改善诊断服务的可及性：急诊科卫星实验室服务评估

Improving access to diagnostics: an evaluation of a satellite laboratory service in the emergency department.

作者信息

Leman P, Guthrie D, Simpson R, Little F

机构信息

Emergency Department, St Thomas' Hospital, London, UK.

出版信息

Emerg Med J. 2004 Jul;21(4):452-6.

PMID:15208229

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1726394/

Abstract

OBJECTIVES

To measure the impact of a satellite laboratory upon laboratory result turnaround times and clinical decision making times.

DESIGN

A prospective cohort study, the intervention group had blood tests sent Monday to Friday 12 noon to 8 pm and the control group had blood tests sent outside these hours. The data were collected over a six week period before the laboratory was opened, and a subsequent six week period.

SETTING

An urban teaching hospital emergency department.

PARTICIPANTS

1065 patients requiring blood tests.

MAIN OUTCOME MEASURE

Time from the blood sample being sent to the laboratory to the results being available on the clinician's computer.

RESULTS

The time to haematology (blood count) results in the intervention group decreased by 47.2 minutes (95% CI 38.3 to 56.1, p<0.001) after the laboratory was opened. The corresponding control group times were unchanged (0.6 minutes; -13.8 to 15.0, p = 0.94). Similar sized differences were also seen for haemostasis (d-dimer) testing 66.1 (41.8 to 90.4) minutes compared with -14.2 (-47.1 to 18.7) and chemistry 41.3 (30.3 to 52.2) compared with -4.2 (-17.4 to 8.9) testing. Decisions to discharge patients were significantly faster (28.2 minutes, 13.5 to 42.8, p<0.0001) in the intervention group after the laboratory was opened (controls; -2.6 minutes -27.0 to 21.7). No change was seen with decisions to admit patients. There was a trend for earlier laboratory results modifying intravenous drug or fluids orders, or both (p = 0.06)

CONCLUSION

A comprehensive satellite laboratory service is an important adjunct to improve the timeliness of care in the emergency department.

摘要

目的

评估卫星实验室对检验结果回报时间及临床决策时间的影响。

设计

一项前瞻性队列研究，干预组的血液检测样本于周一至周五中午12点至晚上8点送检，对照组的血液检测样本于上述时间之外送检。数据收集于实验室开放前的六周期间以及随后的六周期间。

地点

一家城市教学医院的急诊科。

参与者

1065名需要进行血液检测的患者。

主要观察指标

从血液样本送检至临床医生电脑上可获取检测结果的时间。

结果

实验室开放后，干预组血液学（血细胞计数）结果的回报时间缩短了47.2分钟（95%置信区间38.3至56.1，p<0.001）。相应的对照组时间未变（0.6分钟；-13.8至15.0，p = 0.94）。止血（D-二聚体）检测也出现了类似幅度的差异，干预组为66.1（41.8至90.4）分钟，对照组为-14.2（-47.1至18.7）分钟；化学检测方面，干预组为41.3（30.3至52.2）分钟，对照组为-4.2（-17.4至8.9）分钟。实验室开放后，干预组患者出院决策显著加快（28.2分钟，13.5至42.8，p<0.0001）（对照组为-2.6分钟，-27.0至21.7）。收治患者的决策未发生变化。实验室结果有提前改变静脉用药或补液医嘱或两者的趋势（p = 0.06）