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1.
BMC Infect Dis ; 19(Suppl 1): 785, 2019 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-31526381

RESUMEN

BACKGROUND: In June 2015, South Africa introduced early infant HIV diagnosis (EID) at birth and ten weeks postpartum. Guidelines recommended return of birth results within a week and ten weeks postpartum results within four weeks. Task shifting was also suggested to increase service coverage. This study aimed to understand factors affecting return of EID results to caregivers. METHODS: Secondary analysis of data gathered from 571 public-sector primary health care facilities (PHCs) during a nationally representative situational assessment, was conducted. The assessment was performed one to three months prior to facility involvement in the 2010 evaluation of the South African programme to prevent mother-to-child HIV transmission (SAPMTCTE). Self-reported infrastructural and human resource EID-related data were collected from managers and designated staff using a structured questionnaire. The main outcome variable was 'EID turn-around-time (TAT) to caregiver' (caregiver TAT), measured as reported number of weeks from infant blood draw to caregiver receipt of results. This was dichotomized as either short (≤3 weeks) or delayed (> 3 weeks) caregiver TAT. Logit-based risk difference analysis was used to assess factors associated with short caregiver TAT. Analysis included TAT to facility (facility TAT), defined as reported number of weeks from infant blood draw to facility receipt of results. RESULTS: Overall, 26.3% of the 571 PHCs reported short caregiver TAT. In adjusted analyses, short caregiver TAT was less achieved when facility TAT was > 7 days (versus ≤7 days) (adjusted risk difference (aRD): - 0.2 (95% confidence interval - 0.3-(- 0.1)), p = 0.006 for 8-14 days and - 0.3 (- 0.5-(- 0.1)), p = 0.006 for > 14 days), and in facilities with staff nurses (compared to those without) (aRD: - 9.4 (- 16.6-(- 2.2), p = 0.011). CONCLUSION: Although short caregiver TAT for EID was only reported in approximately 26% of facilities, these facilities demonstrate that achieving EID TAT of ≤3 weeks is possible, making timely ART initiation within 3 weeks of diagnosis feasible within the public health sector. Our adjusted analyses underpin the need for quick return of results to facilities. They also raise questions around staff mentoring: we hypothesise that facilities with staff nurses were likely to have fewer professional nurses, and thus inadequate senior support.


Asunto(s)
Cuidadores , Infecciones por VIH/diagnóstico , VIH/inmunología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Laboratorios de Hospital/organización & administración , Recursos Humanos/organización & administración , Serodiagnóstico del SIDA , Estudios Transversales , Diagnóstico Precoz , Femenino , Humanos , Recién Nacido , Tamizaje Masivo , Análisis Multivariante , Enfermeras Neonatales , Parto/sangre , Periodo Posparto , Embarazo , Autoinforme , Sudáfrica
2.
Int J Lab Hematol ; 41 Suppl 1: 177-183, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31069974

RESUMEN

Quality management (QM), including quality assurance and quality control, was developed in clinical laboratories in North America and Western Europe, but must be implemented worldwide to ensure accurate, reproducible, and clinically useful results. India, a middle income country with a population of over 1.34 billion, has limited budget allotted to health care. As yet accreditation for clinical laboratories is not mandatory, which contributes to challenges in implementing good laboratory practice. This review provides a summary of internationally laid down QM principles and their application in a middle income country like India.


Asunto(s)
Acreditación , Laboratorios de Hospital/normas , Concesión de Licencias , Garantía de la Calidad de Atención de Salud , Control de Calidad , Humanos , India , Laboratorios de Hospital/organización & administración
3.
Int J Lab Hematol ; 41 Suppl 1: 151-161, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31069984

RESUMEN

Recurrent, inappropriate laboratory testing is a costly and wasteful use of healthcare resources. Recognizing this problem, the American Board of Internal Medicine, Canadian Society of Internal Medicine, and the Canadian Association of Pathologist all supported the Choosing Wisely campaign to reduce laboratory investigations in patients who demonstrate clinical and laboratory stability. In this narrative, we review studies looking at a variety of approaches to reduce excessive testing including education, audit and feedback, computerized physician order entry system changes, and forcing functions. Each type of intervention has its own unique advantages and disadvantages, varying in complexity, disruptiveness, effectiveness, and sustainability. Before implementing any quality improvement project, it is important to analyze the local context to identify the root causes for the practice behavior and aim to use the minimal amount of intervention to achieve the desired result. Change is often incremental and will seldom occur with a single intervention or Plan-Do-Study-Act cycle. Garnering the support of opinion leaders and a quality improvement team will help make the process and intervention a success.


Asunto(s)
Prestación de Atención de Salud , Pruebas Hematológicas , Laboratorios de Hospital/normas , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Carga de Trabajo , Canadá , Humanos , Laboratorios de Hospital/organización & administración , Estados Unidos
5.
Artículo en Inglés | MEDLINE | ID: mdl-30893906

RESUMEN

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.


Asunto(s)
Hospitales Públicos/organización & administración , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Femenino , Hospitales Públicos/normas , Humanos , Laboratorios de Hospital/organización & administración , Laboratorios de Hospital/normas , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Pakistán , Servicio de Farmacia en Hospital/organización & administración , Servicio de Farmacia en Hospital/normas , Relaciones Médico-Paciente , Encuestas y Cuestionarios
6.
J Clin Pathol ; 72(3): 237-243, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30782622

RESUMEN

The ability to effectively monitor key indicators is important for continuous quality improvement in laboratory immunohistochemistry. This article deals specifically with laboratory turnaround time (TAT) as a key delivery indicator and the impact of laboratory workflow on laboratory TATs. While our laboratory has traditionally relied on the manual calculation of slide-TAT (S-TAT) to monitor delivery, we have determined that automated calculation of case-TAT (C-TAT) would be superior as a delivery indicator. AABACUS (Automatable Activity-Based Approach to Complexity Unit Scoring) is an activity-based workload model designed to function primarily as a decision support tool to monitor pathologist staffing levels. We devised a high-level proof-of-principle approach to determine whether it is possible to apply AABACUS as a decision support tool for quality improvement through analysis of alternative laboratory workflows that have potential to impact C-TAT. Our use of AABACUS in this proof-of-principle quality improvement endeavour was two-fold: (1) we leveraged the ability of AABACUS to link data at the slide level to data at the case level, which enabled the automated calculation of C-TAT; and (2) we adapted AABACUS to evaluate the impact of laboratory workflow activities (specifically workflow bifurcation activities) on the calculated C-TATs. We have coined the term 'L-AABACUS' to describe the adaptation of AABACUS to the analysis of laboratory workflow.


Asunto(s)
Técnicas de Apoyo para la Decisión , Laboratorios de Hospital/organización & administración , Mejoramiento de la Calidad , Flujo de Trabajo , Humanos , Factores de Tiempo , Carga de Trabajo
7.
Clin Biochem ; 64: 57-59, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30543792

RESUMEN

BACKGROUND: Aspartate aminotransferase (AST) is regularly ordered with alanine aminotransferase (ALT) to assess liver integrity. In many situations, AST testing provides little or no added clinical value, since ALT is more specific and the both enzyme activities highly correlate. The objective of this study is to determine the potential reduction in AST testing, if not performed when ALT results are within reference intervals (RI). METHODS: Results for patients >18 years of age for both AST and ALT from the same specimen were obtained for the period January 1, 2017 - December 31, 2017. We calculated frequency of AST and ALT results that had various combinations of results within and above the RI. We also investigated the clinical locations of origin for the samples. RESULTS: In total 87,704 paired samples with both AST and ALT test results were recovered. The total of 73.2% of AST tests for males and 66.9% for females would be eliminated if we performed AST testing only when ALT was increased. However, 7.4% of elevated AST tests would be missed for males and 3.8% for females due to ALT being within limits. Specifically in the outpatient clinics, 79% male and 73% females paired enzyme results were within RI. Only 4% of males and 3% of females had paired results where ALT was within RI while AST > RI. CONCLUSIONS: The rate of test results with increased AST while ALT is within the RI is low enough to recommend limiting AST testing only to cases where ALT is above the RI. Our recommendation for AST restriction is to begin with the hospitals outpatient clinics.


Asunto(s)
Aspartato Aminotransferasas/sangre , Pruebas de Función Hepática/estadística & datos numéricos , Servicio Ambulatorio en Hospital/organización & administración , Adulto , Anciano , Alanina Transaminasa/sangre , Alanina Transaminasa/normas , Aspartato Aminotransferasas/normas , Femenino , Humanos , Laboratorios de Hospital/organización & administración , Masculino , Persona de Mediana Edad , Utilización de Procedimientos y Técnicas , Estándares de Referencia , Factores Sexuales , Procedimientos Innecesarios , Adulto Joven
8.
Singapore Med J ; 59(11): 597-601, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30498842

RESUMEN

Clinical laboratories for in vitro diagnostics are facing pressure to preserve cost control while providing better services through new initiatives. Laboratory automation is a partial answer to this problem, having come a long way from the early days of clinical laboratory testing. The journey and implementation of automation in the Singapore General Hospital's Clinical Biochemistry Laboratory has allowed for sustained performance in the light of increasing workload and service commitments amid an evolving healthcare environment. Key to realising predicted outcomes is the optimisation of workflow processes, reduction of errors, and spatial placement of specimen reception and analytical areas. This paper gives an overview of our experience with automation in the clinical laboratory and its subsequent impact on service standards.


Asunto(s)
Automatización de Laboratorios , Sistemas de Información en Laboratorio Clínico/organización & administración , Técnicas de Laboratorio Clínico , Laboratorios de Hospital/organización & administración , Atención Terciaria de Salud/organización & administración , Anciano , Eficiencia Organizacional/estadística & datos numéricos , Hospitales Generales , Humanos , Persona de Mediana Edad , Calidad de la Atención de Salud , Singapur , Interfaz Usuario-Computador , Carga de Trabajo
9.
Ann Saudi Med ; 38(5): 352-357, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30284990

RESUMEN

BACKGROUND: Total laboratory automation (TLA) is a relatively new way of improving the management of high volume clinical laboratories. TLA may reduce staff, reduce operating costs, decrease testing time and provide enhanced process control. OBJECTIVES: Establish a cost efficient TLA that is less labor intensive, improves productivity and reduces turnaround time (TAT). DESIGN: Implementation of TLA for random glucose and troponin-T as sentinel tests to compare change in TAT. SETTING: Tertiary hospital with high volume of laboratory tests. METHODS: Routine patient samples for random glucose and troponin-T were used to capture TAT. Information on staff grades and schedules before and after implementing the TLA, and cost of contracts to deliver the service were collected. MAIN OUTCOME MEASURES: TAT, cost efficiency, and reduction in labor. RESULTS: The consolidation of contracts resulted in a reduction of 28.8 million SAR in direct costs. Staffing cost was reduced by 1.14 million SAR with less senior staff required; there were reductions in staff at both senior and junior level. The overall TAT for all tests was reduced by 32% in 2016 (after TLA implementation) compared to 2012 (before TLA implementation). The median TAT for random glucose tests was reduced by 21% (to 55.7 minutes in 2016 from 70.1 minutes in 2012). Evidence of test optimization by exploring the impact of stat tests, auto-dilutions and reruns on the overall TAT of the TLA is shown by comparing troponin T TATs after reclassifying stat tests (in 2016) to routine (in 2017). At the 75th percentile, there was a 27% reduction in TAT when comparing August 2016 to March 2017 with a 19% reduction in median TAT. CONCLUSION: By moving from stat to routine assays, the TAT was reduced, which is counter-intuitive. The use of stat assays slowed down the performance of the TLA. A careful review of the mix of assays should be conducted to maximize performance and to ensure that the system delivers what is required. LIMITATIONS: Room for improvement by systematically analyzing and reviewing the impact of making minor changes that could have significant impact on TAT. CONFLICT OF INTEREST: None.


Asunto(s)
Automatización de Laboratorios/economía , Automatización de Laboratorios/estadística & datos numéricos , Eficiencia Organizacional , Laboratorios de Hospital/organización & administración , Servicios Contratados/economía , Análisis Costo-Beneficio , Costos Directos de Servicios , Humanos , Laboratorios de Hospital/economía , Admisión y Programación de Personal , Arabia Saudita , Centros de Atención Terciaria , Factores de Tiempo
10.
Neth J Med ; 76(8): 351-357, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30362944

RESUMEN

BACKGROUND: Patients with bloodstream infections need early adequate antimicrobial treatment to reduce mortality. This raises the question of timing and logistics. How important is the time of day when a culture is flagged positive to the processing of blood cultures and optimisation of antimicrobial therapy? METHODS: We performed a retrospective study assessing the time delay of a positive blood culture result during and after office hours and its impact on adequate antimicrobial therapy. Process duration from the moment of culture positivity to Gram stain completion was compared at different timepoints during the day in a medium-sized hospital with an offsite microbiological laboratory. RESULTS: Ninety-four patients with positive, noncontaminated blood cultures were included. Sixty-six patients (70%) received adequate empirical therapy; this increased to 76 cases (82%) and to 88 cases (95%) after analysis of Gram stain results and complete determination, respectively (p < 0.05 for all comparisons). Median duration from culture positivity to Gram stain completion (including offsite culture transport) increased from a median of four to 12 hours if time of cultures turned positive after office hours (p < 0.05), irrespective of the adequacy of empirical coverage. This also resulted in a median 12-hour delay for the complete process from time of culture positivity to administration of the antimicrobial drug (p < 0.05). CONCLUSION: Processing blood cultures after office hours is often deferred, which can lead to a delay in adequate antimicrobial therapy for patients with bloodstream infections.


Asunto(s)
Bacteriemia/diagnóstico , Diagnóstico Tardío/estadística & datos numéricos , Laboratorios de Hospital/organización & administración , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , Citas y Horarios , Femenino , Humanos , Masculino , Países Bajos , Estudios Retrospectivos
11.
Med Clin North Am ; 102(5): 883-898, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30126578

RESUMEN

For adequate antimicrobial stewardship, microbiology needs to move from the laboratory to become physically and verbally amenable to the caregivers of an institution. Herein, we describe the contributions of our microbiology department to the antimicrobial stewardship program of a large teaching hospital as 10 main points ranging from the selection of patients deemed likely to benefit from a fast track approach, to their clinical samples, or the rapid reporting of results via a microbiology hotline, to rapid searches for pathogens and susceptibility testing. These points should serve as guidelines for similar programs designed to decrease the unnecessary use of antimicrobials.


Asunto(s)
Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Servicios de Laboratorio Clínico/organización & administración , Farmacorresistencia Microbiana/efectos de los fármacos , Laboratorios de Hospital/organización & administración , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Antiinfecciosos/administración & dosificación , Antiinfecciosos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Humanos , Pruebas de Sensibilidad Microbiana , Factores de Tiempo , Flujo de Trabajo
12.
Ann Biol Clin (Paris) ; 76(4): 365-372, 2018 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-30078775

RESUMEN

Bacteriology remained essentially manual for many years. After a partial automation for blood cultures, identifications and sensitivity testing, new technological developments including robotisation and digital pictures made it possible to open new ways. In the context of economic pression and need to increase the quality, automation offers multiple advantages concerning increase of productivity, standardization, traceability and decreasing of the delay to obtain the results. Moreover the use of digitalized pictures opens the way to tele-bacteriology, particularly useful when considering the merging of hospital laboratories because it makes it possible to geographically dissociate strict manipulation from the validation of the results and from the consultant activity of the microbiologist. The choice criteria of the equipment are detailed as well as the experience of the LHUB-ULB bacteriological laboratory which was automated at the time of merging of the Brussels public hospital laboratories and developed a conclusive experience of tele-bacteriology for the peripheral lab.


Asunto(s)
Técnicas Bacteriológicas/tendencias , Bacteriología/tendencias , Laboratorios de Hospital/tendencias , Automatización de Laboratorios/instrumentación , Automatización de Laboratorios/métodos , Técnicas Bacteriológicas/métodos , Técnicas Bacteriológicas/normas , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/tendencias , Humanos , Laboratorios de Hospital/organización & administración , Laboratorios de Hospital/normas , Telemedicina/métodos , Telemedicina/tendencias
13.
Am J Clin Pathol ; 150(4): 303-309, 2018 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-29992301

RESUMEN

Objectives: The World Health Organization African Regional Office recommends ISO 15189 standards to improve performance quality in sub-Saharan African laboratories. We specify challenges Ethiopian laboratorians encountered applying ISO 15189 standards. Methods: From a structured survey at 12 Ethiopian government hospitals, 175 laboratory staff replied; all were aware of the ISO standards and 138 had been involved in the ISO 15189 inspection process. In addition, 11 laboratory heads, 10 quality officers, and three medical directors were interviewed in depth. Results: Half or more respondents identified six challenges obstructing accreditation to a "large" or "very large" degree: (1) low management support, (2) inadequate training, (3) insufficient infrastructure, (4) excessive documentation, (5) little mentorship, and (6) increased accreditation-related workload. Interviewees added (7) poor equipment, (8) unavailable/poor-quality reagents, and (9) high staff turnover. Conclusions: The survey and interviews specified nine major challenges for Ethiopian government hospital laboratories that seriously obstruct meeting ISO 15189 demands.


Asunto(s)
Acreditación/normas , Países en Desarrollo , Recursos en Salud , Hospitales Públicos/normas , Laboratorios de Hospital/normas , Adulto , Actitud del Personal de Salud , Etiopía , Femenino , Encuestas de Atención de la Salud , Hospitales Públicos/organización & administración , Humanos , Entrevistas como Asunto , Laboratorios de Hospital/organización & administración , Masculino , Persona de Mediana Edad , Organización Mundial de la Salud
15.
Eur J Clin Microbiol Infect Dis ; 37(10): 1857-1861, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29980897

RESUMEN

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections and mortality, and therefore constitutes a serious cost factor in public health. Culture-based MRSA screening is a crucial part of MRSA-infection prevention and control strategies in the hospital setting. Manual inoculation of screening swabs onto culture plates still constitutes the major part of the technicians' workload in laboratories. We present a modified inoculation protocol that comprises direct inoculation of specimen onto a chromogenic MRSA-selective agar plate without further streaking for isolation. This study aims to evaluate the impact of this inoculation protocol on technicians' workload and the downstream workflow in our laboratory. Batches of 50 specimens were processed by different technicians and the hands-on time was compared between the standard and modified inoculation protocol. To assess the impact on downstream processing, a retrospective analysis of the rate of subcultures and turnaround time (TAT) of specimens yielding putative MRSA colonies from 9 months before (n = 1548) and after (n = 1267) the protocol change was carried out based on laboratory information system (LIS) data. The implementation of the modified protocol significantly reduced technicians' hands-on time needed for inoculation by 26.5% without altering the overall turnaround time of surveillance cultures or causing higher costs for extra plates needed for subcultures. Our modified inoculation protocol offers a cost-effective and easy to implement procedure for MRSA surveillance cultures which significantly decreases technicians' workload and does not impede the downstream workflow. It therefore increases the capacity of laboratory technicians' to execute more demanding tasks.


Asunto(s)
Técnicas Bacteriológicas/métodos , Laboratorios de Hospital/organización & administración , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/microbiología , Humanos , Personal de Laboratorio Clínico , Manejo de Especímenes , Factores de Tiempo , Flujo de Trabajo
16.
Int J Health Care Qual Assur ; 31(4): 295-308, 2018 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-29790443

RESUMEN

Purpose The purpose of this paper is to discuss the implementation of lean methodology to reduce the turnaround time (TAT) of a clinical laboratory in a super speciality hospital. Delays in report delivery lead to delayed diagnosis increased waiting time and decreased customer satisfaction. The reduction in TAT will lead to increased patient satisfaction, quality of care, employee satisfaction and ultimately the hospital's revenue. Design/methodology/approach The generic causes resulting in increasing TAT of clinical laboratories were identified using lean tools and techniques such as value stream mapping (VSM), Gemba, Pareto Analysis and Root Cause Analysis. VSM was used as a tool to analyze the current state of the process and further VSM was used to design the future state with suggestions for process improvements. Findings This study identified 12 major non-value added factors for the hematology laboratory and 5 major non-value added factors for the biochemistry lab which were acting as bottlenecks resulting in limiting throughput. A four-month research study by the authors together with hospital quality department and laboratory staff members led to reduction of the average TAT from 180 to 95minutes in the hematology lab and from 268 to 208 minutes in the biochemistry lab. Practical implications Very few improvement initiatives in Indian healthcare are based on industrial engineering tools and techniques, which might be due to a lack of interaction between healthcare and engineering. The study provides a positive outcome in terms of improving the efficiency of services in hospitals and identifies a scope for lean in the Indian healthcare sector. Social implications Applying lean in the Indian healthcare sector gives its own potential solution to the problem caused, due to a wide gap between lean accessibility and lean implementation. Lean helped in changing the mindset of an organization toward providing the highest quality of services with faster delivery at an optimal cost. Originality/value This paper is an effort to reduce the gap between healthcare and industrial engineering and enhancing the use of lean practices in Indian healthcare. The study is motivated toward implementing lean methodology successfully in services.


Asunto(s)
Eficiencia Organizacional , Hospitales Especializados/organización & administración , Laboratorios de Hospital/organización & administración , Mejoramiento de la Calidad/organización & administración , Humanos , India , Cultura Organizacional , Calidad de la Atención de Salud , Factores de Tiempo
17.
JACC Cardiovasc Interv ; 11(4): 329-338, 2018 02 26.
Artículo en Inglés | MEDLINE | ID: mdl-29397359

RESUMEN

OBJECTIVES: This study sought to report outcomes from an efficiency improvement project in a large cardiac cath lab. BACKGROUND: Operational inefficiencies are common in the cath lab, yet solutions are challenging. A detailed report describing and providing solutions for these inefficiencies may be valuable in guiding improvements in productivity. METHODS: In this observational study, the authors report metrics of efficiency before and after a cath lab quality improvement program in June 2014. Main outcomes included lab room start times, room turnaround times, laboratory use, and employee satisfaction. Time series analysis was used to assess trend over time. Chi-square testing and analysis of variance were used to assess change before and after the initiative. RESULTS: The principal changes included implementation of a pyramidal nursing schedule, increased use of an electronic scheduling system, and increased utilization of a preparation and recovery area. Comparing before with after the program, start times improved an average of 17 min, and on-time starts improved from 61.8% to 81.7% (p = 0.0024). Turnaround times improved from 20.5 min to 16.4 min (trend p < 0.0001), and the proportion of days at full lab utilization improved from 7.7% to 77.3% (p < 0.00001). There were no increases in overtime, night, or weekend cases. There was a reduction in full time employees from 36.1 in 2013 to 29.6 in 2016, with an improvement in employee satisfaction. CONCLUSIONS: A systematic approach to reducing inefficiencies can improve cath lab start times, turnaround times, and overall productivity. This knowledge may be helpful in assisting other cath labs in similar efficiency improvement initiatives.


Asunto(s)
Citas y Horarios , Cateterismo Cardíaco , Eficiencia Organizacional , Laboratorios de Hospital/organización & administración , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administración , Flujo de Trabajo , Atención Posterior/organización & administración , Análisis de Varianza , Actitud del Personal de Salud , Cateterismo Cardíaco/estadística & datos numéricos , Distribución de Chi-Cuadrado , Humanos , Satisfacción en el Trabajo , Laboratorios de Hospital/estadística & datos numéricos , Modelos Organizacionales , Personal de Enfermería en Hospital/organización & administración , Admisión y Programación de Personal/organización & administración , Sistemas de Información para Admisión y Escalafón de Personal/organización & administración , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo
19.
Int J Evid Based Healthc ; 16(1): 66-72, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28937412

RESUMEN

BACKGROUND: Healthcare and clinical laboratory practices are constantly evolving, leading a need for evidence-based practice (EBP) among all laboratory professionals. However, EBP among laboratory professionals has not yet been studied in Ethiopia. AIMS: This study aimed to determine EBP and associated factors among medical laboratory professionals in West Amhara hospitals, Northwest Ethiopia. METHODS: An analytic and descriptive cross-sectional study was conducted in West Amhara hospitals from February to March 2014. Data were collected using a pretested, structured self-administered questionnaire. Bivariate and multivariate logistic regressions were performed to identify factors associated with evidence-based laboratory practice. Odds ratios with 95% confidence interval (CI) were computed and the level of significance determined. RESULTS: A total of 169 respondents completed the questionnaire (response rate 95.4%), 40.8% (n = 69) of whom had a good level of EBP. Knowledge about EBP [adjusted odds ratio (AOR) = 2.22, 95% CI: 1.10-4.49], internet access (AOR = 2.43, 95% CI: 1.12-5.29), adoption EBP (AOR = 2.79, 95% CI: 1.41-5.52) and being single in marital status (AOR = 2.21, 95% CI: 1.08-4.51) were factors associated with EBP in multivariable logistic regression after controlling the effects of the confounding variables. CONCLUSION: EBP among laboratory professionals was found to be low. Having good knowledge towards EBP, organizational adoption of EBP, having internet access in their organization and being single in marital status were factors associated with EBP.


Asunto(s)
Práctica Clínica Basada en la Evidencia/estadística & datos numéricos , Personal de Laboratorio Clínico/estadística & datos numéricos , Adulto , Estudios Transversales , Etiopía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Internet , Laboratorios de Hospital/organización & administración , Masculino , Estado Civil , Encuestas y Cuestionarios
20.
Ann Clin Biochem ; 55(2): 254-263, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28490181

RESUMEN

Purpose Following the analytical phase, the current practice of many hospital laboratories involves the manual verification of all test results followed by the production of the report. However, manual verification is a time-consuming and tedious process. In this paper, we provide a detailed description of how to design autoverification rules for thyroid function test profiles and sex hormones. Materials and methods We used DM2 (Data manager 2) to construct the algorithm and build the database for autoverification of thyroid function test profiles and sex hormones, with reference to Boolean logic, Auto 10-A and CLSI'88. The rules consist of checking quality control, instrument error flags, critical values, the analytical measurement range (AMR), the limit range, consistency check and delta check. Firstly, we established the rules in the DM2, collected clinical specimens for validation, then tested the rules in a 'live' environment. Results Agreement was achieved between manual verification by two senior laboratory personnel and verification using the autoverification rules in 99.78% of the cases. The total autoverification rate for all tests was 77.06%. Following implementation of the rules, the laboratory turnaround time (TAT) was reduced by 54.55% and staffing numbers fell from three to two whole time equivalents (WTE). Statistical analysis resulted in a kappa statistic of 0.99 ( P < 0.001). Moreover, after implementing the autoverification rules, the error rate fell to 0.04%, indicating that errors were almost completely eliminated. Conclusion Implementing autoverification rules can reduce TAT, minimize the number of samples that require manual verification and allow for a reduction in staffing numbers. It also allows laboratory staff to devote more time and effort to the handling of problematic test results and contributing to improved patient care.


Asunto(s)
Técnicas de Diagnóstico Endocrino/normas , Hormonas Esteroides Gonadales/sangre , Laboratorios de Hospital/organización & administración , Laboratorios de Hospital/normas , Validación de Programas de Computación , Pruebas de Función de la Tiroides/normas , Algoritmos , Humanos , Control de Calidad , Valores de Referencia
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