CAJ | 학술논문

目的调查现有工作流程下急诊生化检验结果回报时间(TAT),探讨实验室内影响急诊生化检验TAT的因素,根据临床需要,优化工作流程,改进服务质量.方法记录临床科室急诊生化检验样本送实验室至检验结果回报l临床过程中的一些时间点,分析样本构成、实验室接收急诊样本至上机分析(阶段一)、上机分析至检验结果回报(阶段二)的时间和总的TAT及影响各阶段时间的因素,通过问卷调查获得I临床医生对实验室急诊生化检验TAT的满意度和期望值.结果急诊生化检验记录1 063例中,样本构成前四位:心血管内科22.52%、急诊内科20.64%、ICU17.07%和内分泌科8.94%.急诊生化检验阶段一、阶段二和总的TAT 3个时间段各自的中位数、第90百分位数分别为30 min、66 min,17 min、36 min及50 min、90 min.阶段一与TAT高度正相关(r=0.853,P<0.001),阶段二与TAT相关性下降(r=0.549,P<0.001).临床医生对目前急诊生化检验TAT(≤120 min)满意度占63.63%,90.91%的医生希望此时间能缩短到60 min内.结论当前本实验室急诊生化检验TAT满足科室现行的规定要求,但未能很好满足临床的需要,急诊生化样本检验过程中第一阶段较长,但此阶段仍有改善空间,通过加强人力和岗位培训、优化工作流程、临床沟通、提高前处理阶段信息化程度等改进措施,可望把急诊生化检验结果TAT缩短到60 min内,更好地为临床和患者服务.
목적 조사현유공작류정하급진생화검험결과회보시간(TAT),탐토실험실내영향급진생화검험TAT적인소,근거림상수요,우화공작류정,개진복무질량.방법 기록림상과실급진생화검험양본송실험실지검험결과회보l림상과정중적일사시간점,분석양본구성、실험실접수급진양본지상궤분석(계단일)、상궤분석지검험결과회보(계단이)적시간화총적TAT급영향각계단시간적인소,통과문권조사획득I림상의생대실험실급진생화검험TAT적만의도화기망치.결과 급진생화검험기록1 063례중,양본구성전사위:심혈관내과22.52%、급진내과20.64%、ICU17.07%화내분비과8.94%.급진생화검험계단일、계단이화총적TAT 3개시간단각자적중위수、제90백분위수분별위30 min、66 min,17 min、36 min급50 min、90 min.계단일여TAT고도정상관(r=0.853,P<0.001),계단이여TAT상관성하강(r=0.549,P<0.001).림상의생대목전급진생화검험TAT(≤120 min)만의도점63.63%,90.91%적의생희망차시간능축단도60 min내.결론 당전본실험실급진생화검험TAT만족과실현행적규정요구,단미능흔호만족림상적수요,급진생화양본검험과정중제일계단교장,단차계단잉유개선공간,통과가강인력화강위배훈、우화공작류정、림상구통、제고전처리계단신식화정도등개진조시,가망파급진생화검험결과TAT축단도60 min내,경호지위림상화환자복무.
0bjective To investigate the turnaround time(TAT) in current workflow,explore the intra-laboratory influential factors for emergency biochemical laboratory tests,so as to optimize the workflow and improve the service quality according to the clinical requirements.Methods We recorded the time points at which laboratories received samples,the samples being analysed and the results being reported,then calculated the time intervals:samples receipt to analysis as phase I,analysis to resuits report as phase Ⅱ,and receipt to report as total intra-laboratory TAT.The sample distribution,time intervals and their influential factors in each phase were analyzed,and the clinicians'satisfaction and expectation to the TAT were surveyed by questionaires.Results The department distribution of 1 063 tested samples were as follows:Department of Cardiology 22.52%;Emergency Department 20.64%;ICU 17.07%and Department of Endocrinology 8.94%.The median and 90th percentile TAT were respectively 30 min and 60 min in phase I,second phase 17 min and 36 min in phase Ⅱ,50 min and 90 min in total TAT.The phase Ⅰ was highly positive correlated to the total TAT(r=0.853,P<0.001),and the correlation was a little decreased between phase Ⅱ and TAT(r=0.549,P<0.001).The clinicians'satisfactory rate with current TAT(≤120 min)was 63.63%,and 90.91%clinicians hoped the TAT could be decreased to less than one hour.Conclusion Although the TAT basically meets the current rule of laboratories,it is beyond the clinicians'demands in current workflow.The pre-analytical phase(phase I)is too long,some measures should be taken,such as strengthening the personnel and post training,optimizing workflow,communication with clinicians,improving the application of information system in the pre-analytical phase.It is possible to reduce the emergency TAT to less than one hour arid meet the clinicians and patients'needs.