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.

Parasitic infections in Malaysia: changing and challenges.

A total of 1,885 blood and stool samples of four main protozoan parasitic infections were retrospectively reviewed from January, 2000 to April, 2004. Eleven of the 1,350 stool samples were shown positive for Cryptosporidium and Giardia infections; one of the 5 cases was clinically diagnosed as gastrointestinal cryptosporidiosis, while 6 cases were giardiasis. In patients with giardiasis, children were among the high-risk groups, making up 66.7% of these patients. The common presenting signs and symptoms were: diarrhea (83.3%), loss of appetite (83.3%), lethargy (83.3%), fever (66.7%), nausea/vomiting (50.0%), abdominal pain (16.7%), dehydration (16.7%) and rigor and chills (16.7%). Metronidazole was the drug of choice and was given to all symptomatic patients (83.3%). For the blood samples, 28 of the 92 peripheral smears for Plasmodium spp infection were diagnosed as malaria. The age range was from 4 to 57, with a median of 32.5 years. The sex ratio (M:F) was 3.6:1, while the age group of 30-44 years was the most commonly affected in both sexes. The majority of patients were foreigners (60.7%) and non-professional (39%). Plasmodium vivax (71%) infection was the most common pathogen found in these patients, along with a history of traveling to an endemic area of malaria (31%). The predominant presenting signs and symptoms were: fever (27%), rigor and chills (24%), nausea/vomiting (15%) and headache (8%). Chloroquine and primaquine was the most common anti-malarial regimen used (78.6%) in these patients. The seroprevalence of toxoplasmosis in different groups was 258/443 (58%): seropositive for IgG 143 (32.3%); IgM 67 (15%); and IgG + IgM 48 (10.8%). The age range was from 1 to 85, with a mean of 34 (+/- SD 16.6) years. The predominant age group was 21 to 40 years (126; 28.4%). The sex ratio (M:F) was 1.2:1. Subjects were predominantly male (142; 32%) and the Malay (117; 26.4%). Of these, 32 cases were clinically diagnosed with ocular toxoplasmosis. The range of age was from 10 to 56 years with a mean of 30.5 (+/- SD 12.05) years. The sex ratio (M:F) was 1:1.7. The majority were in the age group of 21 to 40 years, female (20; 62.5%), and Malay (17; 53%). They were also single (16; 50%), unemployed (12; 37%), and resided outside Kuala Lumpur (21; 65.6%). The more common clinical presentations were blurring of vision (25; 78%), floaters (10; 31%) and pain in the eye (7; 22%). We found that funduscopic examination (100%) and seropositivity for anti-Toxoplasma antibodies (93.7%) were the main reasons for investigation. Choroidoretinitis was the most common clinical diagnosis (69%), while clindamycin was the most frequently used antimicrobial in all cases. Among HIV-infected patients, 10 cases were diagnosed as AIDS-related toxoplasmic encephalitis (TE) (9 were active and 1 had relapse TE). In addition, 1 case was confirmed as congenital toxoplasmosis.

Neuroleptic malignant syndrome recovery with nonspecific treatment

Neuroleptic malignant syndrome [NMS] is one of the recently discovered syndromes. It is considered fatal in 20% of cases and may cause irreversible brain damage in other number of cases. This is a case believed to be the first in Jordan University Hospital and probably in Jordan. The case was caused by Haloperidol IM injections. A review of literature on this subject is included

Psychiatric consultations in Jordan University Hospital: a comparative report on 861 referrals

A study of the frequency and pattern of referrals of psychiatric consultations in Jordan University Hospital for four years is reported on. The characteristics of 861 consultations are compared with a published comprehensive review of 42 publications on psychiatric referral patterns in general hospitals