Calidad de atención y satisfacción en un servicio de laboratorio clínico

Introducción: La administración organizacional en salud busca garantizar una atención efectiva y una gestión eficiente; evalúa la atención y satisfacción que a su vez guardan una estrecha y compleja relación. Objetivo: Estimar la asociación entre la calidad de atención y la satisfacción del usuario externo, del servicio de laboratorio clínico. Métodos: Estudio cuantitativo, correlacional, de diseño observacional transversal. La población estudiada fueron usuarios atendidos en el servicio de laboratorio clínico de un hospital privado, en Lima, Perú, a quienes se les aplicó un cuestionario de elaboración propia sobre calidad de atención y otro de satisfacción del usuario adaptado del modelo SERVPERF. La información obtenida fue analizada con el software IBM SPSS Statistics 23.0 y para la prueba de hipótesis se aplicó el coeficiente de correlación de Spearman. Resultados: De los 220 usuarios encuestados, el 69,1 % calificó como alta la calidad brindada, en la cual la dimensión mejor calificada fue la calidad humana (71,8 %); asimismo, el 73,6 % de los usuarios afirmaron estar satisfechos y dentro de ello, las dimensiones con mayor satisfacción fueron la empatía (73,2 %) y la seguridad (73,1 %). Conclusiones: La calidad de atención y sus dimensiones que la conforman se asocian con la satisfacción de los usuarios.

Introduction: The healthcare management seeks to guarantee effective care and efficient management, assesses care and satisfaction, which in turn have a close and complex relationship. Objective: To estimate the association between the quality of care and the satisfaction of the external user of the clinical laboratory service. Methods: Quantitative, correlational study, with a cross-sectional observational design. The population studied were users treated in the clinical laboratory service of a private hospital in Lima, Peru, to whom a self-developed questionnaire was applied on quality of care and another on user satisfaction adapted from the SERVPERF model. The information obtained was analyzed with the IBM SPSS Statistics 23.0 software and Spearman's correlation coefficient was applied for the hypothesis test. Results: Of the 220 users surveyed, 69.1% rated the quality provided as high, in which the best rated dimension was human quality (71.8%); Likewise, 73.6% of the users stated that they were satisfied and within this, the dimensions with the greatest satisfaction were empathy (73.2%) and security (73.1%). Conclusions: The quality of care and its dimensions that make it up are associated with user satisfaction.

SARS-CoV-2 laboratory surveillance during the first year of the COVID-19 pandemic in southern Brazil

ABSTRACT Background: Brazil has one of the highest numbers of COVID-19 cases and deaths. Rio Grande do Sul (RS) in southern Brazil is one of the leading states in terms of case numbers. As part of the national public health network, the State Central Laboratory (LACEN-RS) changed its routine in 2020 to focus on the diagnosis of COVID-19. This study evaluated the laboratory surveillance of COVID-19 suspected cases analyzed at the LACEN-RS in 2020. Methods: Viral detection was performed using RT-qPCR in samples from patients with respiratory infection who met the study criteria. Viral RNA was isolated using commercial manual kits or automated extractors, and SARS-CoV-2 RT-qPCR was performed using the Bio-Manguinhos/Rio de Janeiro, IBMP/Paraná, or Allplex 2019-nCoV assay. In total, 360 representative SARS-CoV-2 samples were sequenced using the Illumina platform. Results: In total, 31,197 of 107,578 (positivity rate = 29%) tested positive for SARS-CoV-2. The number of RT-qPCR tests performed per month followed the COVID-19 epidemic curve observed for the state, with peaks in July-August and December. Females accounted for 63% of the samples, whereas the positivity rate was higher among males (33.1% males vs. 26.5% females). The positivity rate was higher in adults aged 50-79 years compared to the overall positivity rate. The majority of cases were observed in the capital, Porto Alegre, and the metropolitan region. Ten distinct lineages were identified, with B.1.1.28, B.1.1.33, and P.2 being the most frequent. Conclusions: Here, we describe laboratory surveillance of COVID-19 to identify priorities for epidemiological surveillance actions in RS.

Sistema Obligatorio de Garantía de Calidad en Salud: aplicación al laboratorio clínico / Mandatory Quality Assurance System in Health: application to the clinical laboratory

En 1993, el Estado estableció el Sistema General de Seguridad Social en Salud, en el que se introdujeron los diferentes mecanismos legales para promover la calidad en las instituciones prestadoras de servicios de salud en el país. A partir de allí, se implantaron diferentes decretos. En la actualidad, el Sistema Obligatorio de Garantía de Calidad en Salud (SOGCS) se encuentra reglamentado en el Decreto 780 de 2016, Decreto Único Reglamentario del Sector Salud. El SOGCS está integrado por cuatro componentes principales: el Sistema Único de Habilitación (SUH), la Auditoría para el Mejoramiento de la Calidad, el Sistema Único de Acreditación (SUA) y el Sistema de Información para la Calidad en Salud, para dirigir y evaluar el desempeño de estas instituciones en términos de calidad y satisfacción social; además, se adoptó el Manual de Inscripción de Prestadores y Habilitación de Servicios de Salud, el cual contiene las condiciones mínimas que deben cumplir los servicios de salud ofertados y prestados en el país, para brindar seguridad a los usuarios en el proceso de la atención en salud. Dicho manual tiene por objeto definir las condiciones de verificación para la habilitación, como la capacidad técnico-administrativa, suficiencia patrimonial y financiera, y la capacidad tecnológica y científica. En este artículo se revisarán algunos conceptos generales del Sistema Obligatorio de Garantía de Calidad en Salud, así como los estándares y criterios de habilitación para laboratorios clínicos

In 1993, the State established the General System of Social Security in Health, in which different legal mechanisms were introduced to promote quality in the institutions providing health services in the country. From then on, different decrees were implemented. Currently, the Mandatory Health Quality Assurance System (SOGCS) is regulated by Decree 780 of 2016, the Sole Regulatory Decree of the Health Sector. SOGCS is made up of four main components: the Single Qualification System (SUH), the Audit for Quality Improvement, the Single Accreditation System (SUA) and the Health Quality Information System, to direct and evaluate the performance of these institutions in terms of quality and social satisfaction; in addition, the Health Services Provider Registration and Qualification Manual was adopted, which contains the minimum conditions that health services in the country must meet to provide security to users in the health care process. The purpose of this manual is to define the verification conditions for accreditation, such as technical-administrative capacity, patrimonial and financial sufficiency, and technological and scientific capacity. This article will review some general concepts of the Mandatory System of Quality Assurance in Health, as well as the standards and qualification criteria for clinical laboratories

Uso de estudios de laboratorio y gabinete en pacientes con dolor abdominal no traumático, en el servicio de urgencias

Introducción: La evaluación del paciente con dolor abdominal agudo no traumático es un reto diagnóstico. El uso de pruebas de laboratorio y gabinete son herramientas útiles que nos permiten obtener información complementaria sobre cada paciente y con ello confirmar o descartar un diagnóstico y determinar su plan de acción. Objetivo: Estimar la frecuencia de uso de en el servicio de urgencias del Hospital General Regional No.72 en pacientes con dolor abdominal no traumático. Métodos: Se realizó un estudio retrospectivo, observacional, transversal y descriptivo donde se revisaron 126 expedientes clínicos de pacientes ≥20 años, que acudieron a urgencias por, los cuales contaban con una estancia de al menos 8 h y a quienes se practicó alguna; se excluyeron expedientes clínicos de mujeres embarazadas. Los datos se analizaron con estadística descriptiva. Resultados: Se realizaron 827 pruebas a 126 pacientes. Los principales estudios utilizados fueron: biometría hemática (99,2 %), glucosa, urea, creatinina, electrólitos y tiempos de coagulación (en el 100 % de los pacientes). Los estudios de gabinete más utilizados fueron: ultrasonido (31,7 %) y tomografía abdominal (11,9 %). Las cinco patologías más prevalentes fueron: colecistitis, infección urinaria, gastroenteritis, enfermedad ácido péptica y pancreatitis. Conclusiones: El dolor abdominal es una patología de etiología multivariada, por lo que su estudio adecuado es esencial para el manejo de las personas y la implementación de un sistema de gestión de calidad centrado en el paciente.

Introduction: The evaluation of the patient with non-traumatic acute abdominal pain is a diagnostic challenge. The use of laboratory and cabinet tests are useful tools allowing to obtain complementary information about each patient and thereby confirm or rule out a diagnosis and determine its action plan. Objective: To estimate the frequency of use of laboratory and cabinet tests in the emergency department at the Regional General Hospital No.72, in patients with non-traumatic abdominal pain from August to September 2017. Methods: A retrospective, observational, cross-sectional and descriptive study was carried out. One hundred twenty six (126) clinical records of patients ≥20 years old were reviewed, these subjects attended the emergency room for non-traumatic acute abdominal pain, and had a stay of at least 8 hours. They underwent some laboratory and cabinet tests. Clinical records of pregnant women were excluded. The data was analyzed with descriptive statistics. Results: Eight hundred twenty seven (827) tests were performed on 126 patients. The main studies used were blood count (99.2%), glucose, urea, creatinine, electrolytes and coagulation times (in 100% of patients). The most used cabinet studies were ultrasound (31.7%) and abdominal tomography (11.9%). The five most prevalent pathologies were cholecystitis, urinary infection, gastroenteritis, acid peptic disease and pancreatitis. Conclusions: Abdominal pain is a pathology of multivariate etiology, so adequate study is essential for the management of people and the implementation of a quality management system focused on the patient.

Los exámenes de ayuda diagnóstica y los conflictos de interés en nuestros hospitales: ¿Corrupción enmascarada?

Introducción: En los hospitales públicos, las dificultades surgidas por el déficit de recursos logísticos en el laboratorio clínico, dificultan aún más una atención de calidad. La carencia de una gestión por procesos y los conflictos de interés surgidos por la proliferación de laboratorios no certificados ni acreditados, hacen necesaria una nueva visión sobre este tema. La Medicina del Laboratorio Basado en la Evidencia, es una herramienta de la cual clínicos, tecnólogos y biólogos pueden beneficiarse. Por otro lado, es necesario que, a partir del estado, se consensuen los esfuerzos realizados por los distintos actores de este problema: UNAGESP, IETSI, SIS, INACAL, SUSALUD, Defensoría del Pueblo, Contraloría General de la República, Colegios profesionales y Empresa privada para mejorar la gestión del laboratorio clínico.

Background: In public hospitals, the difficulties arising from the lack of logistical resources in the clinical laboratory make quality care even more difficult. The lack of management by processes and the conflicts of interest arising from the proliferation of laboratories that are not certified or accredited make a new vision on this subject necessary. Evidence-Based Laboratory Medicine is a tool from which clinicians, technologists and biologists can benefit. On the other hand, it is necessary that, from the state, the efforts made by the UNAGESP, IETSI, SIS, INACAL, SUSALUD, the Ombudsman's Office, the Comptroller General's Office of the Republic, professional associations and private companies to improve the management of the clinical laboratory be agreed upon.

(Ine)quality in Healthcare: a perspective from the accreditation of clinical laboratories in Costa Rica / (Ine)quidades en la calidad de la atención sanitaria: perspectiva de la acreditación de laboratorios clínicos en Costa Rica

Abstract Introduction: Given the relevance of quality-assured laboratory services for health system strengthening and improvement, this study had the objective of exploring the distribution of ISO 15189-accredited and non-accredited laboratories in Costa Rica, in order to identify possible gaps in the fulfillment of its commitment to provide quality healthcare for all.Methods: Our research was conducted with a descriptive scope and following a quantitative approach. Costa Ricas Accreditation Body and College of Microbiologists databases were searched to collect data regarding clinical laboratory registration and ISO 15189 accreditation status. Laboratory availability indicators by geographical division were computed with this data.Results: Out of 480 clinical laboratories allowed to operate in Costa Rica as of January 2021, only 5 (about 1%) have been accredited in compliance with ISO 15189, all of which are private and located in the province of San José. Also, laboratory density (in terms of facilities per 100 km2 and per 100 000 population) is heterogeneous among provinces. Clinical laboratory services are more easily available in central provinces of the country (e.g. San José and Heredia), where ratios for laboratory density are higher. On the contrary, coastal provinces such as Limón and Puntarenas exhibit low laboratory density ratios, reflecting geographical disparities in access to healthcare.Conclusions: Geographic disparities in the access to clinical laboratory services were observed. This should raise awareness among public health authorities and private healthcare providers regarding the countrys progress in attaining its quality healthcare for all commitment.

Resumen Introducción: Dada la relevancia de asegurar la calidad en los servicios de laboratorio para el fortalecimiento de los sistemas de salud, este estudio tuvo como objetivo explorar la distribución de laboratorios acreditados con ISO 15189 en Costa Rica, buscando identificar posibles brechas en el cumplimiento del compromiso país de brindar atención sanitaria de calidad para todos. Metodología: Se realizó una investigación con alcance descriptivo, siguiendo un enfoque cuantitativo. Se exploraron las bases de datos del Ente Costarricense de Acreditación y del Colegio de Microbiólogos de Costa Rica para recopilar datos sobre el registro y estado de acreditación de laboratorios clínicos. Con estos datos, se calcularon indicadores de densidad de laboratorios por división geográfica. Resultados: De los 480 laboratorios clínicos autorizados para operar en Costa Rica a enero 2021, solo 5 (aproximadamente un 1%) están acreditados por ISO 15189; todos ellos son privados y se ubican en la provincia de San José. Además, hay heterogeneidad entre provincias en cuanto a la densidad de laboratorios (establecimientos por 100 km2 y por 100 000 habitantes). Los servicios de laboratorio clínico están más fácilmente disponibles en provincias "centrales" del país (como San José y Heredia). Por el contrario, provincias costeras como Limón y Puntarenas exhiben bajas densidades de laboratorios, lo que refleja desigualdades en el acceso a la atención en salud. Conclusiones: Se observaron disparidades geográficas en el acceso a los servicios de laboratorio clínico. Esto debería crear conciencia entre los proveedores de salud públicos y privados sobre el progreso del país en el cumplimiento de su compromiso de "atención sanitaria de calidad para todos".

Plataforma laboratorial para monitorear el SARS-CoV-2 basada en la vigilancia de influenza y otros virus respiratorios en Perú / Laboratory platform for monitoring SARS-CoV-2 based on surveillance of influenza and other respiratory viruses in Peru

RESUMEN En el Perú, la pandemia de la COVID-19 ha evidenciado la utilidad de tener un sistema de vigilancia laboratorial estructurado y en funcionamiento desde hace 22 años, basado en la vigilancia de influenza; inicialmente en modalidad de unidades centinela, y después fortaleciéndose e innovándose, con recursos propios y con apoyo externo, para generar información de calidad. Se han implementado avances biotecnológicos para la confirmación diagnóstica e incrementado las capacidades de la red nacional de laboratorios, manteniendo la eficiencia, considerando las diversas y complejas realidades de los niveles regionales, y superando dificultades de comunicación y articulación entre instituciones. Resulta necesario consolidar este sistema, con trabajo colaborativo y coordinado entre sus componentes, impulsando su eficacia y oportunidad y promoviendo la vigilancia genómica de nuevos virus y variantes, como actualmente ocurre con el SARS-CoV-2.

ABSTRACT In Peru, the COVID-19 pandemic demonstrated the usefulness of having a structured laboratory surveillance system that has been operational for 22 years, based on influenza surveillance; initially in the form of sentinel units, and later strengthened and innovated, with its own resources and with external support, to provide quality information. Biotechnological advances have been implemented for diagnostic confirmation and the capacity of the national laboratory network has been expanded, maintaining efficiency, considering the diverse and complex realities of each region, and overcoming difficulties regarding communication and articulation between institutions. It is necessary to consolidate this system, with collaborative and coordinated work between its components, boosting its effectiveness and timeliness and promoting genomic surveillance of new viruses and variants, as is currently the case with SARS-CoV-2.

Evaluación externa de la calidad en laboratorios clínicos del nivel primario de la provincia Camagüey / External quality assessment in clinical laboratories of the primary health care in Camagüey

RESUMEN Introducción: La evaluación externa de la calidad es un procedimiento que compara los resultados de varios laboratorios que analizan la misma muestra, con el propósito de evaluar el desempeño analítico y asegurar la calidad. La provincia Camagüey fue incluida en forma permanente en el programa de evaluación externa de la calidad desde que se inició hasta que por diferentes dificultades nacionales y provinciales dicho programa no pudo continuar. Desde entonces, el comité de calidad de la provincia decidió organizar alternativas de evaluación con este propósito. En el 2016 se aplicó una nueva propuesta de evaluación en los laboratorios clínicos del nivel primario de atención. Objetivo: Evaluar la calidad de los resultados obtenidos en el procesamiento de los componentes de química clínica, en los laboratorios del nivel primario de la provincia Camagüey. Métodos: Se realizó un estudio descriptivo transversal desde septiembre de 2017 hasta julio de 2018, el universo estuvo constituido por todos los laboratorios clínicos de la provincia Camagüey y se trabajó con una muestra no probabilística de 14 laboratorios. Resultados: El desempeño analítico de colesteroles, glucemia y creatinina fue aceptable y los triglicéridos no aceptables, un policlínico del municipio Camagüey mostró el menor por ciento de error de medida de precisión y de exactitud. Conclusiones: Los resultados de los colesteroles mostraron los mejores desempeños analíticos y los resultados obtenidos fueron más exactos que precisos en los componentes evaluados. Fue elevado el por ciento de participación de los laboratorios 04 y 09 durante todo el tiempo que duró el estudio.

ABSTRACT Introduction: External quality assessment is a procedure that compares the results of several laboratories that analyze the same sample, with the purpose of evaluating analytical performance and assuring quality. Camagüey participated constantly in the external quality assessment program from the beginning until, due to different national and provincial difficulties, said program could not continue. Since then, the province(s quality committee decided to organize assessment alternatives for this purpose. In 2016, a new assessment proposal was applied in clinical laboratories al the primary level of care. Objective: To evaluate the quality of the results obtained in the processing of clinical chemistry components in primary level laboratories in the province of Camagüey. Methods: A cross-sectional descriptive study was carried out from September 2017 to July 2018, the universe consisted of all clinical laboratories in the province of Camagüey and a non-probabilistic sample of 14 laboratories was used. Results: The analytical performance of cholesterol, blood-glucose level and creatinine was acceptable and triglycerides were unacceptable. A polyclinic in the municipality of Camagüey showed the lowest percentage of precision and accuracy measurement error. Conclusions: The cholesterols results showed the best performances and the results obtained were more exact than precise in the evaluated components. The participation percentage of laboratories 04 and 09 was high throughout the duration of the study.

Monitoramento da qualidade da amostra para análise de RT-PCR da Covid-19 no LACEN-BA / Sample quality monitoring for Covid-19 RT-PCR analysis at LACEN-BA / Monitoreo de la calidad de la muestra para el análisis Covid-19 RT-PCR en LACEN-BA

A pandemia da Covid-19 tem se apresentado como um dos maiores desafios sanitários desse século. Em dezembro de 2019, na China, o agente etiológico foi identificado como um novo coronavírus, nomeado SARS-CoV-2. No Brasil, o primeiro caso confirmado da Covid-19 ocorreu em fevereiro de 2020 e, no mês seguinte, a Secretaria da Saúde do Estado da Bahia (Sesab) confirmou o primeiro caso na Bahia.O Laboratório Central de Saúde Pública Prof. Gonçalo Moniz (Lacen-BA) centralizou o diagnóstico laboratorial para confirmação dos casos suspeitos de Covid-19 dos 417 municípios baianos, utilizando a técnica de RT-PCR. Este estudo tem como objetivo identificar e analisar as não conformidades das amostras suspeitas de Covid-19 encaminhadas ao Lacen-BA. Trata-se de um estudo descritivo, cujos dados foram obtidos por meio de consulta aos relatórios de amostras e exames em desacordo, disponíveis no sistema Gerenciador de Ambiente Laboratorial (GAL), gerados mensalmente, no período de abril a outubro de 2020. Para garantir a qualidade das amostras recebidas, foram definidos critérios de aceitação/rejeição de amostras e criado o formulário de notificação de não conformidades, assegurando a rastreabilidade das amostras de Covid-19. Através de relatórios diários do sistema GAL, selecionou-se os nove principais motivos de não conformidades, sendo o mais frequente "requisição cancelada pela gerência do GAL devido à expiração do prazo de triagem", com 72,8% dos registros. A inserção da padronização de processos na etapa pré-analítica permite trabalhar com segurança, garantindo a qualidade da amostra a ser processada e, consequentemente, um resultado fidedigno, dentro do prazo acordado.

The Covid-19 pandemic is one of the greatest health challenges of this century. In December 2019, in China, the etiologic agent was identified as a new coronavirus, named SARS-CoV-2. In Brazil, the first case of Covid-19 was confirmed in February 2020 and, in the following month, the Department of Health of the State of Bahia (Sesab) confirms the first case in the state. The Central Public Health Laboratory Prof. Gonçalo Moniz (Lacen/BA) centralized the laboratory diagnosis to confirm the suspected cases of Covid-19 of the 417 municipalities of the state, using the RT-PCR technique. This study aims at identifying and analyzing the non-conformities of the suspected samples of Covid-19 sent to Lacen-BA. This is a descriptive study whose data were obtained by consulting there reports of samples and exams in disagreement, available in the Laboratory Environment Manager (GAL) system, generated monthly, from April to October,2020. To guarantee the quality of the samples received, acceptance / rejection criteria for the samples were defined and a form for the notification of non-conformities was created, ensuring the traceability of the Covid-19 samples. Daily reports from the Laboratory Environment Manager system based the selection of nine main reasons for non-conformities, among which "requisition canceled by the management of the GAL due to the expiration of the screening period" was present in 72.8% of the records. Process standardization, in the pre-analytical stage, allows working with security, guaranteeing the quality of the sample to be processed and a reliable result within the established period.

La pandemia del Covid-19 se ha presentado como uno de los desafíos de salud más grandes de este siglo. En diciembre de 2019, China identificó el agente etiológico del nuevo coronavirus llamado SARS-CoV-2. En Brasil, se notificó el primer caso del Covid-19 en febrero de 2020 y, al mes siguiente, la Secretaría de Salud del Estado de Bahía (Sesab) confirmaba el primer caso en Bahía. El Laboratorio Central de Salud Pública Prof. Gonçalo Moniz (Lacen/BA) centralizó el diagnóstico de laboratorio para confirmar los casos sospechosos del coronavirus de los 417 municipios de Bahía, mediante la técnica de RT-PCR. Este estudio tiene como objetivo identificar y analizar las no conformidades de las muestras sospechosas del Covid-19 enviadas al Lacen/BA. Este es un estudio descriptivo cuyos datos se obtuvieron consultando los informes de muestras y pruebas en desacuerdo disponibles en el sistema Laboratory Environment Manager (GAL), generados mensualmente, de abril a octubre/2020. Con el fin de garantizar la calidad de las muestras recibidas, se definieron criterios de aceptación/rechazo de las muestras y se elaboró un formulario para la notificación de no conformidades, asegurando la trazabilidad de las muestras. Por medio de informes diarios del sistema Laboratory Environment Manager, se seleccionaron nueve principales causas de no conformidades, de las cuales la más frecuente fue "requisición cancelada por la gerencia del GAL por vencimiento del período de cribado" con el 72,8% de los registros. La inserción de la estandarización de procesos en la etapa preanalítica permite trabajar con seguridad, garantizando la calidad de la muestra que procesar y, en consecuencia, un resultado confiable dentro del plazo acordado.

Una visión peruana sobre los servicios de patología clínica: avances y agenda pendiente / A Peruvian view about clinical pathology services: progress and pending issues

RESUMEN Los países realizan muchos esfuerzos, para poder implementar los objetivos de desarrollo sostenible, en búsqueda de la cobertura universal de la salud. Sin embargo, el acceso o la oportunidad de los servicios de Patología Clínica de alta calidad y oportunos, son necesarios para respaldar los sistemas de atención médica que tienen la tarea de lograr estos objetivos. Este acceso es más difícil de lograr en los países de bajos y medianos ingresos. En este artículo especial, se realizó un análisis de la situación global y nacional de esta problemática, en esta especialidad médica. Se identifican las cuatro barreras clave para la provisión de servicios de calidad y óptimos: recursos humanos o capacidad de la fuerza laboral insuficiente, educación y capacitación inadecuada, infraestructura y equipamiento inadecuado, y calidad, normas y acreditación insuficientes.

ABSTRACT Countries do plenty of effort in order to implement the objectives for sustainable development, aiming to achieve universal health coverage. However, access or chances for having high quality Clinical Pathology services are both necessary for supporting medical care systems if such objectives are to be achieved. This access is much more difficult to achieve in low- and medium- income countries. This paper presents an analysis of both the global and local situation in this respect. Four key barriers for delivering high quality and optimal services were identified: insufficient human resources or limited capability of the working force, inadequate education and training, inadequate infrastructure and equipment, and insufficient quality, regulations, and accreditation strategies.

Diagnóstico da rede de atendimento laboratorial de hanseníase no Departamento Regional de Saúde XV, São José do Rio Preto, São Paulo / Diagnóstico de la red de atención de laboratorio de lepra en el Departamento Regional de Salud XV, São José do Rio Preto, São Paulo, Brasil / Diagnosis of the leprosy laboratory care network in Regional Health Department XV, São José do Rio Preto, São Paulo, Brazil

Objetivo: Apresentar o diagnóstico situacional da rede laboratorial para hanseníase na região de São José do Rio Preto, SP, Brasil. Métodos: Pesquisa de avaliação com desenho descritivo. Os dados foram coletados por meio de formulário online preenchido pelos responsáveis pelo programa de hanseníase, em 2018. Resultados: Todos os 102 municípios que compõem a região enviaram os dados solicitados, 84 (82,4%) solicitavam a baciloscopia; e destes, 68 receberam capacitação. Do total, 11,7% enviavam baciloscopia para outros laboratórios sem respeitar a rede de referência. Apenas 59 (57,8%) solicitavam a biópsia, e destes, 47 tinham médico responsável pela coleta e 31 não respeitavam a rede de referência para encaminhamento das biópsias. Foram descritos, como aspectos que dificultavam o diagnóstico dos casos de hanseníase na região, a falta de sala adequada, poucos profissionais capacitados, ausência de material para transporte e de requisição de exames impressa. Conclusão: A rede laboratorial se encontra fragilizada, necessitando reestruturação.

Objetivo: Presentar el diagnóstico de la situación de la red de laboratorios para lepra en la región de São José do Rio Preto, SP, Brasil. Métodos: Estudio de evaluación con diseño descriptivo. Los datos fueron recolectados a través de un formulario en línea por cada persona responsable del programa de lepra en 2018. Resultados: Los 102 municipios que conforman la región enviaron los datos solicitados, el 82,4% (84/102) solicitaba la baciloscopia y de estos 68 recibieron capacitación. Del total, el 11.7% enviaba la baciloscopia a otros laboratorios sin respetar la red de referencia. Solo el 57,8% (59/102) solicitó una biopsia, y de estos, 47 tenía un médico responsable de la recolección y 31 no respetaron la red de referencia para enviar las biopsias. Los aspectos que dificultan el diagnóstico de casos de lepra en la región SJRP se describieron como la falta de una sala adecuada, profesionales capacitados, ausencia de material para el transporte y de solicitudes de exámenes impresos. Conclusión: La red de laboratorios está fragilizada y debe ser respetada en su composición inicial o reexaminada y reorganizada.

Objective: To present the situational diagnosis of the leprosy laboratory reference network in the region of São José do Rio Preto, SP, Brazil. Methods: This was an evaluation study with a descriptive design. The data were collected by means of an online form filled in by those in charge of the leprosy program in 2018. Results: All 102 municipalities that make up the region provided the requested data, 82.4% (84/102) requested slit-skin smear microscopy and of these 68 received training. Of the total, 11.7% sent slit-skin smears to other laboratories outside the reference network. Only 57.8% (59/102) requested a biopsy, of these 47 had a doctor responsible for taking the biopsy sample and 31 did not send biopsy samples for analysis in the reference network. Lack of an adequate room, few trained professionals, absence of material for transportation and absence of printed test requisitions were described as aspects that hinder leprosy case diagnosis in the region. Conclusion: The laboratory network is fragile and needs to be restructured.

Nonconformities in the pre-analytical phase identified in a public health laboratory / Não conformidades na fase pré-analítica identificadas em um laboratório de saúde pública

ABSTRACT Introduction: The nonconformities detected in the pre-analytical phase of laboratory tests sent to the Central Public Health Laboratories (Lacen) culminate in the loss of epidemiological data of great importance for public health and are detrimental to health surveillance. This study aimed to identify the most frequent pre-analytical nonconformities recorded by Lacen/PR and the major difficulties encountered by the primary and regional health units in the registration of exams in the Laboratory Environment Manager (GAL) system. Results: The analysis of data from the Paraná GAL system in 2017 identified 9,723 discards for disagreeing samples in a total of 132,567 tests performed in the same period. The most frequent nonconformities were: request canceled by the GAL management due to expiration of the screening period (28%), and sample unsuitable for the requested analysis (28%). Discussion: After identifying the vulnerabilities of this stage of the process, the greatest detected difficulty was requesting the correct test. Conclusion: Data indicate the need to strengthen training and improve the pre-analytical process in order to ensure patient safety and epidemiological data.

RESUMEN Introducción: Las no conformidades detectadas en la fase preanalítica de las pruebas enviadas a los laboratorios centrales (Lacen) del estado culminan en pérdida de datos epidemiológicos de gran importancia para la salud pública, además de perjudicar la vigilancia en salud. Objetivos: Este estudio intentó identificar las no conformidades preanalíticas más frecuentes registradas por el Lacen/PR y las mayores dificultades encontradas por unidades primarias y regionales de salud en el registro de pruebas en el sistema administrador del ambiente de laboratorio (GAL). Resultados: Del total de 132.765 pruebas realizadas en 2017, el análisis de datos del sistema GAL-Paraná identificó 9.723 descartes de muestras en desacuerdo. Las no conformidades más frecuentes fueron: solicitud rechazada por la gerencia de GAL pues la muestra está fuera de la fecha de caducidad (28%) y muestra inadecuada para el análisis solicitado (28%). Discusión: Al identificar los puntos débiles de esa etapa del proceso, la mayor dificultad detectada fue la solicitud de la prueba correcta. Conclusión: Los datos indican la necesidad de fortalecer las capacidades y la mejora del proceso preanalítico, para garantizar la seguridad del paciente y de los datos epidemiológicos.

RESUMO Introdução: As não conformidades detectadas na fase pré-analítica dos exames enviados aos laboratórios centrais (Lacen) do estado culminam em perda de dados epidemiológicos de grande importância para a saúde pública, além de prejudicar a vigilância em saúde. Objetivos: Este trabalho teve como objetivo identificar as não conformidades pré-analíticas mais frequentes registradas pelo Lacen/PR e as maiores dificuldades encontradas pelas unidades primárias e regionais de saúde no cadastro dos exames no sistema Gerenciador de Ambiente Laboratorial (GAL). Resultados: Do total de 132.567 exames realizados no ano de 2017, a análise dos dados do sistema GAL-Paraná identificou 9.723 descartes de amostras em desacordo. As não conformidades mais frequentes foram: requisição cancelada pela gerência do GAL devido à expiração do prazo de triagem (28%) e amostra imprópria para a análise solicitada (28%). Discussão: Ao identificar os pontos vulneráveis dessa etapa do processo, a maior dificuldade detectada foi solicitação do exame correto. Conclusão: Os dados indicam a necessidade de reforçar as capacitações e a melhoria do processo pré-analítico, a fim de garantir a segurança do paciente e dos dados epidemiológicos.

Results of laboratory tests not accessed in Brazilian private laboratories / Resultados de exames laboratoriais não acessados em laboratórios privados brasileiros

ABSTRACT Background: Laboratory medicine is an important part of the health care system and directly contributes to preventive actions, diagnostics, treatment, and management of diseases. The level and quality of laboratory resources utilization have been frequently questioned. A dissemination of conflicting data regarding the amount of laboratory tests not accessed by the requesting doctors or by the patients themselves is observed, although very often the sources and methodologies used to access these numbers are not properly clarified. Objective: The objective of this study was to obtain data on access to tests results performed in Brazilian private clinical analysis laboratories using the laboratory information system developed by SHIFT Consultoria e Sistemas (Consulting and Systems). Methods: The information was extracted from 81 laboratories, responsible for the performance of 93,240,651 tests, collected from 7,067,087 patients. Results: The total number of tests not accessed, considering all the regions, was 5,071,454, corresponding to a proportion of 5.4%. Due to the potential risks of adverse events or impacts on diagnostic and treatment management, including the economic impacts due to prolonged hospitalization time, the 17.9% proportion which was found to correspond to "not accessed" tests showing "abnormal" results. It is of particular concern, mainly if we observe that from these, 2.5% were related to "abnormal" test results processed by laboratories working in hospital units. Conclusion: Due to the relevance of the theme, Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML), will keep encouraging the monitoring and utilization of adequate laboratory resources, in order to enable sustainable health care systems.

RESUMEN Introducción: La medicina de laboratorio es una parte importante del sistema de salud y contribuye directamente a las acciones preventivas, diagnósticos, tratamiento y manejo de enfermedades. Elnivel y la calidadde la utilización de los recursos de laboratorio se han cuestionado con frecuencia. Se observa una diseminación de datos contradictorios sobre la cantidadde pruebas de laboratorio a las que no han accedido los médicos solicitantes o los propios pacientes, aunque muy a menudo las fuentes y metodologias utilizadas para obtener esas cifras no se aclaran adecuadamente. Objetivo: El objetivo de este estudio fue obtener datos sobre el acceso a los resultados de las pruebas realizadas en los laboratorios de análisis clínicos privados de Brasil que utilizan el sistema de información de laboratorio desarrolladopor SHIFT Consultoria e Sistemas. Métodos: La información se extrajo de 81 laboratorios, que fueron responsables del rendimiento de 93,240,651 pruebas, recolectadas de 7,067,087pacientes. Resultados: El número total de pruebas a las que no se accedió, considerando todas las regiones, fue de 5,071,454, lo que corresponde a una proporción del 5,4%. Ante los riesgos potenciales de eventos adversos o impactos en el manejo de diagnósticos y tratamientos, incluidos los impactos económicos debido al tiempo prolongado de hospitalización, la proporción del 17,9% que se encontró correspondiente a las pruebas "no accedidas" muestra resultados "anormales" es preocupante, principalmente si observamos que de ellos, el 2,5% se relacionó con resultados depruebas "anormales" procesadospor laboratorios que trabajan en la atención hospitalaria. Conclusión: Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML), ante la relevancia del tema, continuará estimulando el monitoreo y la utilización de recursos de laboratorio adecuados para permitir sistemas de salud sostenibles.

RESUMO Introdução: A medicina laboratorial é uma parte importante do sistema de saúde e contribui diretamente para ações preventivas e de diagnósticos, tratamento e monitoramento de doenças. O nível e a qualidade da utilização de recursos laboratoriais são frequentemente questionados. Observa-se uma disseminação de dados conflitantes em relação à quantidade de resultados de exames laboratoriais não acessados pelos médicos solicitantes ou pelos próprios pacientes, embora muitas vezes as fontes e as metodologias utilizadas para acessar esses números não sejam devidamente esclarecidas. Objetivo: O objetivo deste estudo foi obter dados sobre o acesso aos resultados de testes realizados em laboratórios de análises clínicas privados brasileiros que utilizam o sistema de informações laboratoriais desenvolvido pela SHIFT Consultoria e Sistemas. Métodos: As informações foram extraídas de 81 laboratórios, responsáveis pelo desempenho de 93.240.651 testes, coletados de 7.067.087pacientes. Resultados: O total de resultados de exames não acessados, considerando todas as regiões, foi de 5.071.454, correspondendo a uma proporção de 5,4%. Diante dos riscos potenciais de eventos adversos ou de impactos na gestão de diagnósticos e tratamentos, incluindo os impactos econômicos decorrentes do tempo prolongado de internação, a proporção de 17,9% encontrada correspondente a testes não acessados com resultados "anormais" é preocupante, principalmente se observarmos que 2,5%foram relacionados com resultados de testes "anormais" processados por laboratórios que trabalham em unidades hospitalares. Conclusão: A Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML), diante da relevância do tema, continuará estimulando o monitoramento e a utilização de recursos laboratoriais adequados, a fim de permitir sistemas de saúde sustentáveis.

Evaluation of the clinicai analysis service provided to an emergency department / Avaliação do serviço de análises clínicas prestado a uma unidade de emergência

ABSTRACT Introduction: Time for releasing test results and critical value communication by the clinical laboratory are considered important determinants of patients' length of stay in the Emergency Department (ED). As well as physician satisfaction, they are used as quality indicators of the Clinical Analysis Service (CAS). Objective: The aim of this study was to evaluate the time to return a test result, the communication of critical values and the level of satisfaction of the ED physicians of a university hospital with the CAS. Material and methods: A physician satisfaction survey was conducted using a questionnaire. The test turnaround time for emergency requests was analyzed by observation of the pre-analytical phase and monitoring the analytical and post-analytical phases through the laboratory information system. In order to evaluate the communication of critical values by the CAS, a document analysis of the process was performed. Results: Physicians' overall satisfaction with the CAS was considered average. Greater satisfaction was observed with reliability of the results and the staff courtesy and lesser with the delivery time of results. The test turnaround time exceeded clinicians' expectations and the average described in the literature. No experience with critical-value communication was perceived. Conclusion: The results show several opportunities for progress in the relationship between ED and CAS. The improvement of laboratory quality indicators also depends on the involvement of ED physicians and nurses and embraces monitoring, planning, education and investment in system computerization.

RESUMEN Introducción: El tiempo de entrega de pruebas y la comunicación de valores críticos por el laboratorio clínico son considerados factores determinantes del tiempo de permanencia del paciente en la Sección de Urgencias (SU). Por lo tanto, así como la satisfacción de los médicos, estos datos también son utilizados como indicadores de calidad del Servicio de Análisis Clínicos (SAC). Objetivo: Evaluar el tiempo de entrega de pruebas, la comunicación de valores críticos y el grado de satisfacción de los médicos de la SU de un hospital universitario con el SAC. Material y método: Se realizó una encuesta de satisfacción de los médicos, utilizando un cuestionario. El tiempo de reporte de resultados en la SU ha sido analizado por medio de observación presencial de la fase preanalítica y monitoreo en el sistema computorizado de las fases analítica y postanalítica del laboratorio. Para evaluar la comunicación de valores críticos por el SAC, un análisis documental del proceso ha sido realizado. Resultados: La satisfacción general con el SAC fue considerada regular por los médicos participantes; hubo mayor satisfacción con la confianza en los resultados y con la atención del personal, y menor con el tiempo de entrega de resultados. Los tiempos de reporte han sido más largos que las expectativas de los médicosy la media descripta en la literatura. No se ha observado una cultura de comunicación de valores críticos. Conclusión: Los resultados han ensenado varias oportunidades deprogreso en la relación entre SUy SAC. La mejoría de los indicadores de calidad de laboratorio evaluados depende también del envolvimiento de los médicos y enfermeros del SU e incluye monitoreo, planeamiento, educación e investimento en informatización del sistema.

RESUMO Introdução: O tempo de liberação de exames e a comunicação de valores críticos pelo laboratório clínico são considerados importantes determinantes do tempo de permanência do paciente no Serviço de Emergência (SE). Portanto, assim como a satisfação dos médicos, esses dados também são utilizados como indicadores de qualidade do Serviço de Análises Clínicas (SACL). Objetivo: Avaliar o tempo de liberação de exames, a comunicação de valores críticos e o nível de satisfação dos médicos do SE de um hospital universitário em relação ao SACL. Material e métodos: Foi realizada uma pesquisa de satisfação dos médicos, utilizando um questionário. O tempo de liberação dos resultados de exames de emergência foi analisado por meio de observação presencial da fase pré-analítica e monitoramento no sistema informatizado das fases analítica e pós-analítica do laboratório. Para avaliar a comunicação de valores críticos pelo SACL, foi realizada análise documental do processo. Resultados: A satisfação geral com o SACL foi considerada regular pelos médicos participantes, com maior satisfação quanto à confiança nos resultados e à cortesia dos servidores e menor quanto ao tempo de entrega de resultados. Os tempos de liberação de resultados dos exames ultrapassaram as expectativas dos médicos e a média descrita na literatura. Não foi observada cultura de comunicação de valores críticos. Conclusão: Os resultados demonstraram várias oportunidades de progresso na relação entre o SE e o SACL. A melhoria dos indicadores da qualidade laboratorial avaliados depende também do envolvimento dos médicos e dos enfermeiros do SE e inclui monitoramento, planejamento, educação e investimento em informatização do sistema.

Assessment of the pre-analytical phase of a clinical analyses laboratory / Avaliação da fase pré-analítica de um laboratório de análises clínicas

ABSTRACT Introduction: The pre-analytical phase encompasses the procedures prior to the performance of the laboratory tests, which are the physician's requisition, patient and tests registration, collection and transport of samples. This phase involves different professionals and is responsible for the majority of the laboratory errors. Objective: To assess the pre-analytical phase of a public laboratory through quality indicators (QI). Method: Nonconformities (NC) in the physician's requisitions and in the patients and tests registrations were evaluated during the quality checking process. A questionnaire was applied to evaluate the service and the satisfaction of the laboratory's client. The QI were calculated considering the number of NC in the processes in relation to the total opportunities, compared with specifications described in the literature and evaluated by the Sigma metric. Results: The pre-analytical phase was evaluated by 34 QI. From these, 18 presented Sigma score lower than 3.0, six between 3.0 and 4.0, six above 4.0 and four presented Sigma score of 6.0. The completiton of requisitions presented worse performance than the process of tests registration. Regarding the three stages of the pre-analytical phase evaluated, the scheduling presented the worst performance, followed by the service at the reception and the sample collection. Conclusion: The evaluation of the QI allowed organizing the improvements that should be prioritized in the laboratory. The Sigma metric was useful for assessing the QIs considered important to the laboratory, for which there are no published specifications. The questionnaire for evaluating the laboratory's service and client's satisfaction was not a reliable tool for assessing the quality of the pre-analytical phase.

RESUMO Introdução: A fase pré-analítica abrange os procedimentos antes da execução dos testes laboratoriais, sendo eles a requisição, o cadastro de clientes e exames, a coleta e o transporte de amostras. Essa fase envolve diferentes profissionais e é responsável pela maioria dos erros de laboratório. Objetivo: Analisar a fase pré-analítica de um laboratório público por meio de indicadores da qualidade (IQ). Método: As não conformidades (NC) nas requisições e no cadastro dos clientes e dos exames foram avaliadas durante o processo de checagem. Foi aplicado um questionário para avaliar o atendimento e a satisfação dos clientes do laboratório. Os IQ foram calculados considerando o número de NC nos processos em relação ao total de oportunidades, comparando-os com as especificações encontradas na literatura e avaliando-os pela métrica Sigma. Resultados: A fase pré-analítica foi avaliada por 34 IQ. Desses, 18 apresentaram Sigma menor que 3,0; seis, entre 3,0 e 4,0; seis, acima de 4,0; e quatro, Sigma 6,0. O preenchimento das requisições apresentou pior desempenho do que o processo de cadastro dos exames. Em relação às três etapas da fase pré-analítica avaliadas, a que apresentou pior desempenho foi o agendamento, seguido do atendimento na recepção e da coleta. Conclusão: A avaliação dos IQ permitiu ordenar as melhorias que devem ser priorizadas no laboratório. A métrica Sigma foi útil para avaliar IQ, considerados importantes para o laboratório, para os quais não há especificações publicadas. O questionário de avaliação do atendimento e da satisfação do cliente não se mostrou uma ferramenta confiável para avaliar a qualidade da fase pré-analítica.

Nuevos retos de los servicios de medicina de laboratorio por el envejecimiento poblacional / New challanges of Laboratory Medicine due to population aging

El envejecimiento poblacional implica graves consecuencias para la sociedad y el sistema de salud. La medicina de laboratorio, como parte de él, es afectada en sus tres fases: preanalítica, analítica y postanalitica. Tanto por la multimorbilidad que posee el adulto mayor, como por la dificultad para cumplir con algunos requisitos para el diagnóstico por la edad avanzada (determinadas limitaciones dietéticas) constituyen serios problemas para realizar los análisis correctamente. Sin duda alguna, el envejecimiento demográfico trae consigo nuevos retos para los servicios de medicina de laboratorio. El presente trabajo expone los efectos que provoca el fenómeno para el sistema de salud y propone soluciones para enfrentar sus consecuencias.

Population aging implies impacting consequences for the society and the health system. Laboratory Medicine as part of it, is affected in its three phases: Preanalytical, analytical and postanalytical. This is a serious problem to perform these analysis correctly because of the elderly multimorbidity so as the difficulty to comply with some requierements for the dignosis due to age ( certain dietary limitations). Undoubtely demographic aging brings about new challanges for the laboratory medical services. The present work shows the effects of this phenomenun for the health system and proposes solutions to mitigate its consquences.

Frecuencia de parásitos intestinales en exámenes coproparasitológicos directos procesados en el laboratorio de investigación médica, 2011-2015 / Intestinal parasites frequency in direct coproparasitologic tests processed in medical research laboratory, 2011 - 2015

Introducción: Las parasitosis intestinales pueden provocar manifestaciones clínicas importantes, además que están relacionadas con desigualdades económicas y sociales. El objetivo de este estudio es describir la frecuencia, características macroscópicas, distribución etaria, de género y por estaciones del año de parásitos intestinales en exámenes coproparasitológicos directos simples procesados en el Laboratorio de Investigación Médica entre los años 2011 y 2015. Materiales y Métodos: Se trata de un estudio descriptivo de corte transversal. El universo corresponde a 3 728 muestras de exámenes coproparasitológicos directos simples que fueron procesadas en el Laboratorio de Investigación Médica de Cochabamba, Bolivia. Los datos recolectados, fueron procesados y analizados bajo estadística descriptiva con el programa Microsoft Office Excel® 2010. Resultados: Un 36,33% (n=1 328) de las muestras presentaron infección por parásitos intestinales, siendo el parásito más frecuente Blastocystis hominis con 44,5% (n=822); Giardia lamblia con 10,6% (n= 195) y Entamoeba histolytica/dispar con 8,1 % (n=149) representan los protozoarios intestinales patógenos. Entre los helmintos (3,41%), Hymenolepis nana es el más frecuente (2%). Según las características macroscópicas se reporta mayores frecuencias en muestras pastosas y semipastosas (53,69% y 38,33%, respectivamente). Los grupos etarios más parasitados fueron personas de 11-20 y 21-30 años (43% y 43,86%, respectivamente), afectando más al sexo femenino. Finalmente, en primavera se reportaron mayores frecuencias. Conclusión: Existe una considerable frecuencia de parásitos intestinales en la población que acude al laboratorio, cuyas características están acordes a las esperadas para las condiciones de nuestro medio.

Introduction: Intestinal parasites can cause important clinical manifestations, in addition they are related to economic and social inequalities. The objective of this study is to describe the frequency, macroscopic characteristics, age distribution, gender and seasonality of intestinal parasites in simple direct coproparasitological tests processed in the Medical Research Laboratory between 2011 and 2015. Materials and methods: It is a descriptive cross-sectional study. The universe corresponds to 3 728 samples of simple direct coproparasitological tests that were processed in the Medical Research Laboratory of Cochabamba, Bolivia. The data collected was processed and analyzed under descriptive statistics with the Microsoft Office Excel® 2010 program. Results: A 36,33% (n = 1 328) of the samples presented infection by intestinal parasites, being the most frequent parasite Blastocystis hominis with 44,5% (n = 822); Giardia lamblia with 10,6% (n = 195) and Entamoeba histolytica/dispar with 8,1% (n = 149) represent the pathogenic intestinal protozoa. Among the helminths (3,41%), Hymenolepis nana is the most frequent (2%). According to the macroscopic characteristics, higher frequencies are reported in pasty and semipastuous samples (53,69 and 38,33%, respectively).The most parasitized age groups were 11-20 and 21-30 years old (43 and 43,86%, respectively), affecting more the female sex. Finally, the spring year reported higher frequencies. Conclusion: There is a considerable frequency of intestinal parasites in the population that goes to the laboratory, whose characteristics are in line with those expected for the conditions of our environment.

Estimation Of Cost Of Diagnostic Laboratory Services Using Activity Based Costing (ABC) For Implementation Of Malaysia Diagnosis Related Group (My-Drg®) In A Teaching Hospital

The Malaysia Diagnosis Related Group (MY-DRG®), established since 2002, is a patient classification system that stratifies disease severity and categories patients into iso-resource groups. Casemix can be used to estimate costs per episode of care and as a provider payment tool in health services. Casemix has also been used to enhance quality and improve the efficiency of health services. Hence, estimation cost per DRG is important especially in developing countries where costing data are still scarce. We embarked on a study to determine the costs of the diagnostics laboratory services for each MY-DRG® based on the severity of illnesses. Most costing studies for diagnostic laboratory services usually focus on the cost of consumables and equipment alone and employed the step-down costing method. Very few studies applied Activity-Based Costing (ABC) method to estimate the costs for diagnostic laboratory services. This study was done with the purpose of developing the diagnostics laboratory cost using the ABC method. All medical cases discharged from UKM Medical Centre (UKMMC) in 2011 grouped into MY-DRG® were included in this study. In 2011, a total of 2.7 million diagnostic laboratory investigations were carried out in the Department of Diagnostic Laboratory Services in UKMMC. ABC was conducted from January to December 2013 in all units of the department. Cost of 242 types of diagnostic laboratory services were collected using a costing format. Out of 25,754 cases, 16,173 (62.8%) cases were from the medical discipline. After trimming using L3H3 method, 15,387 cases were included in the study. Most of the cases were on severity level one (44.6%), followed by severity level two (32.3%) and severity level three (23.1%). The highest diagnostic laboratory service weight was for Lymphoma & Chronic Leukemia, severity level III (C-4-11-III) with the value of 5.9609. Information on seven cost components was collected form each procedure: human resources, consumables, equipment, reagents, administration, maintenance and utilities. The results revealed that, the biggest cost component for human resources was in Molecular Genetic Unit (89.6%), consumables (34.8%) from Tissue Culture Unit, equipment (11.2%) and reagents (68.1%) from Specialized Haemostasis Unit. In conclusion, the accurate and reliable cost of the diagnostic laboratory services can be determined using ABC. Top management of the department should be able to use the output of the study to take appropriate steps to reduce unnecessary wastages of resources in the various units of the services.

Survey of Eight Hormone Tests Used by Clinical Laboratories in Korea

BACKGROUND: This study aimed to investigate the current statuses of eight hormone tests (testosterone, estradiol, prolactin, progesterone, luteinizing hormone, follicle-stimulating hormone, parathyroid hormone, and thyroglobulin) used by clinical laboratories in Korea. METHODS: From November 1 to December 31, 2016, we surveyed 300 laboratories that participated in the regular proficiency survey program administered by the Korean Association of Quality Assurance for Clinical Laboratory. The survey comprised a questionnaire designed to address factors related to these hormone tests, including the measurement methods, instruments, test numbers per month, turnaround times, reporting units and ranges, reference ranges, and internal or external quality control methods. RESULTS: Fifty-four (18.0%) of 300 laboratories replied to the survey questionnaire. Each laboratory performed hormone analyses that used variable instruments, commercial kits, and calibrators. The test numbers per month, turnaround times, and reporting units (particularly for testosterone) varied among laboratories. Most laboratories used reference intervals that had been transferred from other references and were verified using in-house samples. Many laboratories that assessed luteinizing hormone, follicle-stimulating hormone, and parathyroid hormone levels did not participate in the proficiency survey program conducted by The Korean Association of Quality Assurance for Clinical Laboratory. CONCLUSIONS: We hope that the results of this study, which investigated the status of hormone testing at Korean diagnostic laboratories, will facilitate improvements in the quality of hormone testing and promote the development of guidelines for testing.

Requests of laboratory tests for the diagnosis and management of calcium-phosphate disorders in Spain / Solicitud de pruebas de laboratorio para el diagnóstico y manejo de los desórdenes del metabolismo fosfocálcico en España

Background: Knowledge about the variability in the request of calcium-phosphate metabolism laboratory tests in primary care is important to design strategies to improve health system efficiency. Aim: To compare the inter-practice variability in calcium-phosphate metabolism laboratory tests requested by general practitioners from diverse regions across Spain. Material and Methods: One hundred and forty one clinical laboratories were invited to participate in an observational cross-sectional study. They informed the number of serum calcium, phosphate, parathyroid hormone and 25-hydroxyvitamin D requested by general practitioners. Appropriateness indicators were calculated as number of test requests per 1,000 inhabitants and ratio of related tests requests. The differences according to hospital setting, region and type of management were analyzed. Results: We recruited 76 laboratories (17,679,195 inhabitants). General practitioners requested 3,260,894 calcium-phosphate metabolism tests. The rate of request ranged from 2.97 per 1,000 inhabitants for 25-hydroxyvitamin D to 98.89 per 1,000 inhabitants for calcium. The rates of request for calcium, phosphate, parathyroid hormone in some areas were 30, 100 and 340 times higher than in other areas. Parathyroid hormone and 25-hydroxyvitamin D were highly requested in private management areas. There were also differences in phosphate, parathyroid hormone and 25-hydroxyvitamin D requesting between regions across Spain. Conclusions: The high variability observed is difficult to explain by differences in patient case mix between regions. Depending on the area, calcium could be under requested to detect primary hyperparathyroidism.

Objetivo: Conocer la variabilidad en la solicitud de pruebas de laboratorio en atención primaria es importante para diseñar estrategias que mejoren la eficiencia del sistema de salud. La propuesta de este estudio fue comparar la variabilidad en la solicitud de pruebas para la evaluación del metabolismo fosfocálcico por médicos de atención primaria de diversas regiones de España. Material y Método: Se invitó a participar a 141 laboratorios clínicos de diversas regiones españolas. Completaron una encuesta con el número de determinaciones de calcio, fósforo, hormona paratiroidea y 25-hidroxivitamina D solicitadas por médicos de atención primaria de sus áreas. Se calcularon las tasas en relación a la población y se construyeron indicadores de adecuación. Los resultados se compararon por características del hospital, región y tipo de gestión. Resultados: Obtuvimos los datos de 76 laboratorios (17.679.195 habitantes). Los médicos de atención primaria solicitaron 3.260.894 pruebas de metabolismo fosfocálcico. La tasa de solicitud varió de 2,97 por 1.000 habitantes de 25-hidroxivitamin D a 98,89 por 1.000 habitantes de calcio. Las tasas de calcio, fósforo, hormona paratiroidea en algunas áreas fue 30, 100 y 340 veces más alta respecto a otras. Hormona paratiroidea y 25-hidroxivitamina D fueron más solicitadas significativamente en hospitales con gestión privada. También hubo diferencias en fósforo, hormona paratiroidea y 25-hidroxivitamina D solicitas entre distintas regiones de España. Discusión: La alta variabilidad observada es difícil de explicar por las diferencias de las características de los pacientes. Dependiendo de la región podría haber una infra solicitud para la detección del hiperparatiroidismo primario.