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RESUMEN Fundamento: un sistema de gestión de la calidad brinda la estructura organizativa, los procesos, los procedimientos y las herramientas para implementar las actividades necesarias para alcanzar los objetivos y los requerimientos de la calidad. Objetivo: mostrar las tareas emprendidas en la implementación de un sistema de gestión de la calidad en laboratorios del Centro de Inmunología y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey. Métodos: se realizó una investigación en sistemas y servicios de salud en los tres laboratorios de las Ciencias Básicas Biomédicas y el de determinaciones clínicas en el Centro de Inmunologìa y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey, desde abril de 2016 a diciembre de 2018. Resultados: las tareas fueron la capacitación de todo el personal en temas de gestión de la calidad, el diagnóstico de la situación de los laboratorios en lo referente a la calidad, la elaboración del cronograma de trabajo por etapas, la política, los objetivos de la calidad y la proyección estratégica del centro; todas las actividades que se ejecutan en los laboratorios quedaron organizadas en el Diagrama General de los Procesos; se diseñaron indicadores para medir eficacia y eficiencia, y está en proceso de elaboración la documentación de todo el sistema. Conclusiones: se trabaja en el proceso de implementación de un sistema de gestión de la calidad en los laboratorios docentes de las ciencias básicas biomédicas y el de determinaciones clínicas del Centro de Inmunología y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey, han sido cumplidas las tareas iniciales y en la actualidad está en proceso de elaboración toda la documentación del sistema.
ABSTRACT Background: a quality management system provides the organizational structure, the processes, procedures and tools to implement the necessary activities to achieve the objectives and quality requirements. Objective: to describe the tasks undertaken for implementing a quality management system for laboratories at the Immunology and Biological Products Center of the Camagüey University of Medical Sciences. Methods: a research in health systems and services was carried out in the three teaching laboratories of Basic Biomedical Sciences and the clinical determinations laboratory at the Immunology and Biological Products Center of the Camagüey University of Medical Sciences, from April 2016 to December 2018. Results: the tasks were: training of the whole personnel in quality management issues, diagnosis of the situation of the laboratories in relation to quality, elaboration of the time table by stages, the policy, the objectives of quality and the strategic projection of the center; all the activities carried out in the laboratories were organized in the general diagram of processes; indicators to measure effectiveness and efficiency were designed; and the documentation of the whole system is in process. Conclusions: work is being done in the process of implementing a quality management system in the teaching laboratories of the basic biomedical sciences and in the clinical determinations laboratory of the Immunology and Biological Products Center of the Medical Sciences University of Camagüey, the initial tasks have been fulfilled and presently the elaboration of all the system's documentation is in progress.
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BACKGROUND: Logical Observation Identifiers Names and Codes (LOINC) are a standard for identifying and reporting laboratory investigations that were developed and are maintained by the Regenstrief Institute. LOINC codes have been adopted globally by hospitals, government agencies, laboratories, and research institutions. There are still many healthcare organizations, however, that have not adopted LOINC codes, including rural hospitals in low- and middle- income countries. Hence, organizations in these areas do not receive the benefits that accrue with the adoption of LOINC codes. METHODS: We conducted a literature search by utilizing PubMed, CINAHL, Google Scholar, ACM Digital Library, and the Biomed Central database to look for existing publications on the benefits and challenges of adopting LOINC. We selected and reviewed 16 publications and then conducted a case study via the following steps: (1) we brainstormed, discussed, analyzed, created and revised iteratively the patient's clinical encounter (outpatient or ambulatory settings) process within a laboratory department via utilizing a hypothetical patient; (2) we incorporated the work experience of one of the authors (CU) in a rural hospital laboratory department in Nigeria to break down the clinical encounter process into simpler and discrete steps and created a series of use cases for the process; (3) we then analyzed and summarized the potential usage of LOINC codes (clinically, administratively, and operationally) and the benefits and challenges of adopting LOINC codes in such settings by examining the use cases one by one. RESULTS: Based on the literature review, we noted that LOINC codes' ability to improve laboratory results' interoperability has been recognized broadly. LOINC-coded laboratory results can improve patients' safety due to their consistent meaning as well as the related reduction of duplicate lab tests, easier assessment of workloads in the laboratory departments, and accurate auditing of laboratory accounts. Further, the adoption of LOINC codes may motivate government agencies to upgrade hospitals' infrastructures, which could increase the possibility of international recognition of laboratory test results from those hospitals over the long term. Meanwhile, a lack of LOINC codes in paper format and a lack of LOINC codes experts are major challenges that may limit LOINC adoption. CONCLUSION: In this paper, we intend to provide a snapshot of the possible usage of LOINC codes in rural hospitals in low- and middle-income countries via simpler and detailed use cases. Our analysis may aid policymakers to gain a deeper understanding of LOINC codes in regard to clinical, administrative, and operational aspect and to make better-informed decisions in regard to LOINC codes adoption. The use case analysis also can be used by information system designers and developers to reference workflow within a laboratory department. We recognize that this manuscript is only a case study and that the exact steps and workflows may vary in different laboratory departments; however, the core steps and main benefits should be consistent.
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INTRODUCTION: The complete blood count (CBC) with differential leukocyte count (DIFF) is an important part of clinical laboratory analyses and provides crucial data for clinicians. Delivery time after blood collection and conditions of storage is known to affect the reliability of results of some hematologic parameters. The aim of this study was to assess the variations of hematologic parameters over time and the influence of storage temperature. METHODS: Blood samples were randomly selected from hospitalized patients and stored at room temperature and at 4 °C. CBC and DIFF were performed on an automated hematology analyzer and the results between the two groups were compared. RESULTS: Samples stored at room temperature showed an important increase in mean corpuscular volume and hematocrit and a decrease in mean corpuscular hemoglobin concentration. Neutrophil counts tended to increase, whereas monocyte counts tended to decrease. CONCLUSION: Storing samples at 4 °C improved reproducibility over time of all quantitative and qualitative parameters. We also observed that NEUT-X, a routine parameter useful in detecting myelodysplastic syndrome, became unreliable when analyzed 24 h after sample collection. Our results led us to recommend that samples should be analyzed within 6 h, particularly if samples are transported at room temperature. We also recommend storing samples at 4 °C in case of remote CBC analysis, especially in the context of clinical trials.
