The Key Quality Indicators For Clinical Laboratories: The Investigation And Analysis To Acceptability Of Samples And Turnaround Time

Objective: There were two important quality indicators which areacceptability of samples and turnaround time (TAT) in pre-analytical andpost-analytical process of clinical laboratory. These two indicators connectedand influenced each other. For example, the increase of substandardspecimens will affect the speed of turnaround time. Thus these two qualityindicators play an important monitoring role in accuracy and timeliness toexperimental results. The purpose of this study was to analyze the influencefactor and formulate the corresponding measures through the investigationand analysis of two quality indicators, so as to standardize the laboratoryprocess, improve laboratory services and elevate the accuracy and timelinessof experimental results. The ultimate aim was to provide a high qualityservices for the patients and clinicians. Methods: The system platform wasestablished by integrated with hospital information system and laboratoryinformation system. Applying bar code technology to monitor the samples atevery time point, analyzing the data of LIS so as to understand our hospitalquality comprehensively. The investigation time was from January toDecember of2013. Specimen type including blood, urine and feces, thesubstandard reasons are sample itself and label factors. Such as hemolytic,blood coagulation and improper selection of containers, we investigated the substandard situation of whole blood cell analysis, biochemistry, coagulationetc, and to calculate the error rates respectively. The TAT was separated tothree parts including emergency, outpatients and inpatients. Meanwhile, theTAT was also separated to five parts on time, which were collection time(TAT1), specimen delivery (TAT2), registration time (TAT3), testing time(TAT4) and doctor reading time (TAT5). The test contents including wholeblood cell analysis, biochemistry tests, cardiac markers tests and coagulationtests, etc. At last, we calculated the median and outliers ratio respectively. Alldata was collected by using Nuoda information systems functions andoutputted by using Microsoft excel2003software, at last, the Chi-square testwas used to compare the difference through SPSS13.0software. Results:Through the last analysis, we get a conclusion that the proportions ofsubstandard samples were16.71%(whole blood cell analysis),19.80%(biochemistry tests),19.23%(blood coagulation specimen),12.70%(urineroutine),11.48%(stool routine), and20.03%(other projects). The principallysubstandard reasons in whole blood cell analysis were blood coagulationsample (37.6%), improper selection of containers (14.79%), sampleinsufficiency (10.48%). the substandard ratio dropped from0.38%to0.10%.The substandard reasons in biochemistry specimens was mainly hemolytic(24.19%), the chilled blood (17.56%), insufficient sample volume (13%), thesubstandard ratio dropped from0.33%to0.12%. Coagulation samples whichunder standard ware mainly coagulation (26.24%), hemolytic (17.1%), insufficient sample volume (12.53%), the substandard ratio dropped from0.94%to0.48%. Urine routine samples which under standard mainly weresample insufficiency (25.66%), container error (18.38%), and no sample(12.73%), the substandard ratio dropped from1.16%to0.24%. Stool sampleswhich are not eligible were container error (27.35%), sample error (20.85%)and label information errors (15.25%), the substandard ratio dropped from1.93%to0.26%. The ratio of substandard samples was0.42%in the first halfyear (from January to June of2013) and0.23%in the second half year (fromJuly to December in2013)(χ2=315.13P<0.05). We analyzed the turnaroundtime of emergency samples, of the total TAT outside the lab was76.00%to88.90%, and inside the lab was11.10%to24.00%. Through continuousimprovement from January to December in2013, the TAT were all decreased,such as emergency whole blood cell analysis,(TAT1, from43minutes to14minutes; TAT2, from26minutes to7minutes; TAT3, from14minutes to3minutes; TAT4, from18minutes to5minutes; TAT5, from118minutes to51minutes), the outlier ratio reduced from19.54%to7.08%; The emergencybiochemistry test,(TAT1, from52minutes to18minutes; TAT2, from61minutes to30minutes; TAT3, from35minutes to8minutes; TAT4, from65minutes to28minutes; TAT5, from130minutes to52minutes), the outliersratio reduced from51.29%to28.61%; the outliers ratio of emergencecoagulation reduced from12.62%to0.57%, the outliers rate of blood gasanalysis reduced from14.14%to2.69%, the outliers ratio of cardiac markers reduced from53.90%to27.44%. The total TAT of ordinary whole blood cellanalysis decreased from106minutes to58minute, the outlier ratio ofoutpatient reduced from7.32%to5.22%, at the same time, The TAT ofinpatient decreased from562minutes to263minute, the outlier ratio ofinpatient reduced from41.36%to17.76%. The total TAT of ordinarybiochemistry test decreased from216minutes to153minutes, its outlier ratioof inpatient reduced from11.66%to2.67%, at the same time, The TAT ofinpatient decreased from675minutes to444minute, its outlier rate ofinpatient reduced from40.86%to16.90%. Conclusion: The continuousimprovement of sample collection, transportation, testing and report canimprove acceptability of samples and decrease the TAT. As a result, it canimprove the service quality and management level of laboratory.