RESUMEN
In the last few years much progress has been made in raising the awareness of laboratory medicine professionals a bout the effectiveness of quality indicators (QIs) in monitoring,and improving upon,performances in the extra-analytical phases of the total testing process (TTP).An effective system for management of QIs includes the implementation of an internal assessment system and participation in inter-laboratory comparison.A well-designed internal assessment system allows the identification of critical activities and their systematic monitoring.Active participation in inter-laboratory comparison provides information on the performance level of one laboratory with respect to that of other participating laboratories.In order to guarantee the use of appropriate QIs and facilitate their implementation,many laboratories have adopted the Model of Quality Indicators (MQI) proposed by Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of IFCC,since 2008,which is the result of international consensus and continuous experimentation,and updating to meet new,con stantly emerging needs.Data from participating laboratories are collected monthly and reports describing the statistical results and evaluating laboratory data,utilizing the Six Sigma metric,issued regularly.Although the results demonstrate that the processes need to be improved upon,overall the comparison with data collected in 2014 shows a general stability of quality levels and that an improvement has been achieved over time for some activities.The continuous monitoring of QI dataallows identification all possible improvements,thus highlighting the value of participation in the inter-laboratory program proposed by WGLEPS.The active participation of numerous laboratories will guarantee an ever more significant State-of-the-Art,promote the reduction of errors and improve quality of the TTP,especially the extra-analytical quality,thus guaranteeing patient safety.
RESUMEN
Objective To analyze laboratory turnaround time (TAT) and find effective ways to shorten TAT.Methods Data associated with cardiac panel (CK,cTnI and Mb) were collected in 2011 including 19 906 outpatient data and 22 973 inpatient data.The medians and the average medians of the quality indicators on TAT were calculated and the results were transformed to the Six Sigma scale to estimate the degree of control over related process.Processes were considered well controlled when σ ≥4.Based on the results of data analysis,an improvement plan was decided by laboratory quality management meeting and clinical communication meeting.The effect of the improvement plan was evaluated through 2011-2012 satisfaction surveys of outpatients and clinicians.Results The average median of overtime reports for outpatient from specimen collection to reception was 2.78％ (3.5σ),and 17.82％ (2.5σ) for inpatients.The average median of overtime reports for outpatient from specimen reception to result reporting was 3.39％ (3.4σ),and 2.96％ (3.4σ) for inpatients.The average median of overtime reports for outpatient from specimen collection to result reporting was 3.93％ (3.3σ),and 12.18％ (2.7σ) for inpatient.The results of TAT satisfaction surveys for outpatients from 2011 to 2012 were similar,which were 78％ in 2011 and 79％ in 2012; the results for clinicians showed an increase from 80％ in 2011 to 90％ in 2012,including an increase from 75％ to 79％ for very satisfaction choice.Conclusions Outside the laboratory TAT is a key step in sickroom patients delay TAT.The implementation for ten improvement suggestions enabled to shorten TAT effectively.
RESUMEN
El objetivo del trabajo fue evaluar la efectividad de un programa de auditoría clínica para vigilar y reducir la magnitud de errores preanalíticos en el Laboratorio de Guardia de un hospital público de la provincia de Buenos Aires. En un período de 2004 y otro de 2005 se relevaron los diferentes tipos de errores en 11.949 recipientes de muestras de sangre y orina. Se calcularon los indicadores: porcentaje de errores preanalíticos totales en las muestras (% EP), de muestras coaguladas, de recipientes inadecuados, de volumen inadecuado, de muestras hemolizadas, de muestras batidas y de identificación inadecuada. Se capacitó al personal de enfermería. Se asignaron los costos correspondientes a las etapas de obtención y remisión de muestras de la fase preanalítica. El % EP no presentó modificaciones significativas en 2004, mientras que en 2005 sus variaciones acompañaron las de algunos de los restantes indicadores. Los costos correspondientes a errores preanalíticos constituyeron en promedio el 10% de los costos totales de obtención y remisión de muestras en los períodos estudiados. Se concluye que las actividades de capacitación deben realizarse en forma periódica y someterse a seguimiento continuo a fin de obtener disminuciones significativas y perdurables en la magnitud de los errores preanalíticos.
The aim of this study was to evaluate the effectiveness of a clinical audit program to monitor and reduce the magnitude of pre-analytical errors in the Emergency Laboratory of a Buenos Aires Province public hospital. During a 2004 period and another 2005 one, different types of errors were surveyed in 11.949 blood- and urine-sample flasks. The following indicators were calculated: sample pre-analytical error percentage (% PE), as well as percentages corresponding to coagulated samples, inadequate flask use, inadequate flask volume, samples that underwent haemolysis, shaken samples and poor sample identification. Nursing personnel were trained. Costs incurred were allocated to the extraction and delivery stages within the pre-analytical phase. PE % did not show any meaningful changes in 2004, while in 2005 its variations followed those of some of the other indicators. Costs attributed to pre-analytical error represented 10% of total cost of sample extraction and delivery in the periods that were studied. It can be concluded that training courses must be periodically offered and their results monitored on a permanent basis if any significant and long-lasting reduction in the magnitude of pre-analytical errors is to be achieved.