Steering Standardization of Pathology Services Through Centralisation and Consolidation of Laboratory Procurement

@#The expansion of healthcare services to serve as many people as possible has led to the decentralisation of laboratory testing. Many laboratory tests are now made available at district hospitals and rural health clinics for certain states or provinces. Consequently, there is a proliferation of laboratory tests, techniques, equipment, and other required commodities at the different medical laboratories. The lack of central governance has resulted in a widely-diverse and non-standardised laboratory services that may eventually affect the quality of healthcare delivery to patients. To ensure a high-quality and standardised healthcare delivery across a state or a province, it is important that the relevant stakeholders outline and implement the necessary strategies to establish a streamlined medical laboratory network. In this article, we discuss the significance of laboratory procurement consolidation and centralisation in the steering of the standardisation of laboratory operations leading to a high-quality and efficient chemical pathology services in a defined region.

Evaluation of Blood Sample Rejection in a Clinical Laboratory of an Oncology Institute

@#Introduction: Error in blood sampling is of one the commonest causes of laboratory sample rejection and poses a great challenge particularly amongst oncology patients due to difficult venous access. This study aims to identify the main causes of blood sample rejection in the haematology and chemical pathology (CP) laboratories of an oncology institute. Method: All blood samples received and rejected in the CP and haematology laboratory from 2017 to 2019 were obtained from the laboratory information system (LIS) and sample rejection logbook. The rejection cause for each of the rejected samples was recorded and analysed. Results: Out of the total 39 495 blood samples received, 244 (0.6%) were rejected. The rejection rate in the CP was higher compared with that in the haematology laboratory (51.2% vs. 48.8%). The most frequent cause of rejection was haemolysis (49.6%), clotted sample (32.8%), and insufficient sample volume (6.1%). Conclusion: Haemolysis, clotted blood and insufficient sample were the main causes of sample rejection in our oncology centre. Effective and multidisciplinary targeted interventions to reduce blood sampling error are important to improve pre-analytical handling of blood samples from oncology patients.

Factors Contributing to Non-Communicable Diseases in a Selected Low Socio-Economic Status Community in Kedah, Malaysia

@#Introduction: Non-communicable diseases (NCDs) are evolving as the leading cause of death worldwide, including in Malaysia. Changes in a socio-economic status have increased at-risk populations with NCDs. The objective of this study is to describe the prevalence of self-reported NCDs and its contributing factors in a selected low socio-economic status community in Kedah, Malaysia. Methods: A cross-sectional study with a self-administered questionnaire was done among convenience samples of 139 adults (age more than 18 years old) living in a selected low socio-economic status community in Kedah. Results: Among 139 respondents with a mean (SD) age 48.5 (13.1), there were 40.3% of respondents reported to have chronic illnesses with a prevalence of hypertension (25.9%), diabetes mellitus (21.6%), hypercholesterolemia (7.2%), chronic respiratory diseases (5.0%), heart disease (2.9%) and stroke (1.4%). The significant contributing factors of NCDs by multiple logistic regression were age, marital and working status. A person with an increase in 1 year of age has 1.05 times the odds to have NCDs (95% CI: 1.01 to 1.09, p-value=0.007). A divorcee has 3.55 times the odds compared to a married person to have NCDs (95% CI: 1.28 to 9.80, p-value=0.015). The non-working individual has 2.27 times the odds compared to working individuals to have NCDs (95% CI: 1.03 to 5.01, p-value=0.042). Conclusion: The prevalence of NCDs is high in this selected low socio-economic status community. The contributing factors are age, marital and working status.

Improvement of Urgent Tests Laboratory Turnaround Time Through Laboratory Lean Management

@#Introduction: Laboratory turnaround time (LTAT) is considered a reliable indicator of the quality and efficiency of a laboratory’s service. LTAT achievement, particularly of urgent tests, remains unsatisfactory and challenging in many clinical laboratories especially in tertiary health care centres with high workload and restricted resources. The unresolved issue of unsatisfactory urgent renal profile (RP) LTAT below the standard performance goal prompted our interest to improve laboratory’s handling of urgent test request. We thus implemented the Lean principle in the management of urgent test requests using urgent RP as the test model. Methods: The implementation of laboratory Lean involved 4 steps process; (1) Development of burning platform for change (2) Identification of waste (3) Planning and implementation of control measures (4) Measuring, monitoring, and sustaining the improvement. Urgent RP LTAT and the percentage of the request met the time requirement determined based on the data extracted from laboratory information system (LIS) before and after the implementation of Lean was compared to assess the effectiveness. Results: Urgent RP LTAT after the implementation of Lean was reduced i.e 35 min (before) vs 31 min (after), with the percentage of LTAT met the time requirement was significantly increased above the set target i.e 82.8% (before) to 93.5% (after) with P-value = 0.001. Conclusion: Implementation of innovation using Lean management has significantly improved urgent RP LTAT achievement, thus optimised urgent test management in our Chemical Pathology laboratory. Lean is a strongly recommended strategy to improve urgent test LTAT especially in laboratories with restricted resources.

Procalcitonin as an Early Laboratory Marker of Sepsis in Neonates: Variation in Diagnostic Performance and Discrimination Value

@#Background: As an early recognition of neonatal sepsis is important for triggering the initiation of treatment, this study was thus designed to assess the diagnostic performance and discrimination value of procalcitonin (PCT) in neonatal sepsis cases. Methods: This cross-sectional study, which was carried out at the Paediatric Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia, had involved 60 neonates admitted for suspected sepsis. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and the area under receiver operating characteristics curve (AUC) for PCT were determined at initial presentation (0 h) as well as 12 h and 24 h after presentation in comparison to blood culture as the gold standard. Results: The study consisted of 27 (45.0%) male and 33 (55.0%) female neonates with a mean (SD) age of 76.8 (48.25) h. At cut-off PCT value of > 2 ng/mL, the sensitivity, specificity, PPV and NPV were 66.7%, 66.7%, 33.3% and 88.9% at 0 h. The respective parameters were 83.3%. 56.3%, 32.3% and 93.1% at 12 h and 83.3%, 52.1%, 30.3% and 92.6% at 24 h. AUC was 71.6%, 76.6% and 71.7% at 0 h, 12 h and 24 h. Conclusions: Diagnostic performance and discrimination values of PCT for diagnosis of neonatal sepsis varied with time of obtaining the blood samples. The PCT result at 12 h demonstrates the most optimal diagnostic performance and discrimination values.

Normokalemia in Grossly Haemolysed Samples

@#Haemolysis interferes with many test results through release of red blood cell (RBC) intracellular contents or via specific analytical interferences. In grossly haemolysed sample, potassium level can be raised considerably dependent on the degree of haemolysis and may exceed the critical limit value. In this case report, the potassium level from a grossly haemolysed sample taken after haemodialysis remains within normal range, and this has led to unnecessary repeated blood samplings hence delay the diagnosis. With the persistently high haemolytic index (HI) of ≥ 400mg/ dL and normal potassium levels in sequences of samples taken post haemodialysis should raise a high suspicion of in vivo haemodialysis related-haemolysis. An effective communication between laboratory and clinician, and a proper, well-designed protocol or guideline on the management of sample haemolysis in clinical laboratory therefore is very essential to ensure all clinically important but rare case of in vivo haemolysis can be identified early and the potential unwanted serious outcomes can be prevented accordingly.