published in the English language from January 1980 to February 2021, reporting on TDM and the preanalytical phase. RESULTS Blood collection errors (ie, wrong anticoagulant/clot activator used, via an intravenous line, incorrect time after dosing) delay testing, cause inaccurate results, and adversely impact patient care. Blood collected in lithium heparin tubes instead of heparin sodium tubes produce supertoxic lithium concentrations, which can compromise care. Specimens collected in serum separator gel tubes cause falsely decreased concentrations due to passive absorption into the gel when samples are not processed and analyzed quickly. Dried blood spots are popular for TDM as they are minimally invasive, allowing for self-sampling and direct shipping to a clinical laboratory using regular mail. However, blood collection techniques, such as trauma to the collection site, filter paper fragility, and hematocrit (Hct) bias, can adversely affect the accuracy of the results. Volumetric absorptive microsampling is a potential alternative to dried blood spot that offers fast, volume-fixed sampling, low pain tolerance, and is not susceptible to Hct concentrations. CONCLUSIONS The identification of preanalytical factors that may negatively impact TDM is critical. Developing workflows that can standardize TDM practices, align appropriate timing and blood collection techniques, and specimen processing will eliminate errors.
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Affiliation(s)
- Octavia M Peck Palmer
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, Texas
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Lubin IM. Bringing the clinical laboratory into the strategy to advance diagnostic excellence. Diagnosis (Berl) 2021; 8:281-294. [PMID: 33554526 PMCID: PMC8255320 DOI: 10.1515/dx-2020-0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/16/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. CONTENT Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. SUMMARY An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. OUTLOOK There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.
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Affiliation(s)
- Ira M. Lubin
- Division of Laboratory Systems, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE Mail Stop V24-3, GA 30329, Atlanta, GA, USA
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Millius L, Riedo E, Caron T, Belissent J, Fellay B, Ribordy V, Magnin JL. The "EPiQ"-Study (Evaluation of preanalytical quality): S-Monovette® in manual aspiration mode drastically reduces hemolytic samples in head-to-head study. Pract Lab Med 2021; 27:e00252. [PMID: 34401434 PMCID: PMC8353461 DOI: 10.1016/j.plabm.2021.e00252] [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: 03/24/2021] [Revised: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Hemolytic blood samples are the number one cause for specimen rejection at emergency departments. Triggered by unsuitable blood sampling material or incorrect handling and a related strong vacuum force, hemolytic samples often must be retaken. The objective of this study was to assess whether correct manual aspiration using S-Monovette® could reduce the number of hemolytic samples. Methods Between January and April 2019, a head-to-head study was conducted. Whereas in the first eight weeks, all specimens were collected using Vacutainer®, in the second eight weeks, blood was taken using S-Monovette® in aspiration mode. Specimens were categorized into five classes (0–30, 31–50, 51–75, 76–100, and 101+ mg/dl of cell-free hemoglobin) and for the statistical analyses, all samples exceeding 30 mg/dl were classified as hemolytic. Results Data were collected on 4794 blood specimens (Vacutainer®: 2634 samples, S-Monovette®: 2160 samples). While the percentage of non-hemolytic samples (HI of 0–30 mg/dl) was substantially higher for specimens drawn by S-Monovette® (95.7 %) than Vacutainer® (83.0 %), the opposite was true for all HI categories above 30 mg/dl. Importantly, the reduction of hemolytic samples took place immediately following the imposition of S-Monovette® and remained stable at a low level until the end of the study. Conclusions Based on our results, we conclude that switching to S-Monovette® in manual aspiration mode in the blood sampling process could be highly beneficial, not only from a financial point of view, but also with regards to reducing unnecessary tasks and stress for nursing staff and improving patient outcome overall. S-Monovette® in aspiration mode reduces hemolytic samples by a factor of four at emergency departments. Various stakeholders affected by poor quality blood samples could benefit. The inconvenience due to redundant blood samples could be significantly reduced.
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Affiliation(s)
- Laura Millius
- HFR Fribourg, Hôpital Cantonal, Fribourg, FR, Switzerland
| | - Erwin Riedo
- HFR Fribourg, Hôpital Cantonal, Fribourg, FR, Switzerland
| | - Thierry Caron
- HFR Fribourg, Hôpital Cantonal, Fribourg, FR, Switzerland
| | | | - Benoît Fellay
- HFR Fribourg, Hôpital Cantonal, Fribourg, FR, Switzerland
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14
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Alkhaldy HY, Alqahtani M, Alamri ZS, Althibait NA, Ahmed MA, Alzahrani MA, Bakheet OS, Aziz S. Clinical Appropriateness of Serum Folate ordering pattern in a tertiary care hospital in Saudi Arabia. Saudi Pharm J 2020; 28:905-910. [PMID: 32792834 PMCID: PMC7414075 DOI: 10.1016/j.jsps.2020.06.010] [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: 05/21/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Folate, also known as vitamin B9, is a co-factor necessary for DNA synthesis. Folate deficiency is associated mainly with hematological findings including megaloblastic anemia and pancytopenia. Many countries have mandated grain fortification with micronutrients including folic acid resulting in a reduced prevalence of folate deficiency. Saudi Arabia imports most of the grain products and folate is usually added after milling. There are no local studies to address the folate deficiency prevalence. In this study we aimed to analyse the clinical appropriateness of ordering practice of serum Folate level. Method We reviewed all serum folate requests received at our laboratory in Aseer Central Hospital over one-year period (July 2018 June 2019). We collected patients’ demographics from the electronic requests along with biochemical results of serum B12, ferritin and CBC results. We assessed appropriateness of orders against pre-specified criteria and applied statistical tests to explore for any association or significance. Results Serum folate requests from 614 patients were received during the study period. Serum B12 (543, 88%), and serum ferritin (511, 83%) were concurrently requested. The most common reason for request, when available, was anemia. Anemia was present in (313, 51%) of the subjects for which microcytic anemia was predominant (199, 63.5%), followed by normocytic anemia (101, 33%) and only 10 subjects had macrocytic anemia (3.2%). The most common hematinics’ deficiency was ferritin (30%) followed by B12 (17.2%). Serum folate deficiency was low, observed in only 2.8%. Low folate levels were not significantly different between the group with anemia and the normal hemoglobin group. Conclusion This study identifies a commonly inappropriate serum folate ordering practice that includes ordering all hematinics at the same visit without considering the possible anemia etiologies. The excessive requests might be related to doctors attempt to avoid multiple blood extractions and to try to reduce the time for diagnosis. These policies are generating unnecessary costs and time loss. Education, phasing out or restricting some tests and introducing laboratory policies like sample storing could help reduce unnecessary requests.
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Affiliation(s)
- Husain Y Alkhaldy
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia.,Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, 61413, Saudi Arabia
| | - Mohammed Alqahtani
- Department of Laboratory Medicine and Blood Bank, Aseer Central Hospital, Abha, Saudi Arabia
| | - Zainab S Alamri
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Nuha A Althibait
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Meteb A Ahmed
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohammed A Alzahrani
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Omayma S Bakheet
- Department of Laboratory Medicine and Blood Bank, Aseer Central Hospital, Abha, Saudi Arabia
| | - Shahid Aziz
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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15
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Duan M, Kang F, Zhao H, Wang W, Du Y, He F, Zhong K, Yuan S, Chen B, Wang Z. Analysis and evaluation of the external quality assessment results of quality indicators in laboratory medicine all over China from 2015 to 2018. Clin Chem Lab Med 2020; 57:812-821. [PMID: 30511924 DOI: 10.1515/cclm-2018-0983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/13/2018] [Indexed: 11/15/2022]
Abstract
Background This study aimed to comprehensively evaluate laboratory quality in China and explore factors affecting laboratory errors through analyzing the external quality assessment (EQA) results of quality indicators (QIs). Methods According to model 3 (interpretive) of the proficiency testing scheme, the National Center for Clinical Laboratories of China (CNCCL) developed a questionnaire for 15 QIs. Clinical laboratories from different provinces of China participated in the EQA program of QIs annually and submitted data via an online reporting system named Clinet-EQA. The results of QIs were expressed in percentage and sigma value or minute. Three levels of quality specifications (QSs) were defined based on percentile values. Furthermore, the QIs were analyzed by disciplines, hospital scales and information construction levels of participant laboratories. Results A total of 3450 laboratories nationwide continuously attended the EQA program and submitted complete data from 2015 to 2018. The performance of most QIs has improved year by year. QIs in post-analytical gained the best performance with sigma values that varied from 5.3σ to 6.0σ. The comparison of results among different disciplines showed significant differences for five QIs. More than half of QIs had statistical differences among different hospital scales measured by hospital grades and number of hospital beds. The performance of nine QIs were influenced by information construction levels of participant laboratories. Conclusions The overall laboratory quality in China has improved since the initiation of EQA program for QIs, but the performance of some QIs was still unsatisfactory. Therefore, laboratories should make efforts for continuous quality improvement based on information provided by QSs.
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Affiliation(s)
- Min Duan
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Fengfeng Kang
- Zhejiang Center for Clinical Laboratories, Zhejiang Provincial People's Hospital, Zhejiang, P.R. China
| | - Haijian Zhao
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China
| | - Wei Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China
| | - Yuxuan Du
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China
| | - Falin He
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China
| | - Kun Zhong
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China
| | - Shuai Yuan
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Dongcheng District, Beijing, P.R. China
| | - Bingquan Chen
- Beijing Clinet Information and Technology Co., Ltd, Beijing, P.R. China
| | - Zhiguo Wang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.,National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, No. 1, Dahua Road, Dongdan, Dongcheng District, Beijing 100730, P.R. China, Phone: +86-010-58115054, Fax: +86-010-65273025
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16
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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17
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Chung HJ, Hur M, Choi SG, Lee HK, Lee S, Kim H, Moon HW, Yun YM. Benefits of VISION Max automated cross-matching in comparison with manual cross-matching: A multidimensional analysis. PLoS One 2019; 14:e0226477. [PMID: 31869405 PMCID: PMC6927601 DOI: 10.1371/journal.pone.0226477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND VISION Max (Ortho-Clinical Diagnostics, Raritan, NJ, USA) is a newly introduced automated blood bank system. Cross-matching (XM) is an important test confirming safety by simulating reaction between packed Red Blood Cells (RBCs) and patient blood in vitro before transfusion. We assessed the benefits of VISION Max automated XM (A-XM) in comparison with those of manual XM (M-XM) by using multidimensional analysis (cost-effectiveness and quality improvement). MATERIALS AND METHODS In a total of 327 tests (130 patients), results from A-XM and M-XM were compared. We assessed the concordance rate, risk priority number (RPN), turnaround time, hands-on time, and the costs of both methods. We further simulated their annual effects based on 37,937 XM tests in 2018. RESULTS The concordance rate between A-XM and M-XM was 97.9% (320/327, kappa = 0.83), and the seven discordant results were incompatible for transfusion in A-XM, while compatible for transfusion in M-XM. None of the results was incompatible for transfusion in A-XM, while compatible for transfusion in M-XM, meaning A-XM detect agglutination more sensitively and consequently provides a more safe result than M-XM. A-XM was estimated to have a 6.3-fold lower risk (229 vs. 1,435 RPN), shorter turnaround time (19.1 vs. 23.3 min, P < 0.0001), shorter hands-on time (1.1 vs. 5.3 min, P < 0.0001), and lower costs per single test than M-XM (1.44 vs. 2.70 USD). A-XM permitted annual savings of 46 million RPN, 15.1 months of daytime workers' labor, and 47,042 USD compared with M-XM. CONCLUSION This is the first attempt to implement A-XM using VISION Max. VISION Max A-XM appears to be a safe, practical, and reliable alternative for pre-transfusion workflow with the potential to improve quality and cost-effectiveness in the blood bank.
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Affiliation(s)
- Hee-Jung Chung
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Sang Gyeu Choi
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun-Kyung Lee
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Seungho Lee
- Department of Occupational and Environmental Medicine, Ajou University Medicine, Suwon, South Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
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18
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Lenicek Krleza J, Honovic L, Vlasic Tanaskovic J, Podolar S, Rimac V, Jokic A. Post-analytical laboratory work: national recommendations from the Working Group for Post-analytics on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2019; 29:020502. [PMID: 31223256 PMCID: PMC6559616 DOI: 10.11613/bm.2019.020502] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/14/2019] [Indexed: 12/20/2022] Open
Abstract
The post-analytical phase is the final phase of the total testing process and involves evaluation of laboratory test results; release of test results in a timely manner to appropriate individuals, particularly critical results; and modification, annotation or revocation of results as necessary to support clinical decision-making. Here we present a series of recommendations for post-analytical best practices, tailored to medical biochemistry laboratories in Croatia, which are intended to ensure alignment with national and international norms and guidelines. Implementation of the national recommendations is illustrated through several examples.
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Affiliation(s)
- Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Anja Jokic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Biochemistry, Haematology and Coagulation, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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19
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Tsai ER, Tintu AN, Demirtas D, Boucherie RJ, de Jonge R, de Rijke YB. A critical review of laboratory performance indicators. Crit Rev Clin Lab Sci 2019; 56:458-471. [PMID: 31393193 DOI: 10.1080/10408363.2019.1641789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Healthcare budgets worldwide are under constant pressure to reduce costs while improving efficiency and quality. This phenomenon is also visible in clinical laboratories. Efficiency gains can be achieved by reducing the error rate and by improving the laboratory's layout and logistics. Performance indicators (PIs) play a crucial role in this process as they allow for performance assessment. This review aids in the process for selecting laboratory PIs-which is not trivial-by providing an overview of frequently used PIs in the literature that can also be used in clinical laboratories. We conducted a systematic review of the laboratory medicine literature on PIs. As the testing process in clinical laboratories can be viewed as a production process, we also reviewed the production processes literature on PIs. The reviewed literature relates to the design, optimization or performance assessment of such processes. The most frequently cited PIs relate to pre-analytical errors, timeliness, resource utilization, cost, and the amount of congestion. Their citation frequency in the literature is used as a proxy for their importance. PIs are discussed in terms of their definition, measurability and impact. The use of suitable PIs is crucial in production processes, including clinical laboratories. By also reviewing the production processes literature, additional relevant PIs for clinical laboratories were found. The PIs in the laboratory medicine literature mostly relate to laboratory errors, while the PIs in the production processes literature relate to the amount of congestion in the process.
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Affiliation(s)
- Eline R Tsai
- Department of Clinical Chemistry, Erasmus MC, University Medical Center , Rotterdam , the Netherlands.,Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente , Enschede , the Netherlands.,Department of Clinical Chemistry, Amsterdam UMC , Amsterdam , the Netherlands
| | - Andrei N Tintu
- Department of Clinical Chemistry, Erasmus MC, University Medical Center , Rotterdam , the Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente , Enschede , the Netherlands
| | - Richard J Boucherie
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente , Enschede , the Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam UMC , Amsterdam , the Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center , Rotterdam , the Netherlands
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20
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21
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De la Salle B. Pre‐ and postanalytical errors in haematology. Int J Lab Hematol 2019; 41 Suppl 1:170-176. [DOI: 10.1111/ijlh.13007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/23/2022]
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22
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Messinger BL, Rogers DN, Hawker CD. Automation and Process Re-engineering Work Together to Achieve Six Sigma Quality: A 27-Year History of Continuous Improvement. Lab Med 2019; 50:e23-e35. [PMID: 30726943 DOI: 10.1093/labmed/lmy081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In most clinical laboratories, examination quality is considered excellent, whereas pre-/postexamination quality is an area for focused improvement. In our organization, 1 pre-/postexamination quality metric, namely, lost specimens, as tracked continuously for 27 years, has demonstrated steady improvement. During this period, many of our processes transitioned to highly automated effectors. Concurrently, we implemented behavioral controls and reengineered error-prone processes. We believe that this bilateral approach has conclusively lowered our lost specimen rates. METHODS Using data spanning 27 years, we plotted the correlation between lost specimens and the implementation dates for 8 major phases of automation, as well as 19 process improvements and engineering controls. RESULTS The lost specimen rate decreased nearly 100-fold. In Six Sigma terms, the 12 month moving average for lost specimens currently hovers at approximately 5.94 sigma, with 11 months at or better than 6 sigma. Although the combination of implementation of process improvements, engineering controls, and automation contributed to the reduction, automation was the most significant contributor. CONCLUSIONS The custom automation in use by our laboratory has led to improved pre-/postexamination quality. Although this automation may not be possible for all laboratories, our description of 19 behavior and engineering controls may be useful to others seeking to design high quality pre-/postexamination processes.
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Affiliation(s)
| | | | - Charles D Hawker
- Department of Pathology, University of Utah, Salt Lake City, UT (retired).,ARUP Laboratories, Inc, Salt Lake City, UT (retired)
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23
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Shaikh MS, Ali SA, Rashid A, Karim F, Moiz B. Performance evaluation of a coagulation laboratory using Sigma metrics. Int J Health Care Qual Assur 2018; 31:600-608. [PMID: 29954266 DOI: 10.1108/ijhcqa-07-2017-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Two-thirds of medical decisions are based on laboratory test results. Therefore, laboratories should practice strict quality control (QC) measures. Traditional QC processes may not accurately reflect the magnitude of errors in clinical laboratories. Six Sigma is a statistical tool which provides opportunity to assess performance at the highest level of excellence. The purpose of this paper is to evaluate performance of the coagulation laboratory utilizing Sigma metrics as the highest level of quality. Design/methodology/approach Quality indicators of the coagulation laboratory from January 1, 2009, to December 31, 2015, were evaluated. These QIs were categorized into pre-analytical, analytical and post-analytical. Relative frequencies of errors were calculated and converted to Sigma scale to determine the extent of control over each process. The Sigma level of 4 was considered optimal performance. Findings During the study period, a total of 474,655 specimens were received and 890,535 analyses were performed. These include 831,760 (93.4 percent) routine and 58,775 (6.6 percent) special tests. Stat reporting was requested for 166,921 (18.7 percent). Of 7,535,146 total opportunities (sum of the total opportunities for all indicators), a total of 4,005 errors were detected. There were 2,350 (58.7 percent) pre-analytical, 11 (0.3 percent) analytical and 1,644 (41 percent) post-analytical errors. Average Sigma value obtained was 4.8 with 12 (80 percent) indicators achieving a Sigma value of 4. Three (20 percent) low-performance indicators were: unacceptable proficiency testing (3.8), failure to inform critical results (3.6) and delays in stat reporting (3.9). Practical implications This study shows that a small number of errors can decrease Sigma value to below acceptability limits. If clinical laboratories start using Sigma metrics for monitoring their performance, they can identify gaps in their performance more readily and hence can improve their performance and patient safety. Social implications This study provides an opportunity for the laboratorians to choose and set world-class goals while assessing their performance. Originality/value To the best of the authors' knowledge and belief, this study is the first of its kind that has utilized Sigma metrics as a QC tool for monitoring performance of a coagulation laboratory.
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Meier FA, Badrick TC, Sikaris KA. What's to Be Done About Laboratory Quality? Process Indicators, Laboratory Stewardship, the Outcomes Problem, Risk Assessment, and Economic Value: Responding to Contemporary Global Challenges. Am J Clin Pathol 2018; 149:186-196. [PMID: 29471323 DOI: 10.1093/ajcp/aqx135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe. Connections between structural and process laboratory measures and patient outcomes, however, have rarely been demonstrated. METHODS To inform further development of clinical laboratory quality systems, we conducted a selective but worldwide review of publications on clinical laboratory quality assessment. RESULTS Some QIs, like seven generic College of American Pathologists Q-Tracks monitors, have demonstrated significant process improvement; other measures have uncovered critical opportunities to improve test selection and result management. The College of Pathologists of Australasia Key Indicator Monitoring and Management System has deployed risk calculations, introduced from failure mode effects analysis, as surrogate measures for outcomes. Showing economic value from clinical laboratory testing quality is a challenge. CONCLUSIONS Clinical laboratories should converge on fewer (7-14) rather than more (21-35) process monitors; monitors should cover all steps of the testing process under laboratory control and include especially high-risk specimen-quality QIs. Clinical laboratory stewardship, the combination of education interventions among clinician test orderers and report consumers with revision of test order formats and result reporting schemes, improves test ordering, but improving result reception is more difficult. Risk calculation reorders the importance of quality monitors by balancing three probabilities: defect frequency, weight of potential harm, and detection difficulty. The triple approach of (1) a more focused suite of generic consensus quality indicators, (2) more active clinical laboratory testing stewardship, and (3) integration of formal risk assessment, rather than competing with economic value, enhances it.
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Affiliation(s)
| | - Tony C Badrick
- Bond University, Biomedical Science, RCPAQAP, St Leonards, Sydney, Australia
| | - Kenneth A Sikaris
- Education and Management Division, Melbourne Pathology, Melbourne, Australia
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25
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Rubinstein M, Hirsch R, Bandyopadhyay K, Madison B, Taylor T, Ranne A, Linville M, Donaldson K, Lacbawan F, Cornish N. Effectiveness of Practices to Support Appropriate Laboratory Test Utilization: A Laboratory Medicine Best Practices Systematic Review and Meta-Analysis. Am J Clin Pathol 2018; 149:197-221. [PMID: 29471324 PMCID: PMC6016712 DOI: 10.1093/ajcp/aqx147] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization. Methods This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices. Eligible outcomes included intermediate, systems outcomes (eg, number of tests ordered/performed and cost of tests), as well as patient-related outcomes (eg, length of hospital stay, readmission rates, morbidity, and mortality). Results Eighty-three studies met inclusion criteria. Fifty-one of these studies could be meta-analyzed. Strength of evidence ratings for each practice ranged from high to insufficient. Conclusion Practice recommendations are made for CPOE (specifically, modifications to existing CPOE), reflex testing, and combined practices. No recommendation for or against could be made for CDSS/CDST, education, feedback, test review, and LTU. Findings from this review serve to inform guidance for future studies.
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Affiliation(s)
| | | | | | | | - Thomas Taylor
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Anne Ranne
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Nancy Cornish
- Centers for Disease Control and Prevention, Atlanta, GA
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Krleza JL, Dorotic A, Grzunov A. External quality assessment of medical laboratories in Croatia: preliminary evaluation of post-analytical laboratory testing. Biochem Med (Zagreb) 2017; 27:144-152. [PMID: 28392737 PMCID: PMC5382856 DOI: 10.11613/bm.2017.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/09/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Proper standardization of laboratory testing requires assessment of performance after the tests are performed, known as the post-analytical phase. A nationwide external quality assessment (EQA) scheme implemented in Croatia in 2014 includes a questionnaire on post-analytical practices, and the present study examined laboratory responses in order to identify current post-analytical phase practices and identify areas for improvement. Materials and methods In four EQA exercises between September 2014 and December 2015, 145-174 medical laboratories across Croatia were surveyed using the Module 11 questionnaire on the post-analytical phase of testing. Based on their responses, the laboratories were evaluated on four quality indicators: turnaround time (TAT), critical values, interpretative comments and procedures in the event of abnormal results. Results were presented as absolute numbers and percentages. Results Just over half of laboratories (56.3%) monitored TAT. Laboratories varied substantially in how they dealt with critical values. Most laboratories (65-97%) issued interpretative comments with test results. One third of medical laboratories (30.6-33.3%) issued abnormal test results without confirming them in additional testing. Conclusion Our results suggest that the nationwide post-analytical EQA scheme launched in 2014 in Croatia has yet to be implemented to the full. To close the gaps between existing recommendations and laboratory practice, laboratory professionals should focus on ensuring that TAT is monitored and lists of critical values are established within laboratories. Professional bodies/institutions should focus on clarify and harmonized rules to standardized practices and applied for adding interpretative comments to laboratory test results and for dealing with abnormal test results.
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Affiliation(s)
- Jasna Lenicek Krleza
- Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Adrijana Dorotic
- Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana Grzunov
- Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
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The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Reprod Biomed Online 2017; 35:494-510. [PMID: 28784335 DOI: 10.1016/j.rbmo.2017.06.015] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 11/19/2022]
Abstract
This proceedings report presents the outcomes from an international workshop supported by the European Society of Human Reproduction and Embryology (ESHRE) and Alpha Scientists in Reproductive Medicine, designed to establish consensus on definitions and recommended values for Indicators for the assisted reproductive technology (ART) laboratory. Minimum performance-level values ('competency') and aspirational ('benchmark') values were recommended for a total of 19 Indicators, including 12 Key Performance Indicators (KPIs), five Performance Indicators (PIs), and two Reference Indicators (RIs).
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The Vienna consensus: report of an expert meeting on the development of art laboratory performance indicators. Hum Reprod Open 2017; 2017:hox011. [PMID: 31486806 PMCID: PMC6276649 DOI: 10.1093/hropen/hox011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/15/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION What are appropriate performance indicators (PIs) for ART laboratories for use in monitoring ‘fresh’ IVF and ICSI cycles? SUMMARY ANSWER Minimum performance (competence) levels and aspirational (benchmark) values were recommended for a total of 19 indicators, including 12 key PIs (KPIs), five PIs and two reference indicators (RIs). WHAT IS ALREADY KNOWN PIs are necessary for systematic monitoring of the laboratory and an important element within the Quality Management System. However, there are no established PIs for ART laboratories and there is very little evidence on the topic. STUDY DESIGN, SIZE, DURATION This is the report of a 2-day consensus meeting of expert professionals. As a starting point for the discussion, two surveys were organized to collect information on indicators used in IVF laboratories. During the meeting, the results of the surveys, scientific evidence (where available), and personal clinical experience where integrated into presentations by experts on specific topics. After presentation, each proposed indicator was discussed until consensus was reached within the panel. PARTICIPANTS/MATERIALS, SETTING, METHODS Expert professionals representing different countries and settings convened in the consensus meeting. MAIN RESULTS AND THE ROLE OF CHANCE The paper is divided in two parts: the workshop report and the recommendations of the expert panel. The second part reflects the discussion on each of the indicators, with the agreed definition, competence level and benchmark value for each of the 19 indicators, including 12 KPIs, 5 PIs and 2 RIs. LIMITATIONS, REASONS FOR CAUTION The KPIs are mainly based on expert opinion. Future research may warrant an update of the recommended KPIs, their definition and the competence level and benchmark values. WIDER IMPLICATIONS OF THE FINDINGS Based on the information presented, each ART laboratory should select its own set of KPIs founded on laboratory organization, and processes. STUDY FUNDING/COMPETING INTEREST(S) The consensus meeting and writing of the paper was supported by funds from ESHRE and Alpha. Alpha gratefully acknowledges the following organizations for their financial support, through the provision of unrestricted educational grants: Global Fertility Alliance, Merck, Origio and Vitrolife. There are no conflicts of interest to disclose,
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Affiliation(s)
| | - Alpha Scientists in Reproductive Medicine
- ALPHA Scientists in Reproductive Medicine, 19 Mayis Mah. 19 Mayis Cad. Nova Baran Center No:4 34360 Sisli, Istanbul, Turkey
- Correspondence address. E-mail: (G.C.)/ (Z.P.)
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Epner PL. Appraising laboratory quality and value: What's missing? Clin Biochem 2017; 50:622-624. [DOI: 10.1016/j.clinbiochem.2017.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/21/2017] [Accepted: 04/18/2017] [Indexed: 11/30/2022]
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Lee EJ, Kim M, Kim HS, Park MJ, Lee YK, Kang HJ. Development of a Novel Quality Improvement Indicator Based on the Hemolysis Index. Ann Lab Med 2017; 36:599-602. [PMID: 27578515 PMCID: PMC5011115 DOI: 10.3343/alm.2016.36.6.599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/31/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022] Open
Abstract
Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25. The monthly mean H index and monthly frequency of samples with an H index >25 were significantly different among the types of ward (P=0.001, respectively), and significantly decreased after replacement of a laboratory centrifuge lacking temperature control (20.6±0.58 vs 23.30±1.08, P=0.01; 23.4±1.69% vs 32.6±1.78%, P=0.01). The monthly mean H index and the monthly frequency of samples with an H index above a threshold value may be useful quality improvement indicators for detection of inappropriate procedures in the acquisition and handling of blood samples in medical care units.
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Affiliation(s)
- Eun Jin Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Han Sung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Min Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea.
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Earley MC, Astles JR, Breckenridge K. Practices and Perceived Value of Proficiency Testing in Clinical Laboratories. J Appl Lab Med 2017; 1:415-420. [PMID: 31903445 DOI: 10.1373/jalm.2016.021469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Proficiency testing (PT) can have regulatory and nonregulatory uses, providing an effective tool for quality improvement. Clinical laboratories were surveyed to determine how they perceive PT and how they use PT results and materials to improve laboratory testing quality. Methods All laboratories certified to perform nonwaived testing under the CLIA regulations expected to perform required PT were invited to participate in the survey. We examined respondents' use of PT from 5 laboratory types: hospital, independent, public health, physician office, and "all other." Respondents' awareness of resources about PT was also examined. Several questions allowed responses on a categorical scale. Results Varying proportions of the respondents (n = 769) used PT to identify problems in the preanalytic (48%), analytic (86%), and postanalytic (76%) phases of testing. Responses also showed that PT was important for demonstrating personnel competency (93%), inappropriate specimen handling (80%), incorrect result interpretation (84%), and other uses. Respodents purchased PT even when not required to do so (77%). Based on all responses, most considered PT worth the cost (65%). Conclusions Laboratories, regardless of type, have found ways of using leftover PT samples and the information from PT event summaries to help improve laboratory quality. Our findings suggest many laboratories are not taking full advantage of PT to improve testing quality. Additionally, the study suggests a need to improve awareness of resources about PT.
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Affiliation(s)
| | - J Rex Astles
- Centers for Disease Control and Prevention, Atlanta, GA
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Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship. J Clin Microbiol 2016; 55:715-723. [PMID: 28031432 DOI: 10.1128/jcm.02264-16] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics.
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Quality Measures That Address the Upper Limb. J Hand Surg Am 2016; 41:1041-1048.e22. [PMID: 27577525 DOI: 10.1016/j.jhsa.2016.07.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/20/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Physicians, health care systems, and payers use quality measures to judge performance and monitor the outcomes of interventions. Practicing upper-limb surgeons desire quality measures that are important to patients and feasible to use, and for which it is fair to hold them accountable. METHODS Nine academic upper-limb surgeons completed a RAND/University of California-Los Angeles Delphi Appropriateness process to evaluate the importance, feasibility, and accountability of 134 quality measures identified from systematic review. Panelists rated measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 were equivocal or uncertain, and 7 to 9 were valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), panelists were considered to be in agreement. If 3 or more ratings of a measure were within the 1 to 3 range whereas 3 or more ratings were in the 7 to 9 range, panelists were considered to be in disagreement. RESULTS There was agreement that 58 of the measures are important (43%), 74 are feasible (55%), and surgeons can be held accountable for 39 (29%). All 3 thresholds were met for 33 measures (25%). A total of 36 reached agreement for being unimportant (48%) and 57 were not suited for surgeon accountability (43%). CONCLUSIONS A minority of upper-limb quality measures were rated as important for care, feasible to complete, and suitable for upper-limb surgeon accountability. CLINICAL RELEVANCE Before health systems and payers implement quality measures, we recommend ensuring their importance and feasibility to safeguard against measures that may not improve care and might misappropriate attention and resources.
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Leaven LT. Predicting Tests Ordered in Hospital Laboratories using Generalized Linear Modeling. Hosp Top 2016; 94:49-55. [PMID: 27997297 DOI: 10.1080/00185868.2016.1234315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Laboratory services in healthcare systems play a vital role in inpatient care. Most hospital laboratories are facing the challenge of reducing cost and improving service quality. The author focuses on identifying test order patterns in a laboratory for a large urban hospital. The data collected from this facility consists of all tests ordered over a three-month time frame and contains test orders for approximately 17,500 patients. Poisson and negative binomial regression models are used to determine how well patient characteristics (patient length of stay and the medical units in which patients are placed) will predict the number of tests being ordered. The test order prediction model developed in this study will aid the management and phlebotomists in the hospital laboratory in securing methods to satisfy the test order demand. By implementing the recommendations of this study, hospital laboratories should see significant improvements in phlebotomist productivity and resource utilization, implementation of which could result in cost savings.
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Affiliation(s)
- Laquanda T Leaven
- a Department of Marketing, Transportation, and Supply Chain , College of Business and Economics, North Carolina Agricultural and Technical State University , Greensboro , North Carolina , USA
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Altindis M, Koroglu M, Demiray T, Dal T, Ozdemir M, Sengil AZ, Atasoy AR, Doğan M, Cicek AC, Ece G, Kaya S, Iraz M, Gultepe BS, Temiz H, Kandemir I, Aksaray S, Cetinkol Y, Sahin I, Guducuoglu H, Kilic A, Kocoglu E, Gulhan B, Karabay O. A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria. Jundishapur J Microbiol 2016; 9:e29766. [PMID: 27099693 PMCID: PMC4834024 DOI: 10.5812/jjm.29766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. OBJECTIVES In this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. MATERIALS AND METHODS Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. The blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. RESULTS Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. Of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. The average growth rate in the bottles of blood cultures during the defined period (1259 - 26,400/year) was 32.3%. Of the growing microorganisms, 67% were causative agents, while 33% were contaminants. The contamination rates of the centers ranged from 1% to 17%. The average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. The most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). CONCLUSIONS The high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.
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Affiliation(s)
- Mustafa Altindis
- Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
- Corresponding author: Mustafa Altindis, Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey. Tel: +90-2642957277, Fax: +90-2642956629, E-mail:
| | - Mehmet Koroglu
- Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Tayfur Demiray
- Department of Clinical Microbiology, Training and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Tuba Dal
- Department of Clinical Microbiology, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Mehmet Ozdemir
- Department of Clinical Microbiology, Meram Medical Faculty Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Zeki Sengil
- Department of Medical Microbiology, Medical Faculty, Medipol University, Istanbul, Turkey
| | - Ali Riza Atasoy
- Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Metin Doğan
- Department of Clinical Microbiology, Meram Medical Faculty Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Aysegul Copur Cicek
- Department of Clinical Microbiology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Gulfem Ece
- Department of Clinical Microbiology, School of Medicine, Izmir University, Izmir, Turkey
| | - Selcuk Kaya
- Department of Clinical Microbiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Meryem Iraz
- Department of Clinical Microbiology, School of Medicine, Bezmi Alem University, Istanbul, Turkey
| | - Bilge Sumbul Gultepe
- Department of Clinical Microbiology, School of Medicine, Bezmi Alem University, Istanbul, Turkey
| | - Hakan Temiz
- Department of Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Idris Kandemir
- Department of Clinical Microbiology, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Sebahat Aksaray
- Department of Clinical Microbiology, Haydarpasa Numune Hospital, Istanbul, Turkey
| | - Yeliz Cetinkol
- Department of Clinical Microbiology, School of Medicine, Ordu University, Ordu, Turkey
| | - Idris Sahin
- Department of Clinical Microbiology, School of Medicine, Duzce University, Duzce, Turkey
| | - Huseyin Guducuoglu
- Department of Clinical Microbiology, School of Medicine, Yuzuncuyil University, Van, Turkey
| | - Abdullah Kilic
- Department of Clinical Microbiology, School of Medicine, Gulhane Military Medical School, Ankara, Turkey
| | - Esra Kocoglu
- Department of Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Baris Gulhan
- Department of Clinical Microbiology, School of Medicine, Erzincan University, Erzincan, Turkey
| | - Oguz Karabay
- Department of Infection Diseases, School of Medicine, Sakarya University, Sakarya, Turkey
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Plebani M. Harmonization in laboratory medicine: Requests, samples, measurements and reports. Crit Rev Clin Lab Sci 2015; 53:184-96. [DOI: 10.3109/10408363.2015.1116851] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Jafri L, Khan AH, Ghani F, Shakeel S, Raheem A, Siddiqui I. Error identification in a high-volume clinical chemistry laboratory: Five-year experience. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:296-300. [DOI: 10.3109/00365513.2015.1010175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Atay A, Demir L, Cuhadar S, Saglam G, Unal H, Aksun S, Arslan B, Ozkan A, Sutcu R. Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors. Biochem Med (Zagreb) 2014; 24:376-82. [PMID: 25351356 PMCID: PMC4210258 DOI: 10.11613/bm.2014.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/22/2014] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Preanalytical errors, along the process from the beginning of test requests to the admissions of the specimens to the laboratory, cause the rejection of samples. The aim of this study was to better explain the reasons of rejected samples, regarding to their rates in certain test groups in our laboratory. MATERIALS AND METHODS This preliminary study was designed on the rejected samples in one-year period, based on the rates and types of inappropriateness. Test requests and blood samples of clinical chemistry, immunoassay, hematology, glycated hemoglobin, coagulation and erythrocyte sedimentation rate test units were evaluated. Types of inappropriateness were evaluated as follows: improperly labelled samples, hemolysed, clotted specimen, insufficient volume of specimen and total request errors. RESULTS A total of 5,183,582 test requests from 1,035,743 blood collection tubes were considered. The total rejection rate was 0.65 %. The rejection rate of coagulation group was significantly higher (2.28%) than the other test groups (P < 0.001) including insufficient volume of specimen error rate as 1.38%. Rejection rates of hemolysis, clotted specimen and insufficient volume of sample error were found to be 8%, 24% and 34%, respectively. Total request errors, particularly, for unintelligible requests were 32% of the total for inpatients. CONCLUSIONS The errors were especially attributable to unintelligible requests of inappropriate test requests, improperly labelled samples for inpatients and blood drawing errors especially due to insufficient volume of specimens in a coagulation test group. Further studies should be performed after corrective and preventive actions to detect a possible decrease in rejecting samples.
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Affiliation(s)
- Aysenur Atay
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Leyla Demir
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Serap Cuhadar
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Gulcan Saglam
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Hulya Unal
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Saliha Aksun
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Banu Arslan
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Asuman Ozkan
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
| | - Recep Sutcu
- Katip Celebi University, Ataturk Training and Research Hospital, Department of Clinical Biochemistry, Izmir, Turkey
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Koh YR, Kim SY, Kim IS, Chang CL, Lee EY, Son HC, Kim HH. Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level. Ann Lab Med 2014; 34:380-5. [PMID: 25187892 PMCID: PMC4151008 DOI: 10.3343/alm.2014.34.5.380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 03/25/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level.
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Affiliation(s)
- Young Rae Koh
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Shine Young Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - In Suk Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Chulhun L. Chang
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Han Chul Son
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyung Hoi Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
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Kumar SA, Jayanna P, Prabhudesai S, Kumar A. Evaluation of Quality Indicators in a Laboratory Supporting Tertiary Cancer Care Facilities in India. Lab Med 2014; 45:272-7. [DOI: 10.1309/lmp0e6dvc0oslyis] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Giménez-Marín A, Rivas-Ruiz F, Pérez-Hidalgo MDM, Molina-Mendoza P. Pre-analytical errors management in the clinical laboratory: a five-year study. Biochem Med (Zagreb) 2014; 24:248-57. [PMID: 24969918 PMCID: PMC4083576 DOI: 10.11613/bm.2014.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/27/2014] [Indexed: 11/09/2022] Open
Abstract
Introduction: This study describes quality indicators for the pre-analytical process, grouping errors according to patient risk as critical or major, and assesses their evaluation over a five-year period. Materials and methods: A descriptive study was made of the temporal evolution of quality indicators, with a study population of 751,441 analytical requests made during the period 2007–2011. The Runs Test for randomness was calculated to assess changes in the trend of the series, and the degree of control over the process was estimated by the Six Sigma scale. Results: The overall rate of critical pre-analytical errors was 0.047%, with a Six Sigma value of 4.9. The total rate of sampling errors in the study period was 13.54% (P = 0.003). The highest rates were found for the indicators “haemolysed sample” (8.76%), “urine sample not submitted” (1.66%) and “clotted sample” (1.41%), with Six Sigma values of 3.7, 3.7 and 2.9, respectively. Conclusions: The magnitude of pre-analytical errors was accurately valued. While processes that triggered critical errors are well controlled, the results obtained for those regarding specimen collection are borderline unacceptable; this is particularly so for the indicator “haemolysed sample”.
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Sorita A, Patterson A, Landazuri P, De-Lin S, Fischer C, Husk G, Sivaprasad L. The feasibility and impact of midnight routine blood draws on laboratory orders and processing time. Am J Clin Pathol 2014; 141:805-10. [PMID: 24838324 DOI: 10.1309/ajcppl8kfh3kfhnv] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of midnight routine blood draws and assess their impact on test result availability and stat laboratory orders. METHODS We changed the timing of routine blood draws from early morning to midnight on five inpatient wards during the period November 16 to 30, 2011. RESULTS For the entire institution, of all orders placed each day, laboratory test orders placed from 4:00 to 8:00 am decreased from 55% to 39%, and those placed from 12:00 to 4:00 am increased from 12% to 30%. Stat orders per day decreased during the intervention period (301 ± 53 vs 344 ± 55, P = .04). Morning specimens were more likely to be available by 9:00am (78.1% vs 58.9%, P < .001), and their turnaround time improved by 25.8 minutes (158 vs 184 minutes, P < .001). Patient survey revealed potential preference for midnight blood draws. CONCLUSIONS Midnight is a feasible alternative for the timing of routine blood draws. Redesigning inflow of laboratory orders improved efficiency of laboratory processing and reduced stat orders.
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Affiliation(s)
- Atsushi Sorita
- Departments of Medicine, University of Kansas Medical Center, Kansas City
| | - Aaron Patterson
- Psychiatry, University of Kansas Medical Center, Kansas City
| | | | - Stacy De-Lin
- Family Medicine, University of Kansas Medical Center, Kansas City
| | | | - Gregg Husk
- Emergency Medicine, University of Kansas Medical Center, Kansas City
| | - Latha Sivaprasad
- Executive Administration, Mount Sinai Beth Israel, New York, NY. Dr Sorita is currently with the Division of Preventive Medicine, Mayo Clinic, Rochester, MN, and Dr Landazuri is with the Department of Neurology, University of Kansas Medical Center, Kansas City
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Plebani M, Sciacovelli L, Aita A, Padoan A, Chiozza M. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Chim Acta 2014; 432:44-8. [PMID: 24012653 DOI: 10.1016/j.cca.2013.07.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/16/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
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Tate JR, Johnson R, Barth J, Panteghini M. Harmonization of laboratory testing — Current achievements and future strategies. Clin Chim Acta 2014; 432:4-7. [DOI: 10.1016/j.cca.2013.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Plebani M, Sciacovelli L, Aita A, Chiozza ML. Harmonization of pre-analytical quality indicators. Biochem Med (Zagreb) 2014; 24:105-13. [PMID: 24627719 PMCID: PMC3936970 DOI: 10.11613/bm.2014.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/28/2013] [Indexed: 11/08/2022] Open
Abstract
Quality indicators (QIs) measure the extent to which set targets are attained and provide a quantitative basis for achieving improvement in care and, in particular, laboratory services. A body of evidence collected in recent years has demonstrated that most errors fall outside the analytical phase, while the pre- and post-analytical steps have been found to be more vulnerable to the risk of error. However, the current lack of attention to extra-laboratory factors and related QIs prevent clinical laboratories from effectively improving total quality and reducing errors. Errors in the pre-analytical phase, which account for 50% to 75% of all laboratory errors, have long been included in the ‘identification and sample problems’ category. However, according to the International Standard for medical laboratory accreditation and a patient-centered view, some additional QIs are needed. In particular, there is a need to measure the appropriateness of all test request and request forms, as well as the quality of sample transportation. The QIs model developed by a working group of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) is a valuable starting point for promoting the harmonization of available QIs, but further efforts should be made to achieve a consensus on the road map for harmonization.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Ada Aita
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - Maria Laura Chiozza
- Department for Quality and Accreditation, University Hospital, Padova, Italy
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The comparison of heparinized insulin syringes and safety-engineered blood gas syringes used in arterial blood gas sampling in the ED setting (randomized controlled study). Am J Emerg Med 2014; 32:432-7. [PMID: 24560392 DOI: 10.1016/j.ajem.2014.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Because the patient-related factors that determine the difficulty of the process cannot be controlled, the physician-related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas-specific syringes. In this prospective cross-sectional study, we aimed to compare safety-engineered blood gas syringes and conventional heparinized syringes used during the arterial blood gas extraction process in terms of ease of operation, the physician-patient satisfaction, laboratory appropriateness, and complications. METHODS Our study included patients whose arterial blood gas needed to be measured in the emergency department and who agreed to participate in the study. Patients were randomly divided into 2 groups. The arterial blood gas of the patients from the first group was measured by using conventional heparinized syringes, whereas safety-engineered blood gas syringes were used to measure the arterial blood gas of the patients from the second group. The groups were compared in terms of demographic data, the number of attempts, the physician and patient satisfaction, early and late-term complications, and laboratory appropriateness of the taken sample. RESULTS A total of 550 patients were included in our study in a 2-month study period. There were no significant differences between patients in terms of sex, age, weight, height, body mass index, and wrist circumference. In addition, the number of attempts (P=.489), patients' pain level during the procedure (P=.145), and the degree of difficulty of the procedure according to the patient (P=.109) and physician (P=.554) were not significantly different between the groups. After arterial blood gas extraction procedure, 115 patients (20.9%) developed complications. In the conventional heparinized syringe group, the complication rate (n=69; 25.1%) was significantly higher compared with the group that used safety-engineered blood gas syringes (n=46; 16%; P=.0211). Localized pain, which is one of the most common early complications, was more frequent in the conventional heparinized syringe group (19.3%). Complications in women (P=.003) and local pain (P=.01) developed lesser in the second group that used safety-engineered blood gas syringes, and the patient-physician satisfaction was higher in that group, as well. In the evaluation 48 hours after the procedure, the ratios of infection and local hematoma were higher in the conventional heparinized syringe group (P=.0213 and P < .0001). CONCLUSION In this study, we did not find any significant differences between the conventional heparinized syringes and safety-engineered blood gas syringes in terms of ease of operation, physician and patient satisfaction, and appropriateness of the taken sample. However, patients whose arterial blood gas was extracted by using safety-engineered blood gas syringes felt less pain and experienced fewer infections and hematomas at their puncture site.
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Quality indicators in laboratory medicine: A fundamental tool for quality and patient safety. Clin Biochem 2013; 46:1170-4. [DOI: 10.1016/j.clinbiochem.2012.11.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/31/2012] [Accepted: 11/08/2012] [Indexed: 11/23/2022]
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50
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Meier F, Jones BA. Ex Africa semper aliquid novi. Am J Clin Pathol 2013; 140:289-91. [PMID: 23955445 DOI: 10.1309/ajcp8am8hwyuxhhr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Frederick Meier
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI
| | - Bruce A. Jones
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI
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