Perceived and real histopathology turnaround time: A teaching hospital experience

Background: This study aims to audit analytic turnaround time (TAT) in a histopathology laboratory with a view to assessing the timeliness of its reports, identify causes of delay in its TAT, and compare this with client perception of its performance. Materials and Methods: Records of 1440 batches of specimens processed over a 5-year period in the histopathology laboratory of a teaching hospital were retrieved from archives. From these, median and mean TATs were calculated and causes of delay identified. Questionnaires were also deployed to assess physicians' perception of the laboratory's performance. Results: Analytic TAT was 3.6 ± 2 days, with 86.7% of reports being ready within 5 working days. The delays in timeliness of report generation were due mainly to residency training-related factors; tissue processing-related factors, and inadequate clinical information among others. Client perception of TAT rated the laboratory below average by 18.4%; average by 57.5%; good by 20.7%, and excellent in its performance by 3.4% of respondents. Conclusion: Even though physicians perceived the laboratory's TAT to be just average, its analytic TAT for reports is within acceptable international standards but with room for improvement in its performance

O uso de indicadores da fase pré-analítica como ferramenta da gestão laboratorial / The use of indicators in the pre-analytical phase as a laboratory management tool

Introduction: Efficient laboratory services are the basis of modern health systems. Scientific innovations have contributed to substantial improvements in the laboratory environment, but errors still persist. These errors are classified as pre-analytical, analytical and post-analytical, according to the time of occurrence. Objective: To evaluate the frequency of pre-analytical errors in the clinical laboratory service of a military hospital. Methods: A total of 329,582 tests were performed in the clinical laboratory of Hospital Naval Marcílio Dias (HNMD) from August to October 2012, and pre-analytical errors were documented. Results: The most frequent cause of the observed pre-analytical errors was hemolysis (27.54%), followed by samples not received (25.43%) and insufficient sample volume (18.49%). The samples from the Integrated Home Care Service (SIAD) showed the highest frequency of errors (3.38%), followed by those from the inpatient (0.76%) and the outpatient departments (0.21%). Conclusion: Our study demonstrates the importance of managing laboratory pre-analytical quality in order to ensure service excellence...

Introdução: Serviços laboratoriais efetivos são a base dos sistemas de saúde modernos. Inovações científicas têm contribuído para melhorias substanciais no meio laboratorial, mas os erros ainda persistem. Esses erros são classificados como pré-analíticos, analíticos e pós-analíticos, dependendo do momento de sua ocorrência. Objetivo: Avaliar a frequência de erros pré-analíticos ocorridos no serviço de análises clínicas de um hospital militar. Métodos: Um total de 329.582 exames foram realizados no laboratório de análises clínicas do Hospital Naval Marcílio Dias no período de agosto a outubro de 2012, e os erros pré-analíticos documentados. Resultados: Os erros pré-analíticos mais observados foram decorrentes da hemólise (27,54%), seguidos de material não recebido (25,43%) e amostra insuficiente (18,49%). As amostras oriundas do Serviço Integrado de Atendimento Domiciliar (SIAD) foram as que apresentaram a maior frequência de erros (3,38%), seguidas pelo setor de pacientes internos (0,76%) e ambulatoriais (0,21%), respectivamente. Conclusão: Nosso estudo demonstra a importância da gestão da fase pré-analítica na garantia da qualidade laboratorial, de maneira a assegurar um serviço de excelência...

Desafios do Sistema Único de Saúde: situação da assistência laboratorial pública em 31 municípios de Minas Gerais, Brasil / Challenges of the Unified Health System: present status of public laboratory services in 31 cities of Minas Gerais, Brazil

Introduction: Modifications in the Brazilian Unified Health System (SUS) have led to a significant improvement in the national health indexes. However, some challenges still need to be faced, especially concerning SUS patients' access to high-quality laboratory support services. Objective: To evaluate the present status of laboratory services in SUS in 31 cities of Minas Gerais, Brazil, between 2008 and 2011. Material and method: This analysis was performed through data from the Information Technology Department of SUS (DATASUS) and through interviews with local public health managers with structured questionnaires. Results: Among all the studied cities, 21 had their own laboratory, 90.2% of which were in precarious conditions, not meeting the requirements established by the legislation in force, and employing inappropriate procedures and techniques, in addition to using obsolete equipment. The range of available laboratory tests was limited, what demanded the services of supporting laboratories. None of the evaluated laboratories developed any systematic activity on quality management, including control of analytical quality, maintenance of laboratory equipment, calibration and performance evaluation of critical equipment, continuing education programs, and safety and biosecurity. Conclusion: The effective role of laboratory test results in medical decision is unquestionably impaired, risking the safety of SUS patients. The present work reveals the deficiencies of public laboratory services in Minas Gerais, and proposes a new management model, which is able to associate operational quality, technological development and optimization of human and material resources with higher productivity...

Introdução: Desde a sua criação, modificações no Sistema Único de Saúde (SUS) levaram a uma melhoria significativa nos índices nacionais de saúde. No entanto, alguns desafios ainda precisam ser enfrentados, especialmente o acesso de pacientes do SUS aos serviços de apoio de laboratório de qualidade. Objetivo: Avaliar a situação atual da assistência laboratorial no SUS em 31 municípios de Minas Gerais, Brasil, entre 2008 e 2011. Material e método: Foi realizado levantamento de dados do Departamento de Informática do SUS (DATASUS) e de entrevistas com gestores utilizando questionário estruturado. Resultados: Dos municípios estudados, 21 possuíam laboratório próprio, sendo que 90,2% deles apresentavam instalações físicas precárias, fora das especificações previstas na legislação vigente, e empregavam procedimentos e técnicas inadequadas, com utilização de equipamentos obsoletos. O perfil de exames era restrito, necessitando da utilização de laboratórios de apoio. Nenhum dos laboratórios avaliados apresentava programas de educação permanente, de controle da qualidade dos exames laboratoriais, de manutenção dos equipamentos analíticos, de aferição de instrumentos críticos e de segurança e biossegurança. Conclusão: O papel efetivo dos resultados dos testes de laboratório na decisão médica mostrou-se, sem dúvida, prejudicado, acarretando risco à segurança dos pacientes usuários do SUS. O presente trabalho revelou a precariedade da assistência laboratorial pública em MG e propõe a mudança para um modelo de gestão capaz de aliar qualidade operacional, desenvolvimento tecnológico, otimização de recursos humanos e materiais...

Evaluación de control de calidad, gestión y costos del hemograma en un hospital complejo tipo 1 / Evaluation of hemogram quality control, management and cost in a complex hospital type 1

Determinar criterios de evaluación morfológica del hemograma, basados en parámetros clínicos y resultados del contador hematológico, en términos de gestión, costos y clínica en un hospital tipo 1. Pacientes, materiales y métodos: muestras de hemogramas de pacientes del hospital de carabineros de Chile durante el mes de agosto de 2009, analizadas en un equipo HMX Beckman-Coulter y evaluadas morfológicamente por Tecnólogo Médico(TM). Se registraron parámetros clínicos como hemoglobina, leucocitos y plaquetas; además se consideró el lugar de derivación, especialidad y edad del paciente. Se determinaron los costos e ingresos en función de los resultados obtenidos. Resultados: de los 2.222 pacientes evaluados, existió concordancia entre el Tecnólogo Médico y el analizador en 93,3 por ciento de los casos, con una sensibilidad de 97,3 por ciento y una especificidad de 88,9 por ciento con valores predictivos positivo y negativo de 95,9 por ciento y 92,7 por ciento respectivamente, para detectar una muestra anormal. Con los criterios de selección fue posible eliminar la evaluación morfológca en 79,5 por ciento de los casos, permitiendo un ahorro de $3655929 en el mes por concepto de hemogramas. Discusión: el estudio demostró que es posible disminuir el número de evaluaciones morfológicas realizadas al hemograma a valores similares obtenidos en estudios internacionales, con reducción significativa de los costos y tiempos de TM.

Objective: to determine criteria for the morphological analysis of the full blood count, based on the clinical parameters and the results of the full blood count using an automatic counter in terms of cost and clinicla implications in a distric hospital. Patients, Materials and Method: Full blood count samples from patients attended in the Hospital de Carabineros de Chile during the month of August 2009 were analyzed using HmX Beckman-Coulter and evaluated morpholigically by the Medical Science Officer(Medical Technologist). Clinical parameters, hemoglobin, white cell count platete count were registered, as well the origin of the specimen, medical speciality an patient age. The cost an income derived from the full blood count were determined by the Unit of Cost, Hospital of Carabineros and the changes in costs calculated in function of the results obtained. Results: Of the 2,222 patients evaluated, there was a concordance between the Clinical Science Officer(Medical Technologist) and the automatic counter in 93,9 percent of the samples, with a sensitivity of 97,3 percent and a specificy of 88,9 percent, a positive and negative predictive evalues of 95,9 percent and 92,7 percent respectively for detecting an abnormal sample. Using the criteria of selection it was possible to eliminate the evaluation morphological in 79,5 percent of the samples permitting a saving of $3655929 per month for the analysis of full morphological evaluations of the blood count without losing clinically important data in 80 percent of the samples, which is similar to that reported internationally, with a significant decrease in cost an Medical Scientific Officer time.

Aviso de valores de alerta por parte del laboratorio clínico en una red de salud universitaria / Laboratory alert value reporting by the clinical laboratory at an academic medical network

Background: An alert value is a result suggesting that the patient is at imminent danger unless appropriate remedial actions begin promptly. Report of alert values (AV) by the clinical laboratories has taken special relevance in recent years due to its contribution to patient's care. Aim: To report results of AV informed during 2007 within the Health Network of the Pontificia Universidad Católica de Chile. Material and methods: Analysis of AV recorded in a centralized database of the laboratories of the health network, between January and December, 2007. Results: Total number of AV was 5.366, which represented 0.3 percent of total examinations and corresponded mainly to the clinical chemistry area. Potassium levels generated the higher number of AV detected, followed by positive blood cultures. Eighty two percent of AV corresponded to hospitalized patients. The greater number of AV was reported to intermediate and intensive care services. Thirty two percent of AV was informed to the physician or professional in charge of the patient within 5 minutes of obtaining the results and 79 percent within 30 minutes. Conclusions: To obtain a real impact on patient management, it is fundamental to shorten the ¡apse between the obtainment of tests results and the warning, supported on appropriate computerized systems, and to spread the procedure to all personnel involved in patient's care (RevMéd Chile 2009; 137: 1137-44).

Aseguramiento de la calidad: gestión funcional de la informática del laboratorio de análisis clínicos / Insurance of the quality: functional management of the laboratory informatics of clinical analyses

Atento a las normas internacionales para la acreditación de los laboratorios clínicos habíamos propuesto, para el mediano plazo, establecer dos objetivos para nuestro laboratorio: implantar un Sistema de Gestión de la Calidad (SGC) y dotar al mismo de la informática apropiada, con vistas a la futura acreditación del servicio. En ocasión de la implantación del Sistema Informático del laboratorio se establecieron los siguientes estándares: Diseño de un protocolo único que abarca todas las secciones del laboratorio, identificación unívoca de pacientes por código universal, reducción del tiempo de espera de turnos y de atención, unificación de reportes, acceso a la trazabilidad de todos los procesos y a la información y reducción de costos por la detección temprana de errores. Paralelamente se capacitó al recurso humano para el desarrollo y utilización del Sistema Informático por medio de reuniones con todas las áreas del laboratorio. Se expusieron y analizaron los beneficios y la factibilidad operativa, a la vez que se evaluaron los indicadores pre-mejora. Para efectuar el diagnóstico de situación describimos los procesos del laboratorio con todos sus procedimientos administrativos pre-analíticos, analíticos y post-analíticos y luego de planificar la mejora, pusimos en marcha el plan operativo. Se analizaron 4.024 protocolos durante cuatro semanas. A los 20 días hábiles de la implementación monitoreamos los indicadores post-mejora, cuya disminución en un tiempo tan corto permite afirmar que el proceso está bien encaminado. La experiencia de esta mejora es el resultado de un ambicioso proyecto que refleja la producción y dificultades de un laboratorio de atención asistencial que aporta datos del conjunto de los sectores y muestra la visión del grupo de dirección del laboratorio a través de la actividad del servicio.

Importancia de la gestión de seguridad en el laboratorio clínico de un Hospital Materno Infantil / Importance of the safety management in the clinical laboratory of the maternal child hospital

Dentro de un hospital materno infantil, quienes trabajan en el laboratorio clínico comprenden no sólo el personal sino a toda la población, incluyendo los pacientes y proveedores. Es menester tomar los recaudos necesarios a efectos de minimizar los riesgos para los trabajadores, medio ambiente y pacientes ante los potenciales peligros físicos, químicos y biológicos que están presentes en este entorno.

Those who work in clinical laboratory of a perinatologic hospital include not only the personnel or professionals but also its population including patients and suppliers. It is necessary to take advantage in prevention of risks. The objective is minimizing the risks for the workers, environment and patients in the face of the potential physical, chemical and biological dangers that are present in this environment.

Canales Endémicos y Marcadores de Resistencia Bacteriana, en Instituciones de Tercer nivel de Bogota, Colombia / Endemic channels and bacterial resistance markers in third-level hospitals in Bogotá, Colombia

Objetivo: Determinar los perfiles de resistencia bacteriana y los canales endémicos en 14 instituciones de tercer nivel. Métodos: Población. Bogotá-Colombia, 14 hospitales pertenecientes al Grupo para el Control de la Resistencia Bacteriana de Bogotá (GREBO). A partir de la información obtenida de los laboratorios de microbiología de los centros participantes (métodos automatizados y manuales), se creó una base de datos usando los programas BacLink 2.0 y Whonet 5.3, durante los años 2001, 2002 y 2003. Los perfiles de susceptibilidad fueron hallados acordes a las normas de la nCCLS (2003). Se realizó un análisis descriptivo de los diferentes marcadores de resistencia y se determinó el canal endémico de la resistencia para los hospitales, utilizando los puntos entre los percentiles 25 y 75 por ciento, para cada mes durante el periodo de estudio. Resultados: Se analizaron 84664 aislamientos. Los más frecuentes fueron Escherichia coli, Staphylococcus aureus, Staphylococcus coagulasa negativo, Klebsiella pneumoniae y Pseudomonas aeruginosa. La resistencia para los años 2001, 2002 y 2003 fue respectivamente: S. aureus meticilino resistente: 41 por ciento, 48 por ciento, 48 por ciento; Staphylococcus coagulasa negativo resistente a oxacilina: 75 por ciento, 73 por ciento, 72 por ciento; E. faecium vancomicina resistente: 14 por ciento, 9 por ciento, 3 por ciento; K. pneumoniae resistente a cefalosporinas de tercera generación: 37 por ciento, 25 por ciento, 23 por ciento; P. aeruginosa resistente a imipenem: 24 por ciento, 22 por ciento, 17 por ciento; P. aeruginosa resistente a ciprofloxacina: 46 por ciento, 46 por ciento, 35 por ciento, A. baumannii resistente a imipenem: 11 por ciento, 29 por ciento, 39 por ciento. Los canales endémicos evidenciaron la problemática de la resistencia bacteriana, esta se centró en la presencia de S. aureus meticilino resistente y en el marcado incremento de la resistencia de A. baumanni a imipenem. Conclusiones: Se destacan los altos porcentajes de resistencia para todos los marcadores de impacto epidemiológico a nivel hospitalario especialmente en Unidades de Cuidado Intensivo.

Plan and process for hematology laboratory standard in Thailand.

In Thailand, there are around 2,000 clinical laboratories in private and government hospitals, By the end of year 2004, all of these laboratories are required to use the same or comparable standard nationwide. Many laboratories are in the process of starting ISO/IEC Guide 25 for the fulfillment of laboratory accreditation. To run the standard system of hematology laboratories in Thailand, we have considered three main aspects: standard in process, method selection and academic interpretation. Because of the wide spectrum of blood diseases in Thailand: thalassemia, iron deficiency anemia and G6PD deficiency hemolytic disease, the analysis and interpretation of laboratory results using different technology are of great importance. National plan has thus set up in two direction, one for standard process and another for academic approach.

Laboratory accreditation: quality in management and analysis and the input-output control.

An attempt to overcome the uncertainties and errors of all processes in clinical laboratory has been done in systematic ways. To reach the stage of laboratory accreditation, quality and standard criteria in the laboratory must be developed. Two aspects of quality are considered as management and analysis. Input-output control is proposed to handle the process from the beginning of laboratory design until post analytical phase or the control at the outcome. The model of ten Ms including model, material, machine, man, mind, money, method, mechanism, measurement and menace and one O or outcome, is elaborated to cover pre-analytical, analytical and post-analytical phases. Laboratory accreditation is then an integral part of hospital accreditation with total quality management.

En busca de la calidad en el Laboratorio de Patología Clínica / In search of quality in the Laboratory of Clinical Patology

Marco téorico: Calidad en la atención médica es otorgar el máximo beneficio con el menor riesgo y costo. Desde el punto de vista analítico, control de calidad en el estudio de las variaciones que son responsabilidad del laboratorio y el establecimiento de procedimientos para reconocerlos y minimizarlos. Objetivo: Evaluar el impacto del control de calidad analítico en el crecimiento de la productividad y eficiencia departamental a lo largo de 11 años (1982-1992). Tipo de estudio: prospectivo, longitudinal, descriptivo, comparativo y analítico en el que se observan: glucosa, urea, creatinina, ácido úrico, colesterol, bilirrubinas, protéinas y albúmina. Para medir la eficiencia y la productividad departamental se consideran indicadores por día hábil de trabajo. Resultados: precisión media en programa interno: (CV= 5.5 por ciento). Exactitud promedio en programa externo: (Rm = 0.91). Indice de variación media (IV = 98.5). El número de pacientes se incrementó en un 37 por ciento y el volumen de estudio creció en 394 por ciento. La eficiencia mejoró de 31.5 a 17.4 minutos/paciente/recepcionista mientras que en las áreas técnicas pasó de 20.6 a 10.3 minutos/estudio/técnico. Conclusión: La confiabilidad de los resultados es el factor más importante en el aumento en la demanda de los estudios. Los índices de productividad permiten evaluar las cargas de trabajo para asignar recursos que permitan mejorar la eficiencia