CAJ | 학술논문

目的通过在北京儿童医院集团平台上开展全血细胞计数项目检验过程质量持续改进活动,提高儿科临床实验室检验过程的质量水平,确保检验质量.方法由北京儿童医院集团牵头联合15家儿童医院检验科,采用戴明环(PDCA循环)质量持续改进的方法,通过第1次问卷调查、实验室间比对等方法发现存在的问题、分析原因、制定质量目标并实施.通过开展针对性的培训、第2次问卷调查、实验室自查和集团在线室内质量控制平台的建立等活动,评估整体活动效果,并为下一步PDCA奠定基础.结果本次活动的开展使各实验室完善了质量管理体系文件和全血细胞计数的室内质量控制方案;性能验证的规范性有所提高,特别是精密度和实验室内结果可比性的验证率达到100％;仪器的校准和强检率从2013年15家医院的46.67％ (7/15)未达标,降低到2014年的20％(3/15)未达标;2014年各实验室全血细胞计数的5个指标参数日间精密度变异系数异常数据所占比例为1.2％ (2/165),比2013年调查的9.6％(14/145)有明显下降.仅使用1个水平质控物进行每日质控的医院由5家减少到3家.15家医院组织培训总数从2013年的101次增长到2014年的263次,增加160％.结论在医院集团平台上开展检验过程的质量改进活动,可以促进各医院儿科检验专业的共同发展,改进效果显著,经验值得推广.
목적 통과재북경인동의원집단평태상개전전혈세포계수항목검험과정질량지속개진활동,제고인과림상실험실검험과정적질량수평,학보검험질량.방법 유북경인동의원집단견두연합15가인동의원검험과,채용대명배(PDCA순배)질량지속개진적방법,통과제1차문권조사、실험실간비대등방법발현존재적문제、분석원인、제정질량목표병실시.통과개전침대성적배훈、제2차문권조사、실험실자사화집단재선실내질량공제평태적건립등활동,평고정체활동효과,병위하일보PDCA전정기출.결과 본차활동적개전사각실험실완선료질량관리체계문건화전혈세포계수적실내질량공제방안;성능험증적규범성유소제고,특별시정밀도화실험실내결과가비성적험증솔체도100％;의기적교준화강검솔종2013년15가의원적46.67％ (7/15)미체표,강저도2014년적20％(3/15)미체표;2014년각실험실전혈세포계수적5개지표삼수일간정밀도변이계수이상수거소점비례위1.2％ (2/165),비2013년조사적9.6％(14/145)유명현하강.부사용1개수평질공물진행매일질공적의원유5가감소도3가.15가의원조직배훈총수종2013년적101차증장도2014년적263차,증가160％.결론 재의원집단평태상개전검험과정적질량개진활동,가이촉진각의원인과검험전업적공동발전,개진효과현저,경험치득추엄.
Objective The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children' s Hospital Group in order to improve the quality of pediatric clinical laboratories.Methods Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action).The questionnaire survey and interlaboratory comparison was conducted to find the existing problems,to analyze reasons,to set forth quality targets and to put them into practice.Then,targeted training was conducted to 15 children's hospitals and the second questionnaire survey,self examinations by the clinical laboratories was performed.At the same time,the Group's online internal quality control platform was established.Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA.Results Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program.In addition,standardization of performance verification was also improved,especially with the comparable verification rate of precision and internal laboratory results up to 100％.In terms of instrument calibration and mandatory diagnostic rates,only three out of the 15 hospitals (20％) failed to pass muster in 2014 from 46.67％ (seven out of the 15 hospitals) in 2013.The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC,RBC,Hb,Plt and Hct) of all the 15 laboratories accounted for 1.2％ (2/165) in 2014,a marked decrease from 9.6％ (14/145) in 2013.While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five.The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013,up 160％.Conclusion The quality improvement program for the clinical laboratories launched via the Hospital Group platform can promote the joint development of the pediatric clinical laboratory discipline of all the member hospitals with remarkable improvement results,and the experience is recommendable for further rollout.