Characterization of Laboratory Flow and Performance for Process Improvements via Application of Process Mining.

BACKGROUND: The rising level of laboratory automation provides an increasing number of logged events that can be used for the characterization of laboratory performance and process improvements. This abundance of data is often underutilized for improving laboratory efficiency. OBJECTIVES: The first aim of this descriptive study is to provide a structured approach for transforming raw laboratory data to data that is suitable for process mining. The second aim is to describe a process mining approach for mapping and characterizing the sample flow in a clinical chemistry laboratory to identify areas for improvement in the testing process. METHODS: Data were extracted from instrument log files and the middleware between laboratory instruments and information technology infrastructure. Process mining was used for automated process discovery and analysis. Laboratory performance was quantified in terms of relevant key performance indicators (KPIs): turnaround time, timeliness, workload, work-in-process, and machine downtime. RESULTS: The method was applied to two Dutch university hospital clinical chemistry laboratories. We identified areas where alternative routes might increase laboratory efficiency and observed the negative effects of machine downtime on laboratory performance. This encourages the laboratory to review sample routes in its analyzer lines, the routes of high priority samples during instrument downtime, as well as the preventive maintenance policy. CONCLUSION: This article provides the first application of process mining to event data from a medical diagnostic laboratory for automated process model discovery. Our study shows that process mining, with the use of relevant KPIs, provides valuable insights for laboratories that motivates the disclosure and increased utilization of laboratory event data, which in turn drive the analytical staff to intervene in the process to achieve the set performance goals. Our approach is vendor independent and widely applicable for all medical diagnostic laboratories.

[Anaemia]. / Anemie.

The first scientific article on anaemia was published in 1807, marking a tipping point in modern medicine. Despite a vast bulk of literature on this topic, the interpretation of anaemia is not always straight forward. The most common form of anaemia, the iron deficiency anaemia, shares several characteristics with another common form of anaemia, the anaemia of chronic disease, or better: 'inflammatory anaemia'.This article provides the clinician with several factors which could aid in differentiating both forms of anaemia, such as parameters of iron transport, bone marrow investigation as well as atrial with iron supplements. Furthermore, this article discusses iron metabolism and methods of supplementing iron, gives guidance in the use of cut-off values for haemoglobin in the elderly and interpretation of the adequacy of the reticulocyte response. Lastly this article discusses the added value of a manual differentiation to determine the nature of the anaemia.

Hyperoxia does not affect oxygen delivery in healthy volunteers while causing a decrease in sublingual perfusion.

OBJECTIVE: To determine the human dose-response relationship between a stepwise increase in arterial oxygen tension and its associated changes in DO2 and sublingual microcirculatory perfusion. METHODS: Fifteen healthy volunteers breathed increasing oxygen fractions for 10 minutes to reach arterial oxygen tensions of baseline (breathing air), 20, 40, 60 kPa, and max kPa (breathing oxygen). Systemic hemodynamics were measured continuously by the volume-clamp method. At the end of each period, the sublingual microcirculation was assessed by SDF. RESULTS: Systemic DO2 was unchanged throughout the study (Pslope  = .8). PVD decreased in a sigmoidal fashion (max -15% while breathing oxygen, SD18, Pslope  = .001). CI decreased linearly (max -10%, SD10, Pslope  < .001) due to a reduction in HR (max -10%, SD7, Pslope  = .009). There were no changes in stroke volume or MAP. Most changes became apparent above an arterial oxygen tension of 20 kPa. CONCLUSIONS: In healthy volunteers, supraphysiological arterial oxygen tensions have no effect on systemic DO2 . Sublingual microcirculatory PVD decreased in a dose-dependent fashion. All hemodynamic changes appear negligible up to an arterial oxygen tension of 20 kPa.