气动传输系统和计算机化医嘱管理对实验室周转时间的影响。

The impact of a pneumatic tube and computerized physician order management on laboratory turnaround time.

作者信息

Guss David A, Chan Theodore C, Killeen James P

机构信息

Department of Emergency Medicine, University of California, UC San Diego Medical Center, 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, USA.

出版信息

Ann Emerg Med. 2008 Feb;51(2):181-5. doi: 10.1016/j.annemergmed.2007.03.010. Epub 2007 Apr 30.

DOI:10.1016/j.annemergmed.2007.03.010

PMID:17467118

Abstract

STUDY OBJECTIVE

We assess the effect of sequential modifications in laboratory processing, including pneumatic tube transport and fully computerized order management, on laboratory turnaround time in the emergency department (ED).

METHODS

This was an observational analysis of a comprehensive computerized database derived from ED, laboratory, and hospital information systems. The setting was an academic urban ED with annual census of 38,000. Participants and interventions included all patients who had laboratory testing (serum sodium level, troponin level, or CBC count) during three 1-month study periods: before pneumatic tube and computerized order management (prepneumatic tube), after pneumatic tube but before computerized order management (postpneumatic tube), and after both pneumatic tube and computerized order management (postpneumatic tube/computerized order management). The primary outcome measure was median laboratory turnaround time, reported with interquartile ranges. Additional measures included ED census and number of laboratory tests ordered during each study period.

RESULTS

The monthly ED census was 3,021, 3,428, and 3,066 for the prepneumatic tube, postpneumatic tube, and postpneumatic tube/computerized order management periods. There was a significant decrease in turnaround time with each period and each test over time. For serum sodium testing, the median laboratory turnaround time decreased from 55.9 to 46.7 to 37.2 minutes for prepneumatic tube, postpneumatic tube, and postpneumatic tube/computerized order management periods. For CBC-count testing, median times decreased from 55.6 to 42.2 to 36.3 minutes, respectively. For troponin I testing, median times decreased from 52.8 to 41.8 to 30.6 minutes, respectively.

CONCLUSION

Changes in laboratory specimen management, including the use of a pneumatic tube and computerized order management, resulted in a progressive decrease in laboratory turnaround time in the study ED.

摘要

研究目的

我们评估实验室流程中的一系列改进措施，包括气动管道传输和全计算机化医嘱管理，对急诊科（ED）实验室周转时间的影响。

方法

这是一项对源自急诊科、实验室和医院信息系统的综合计算机化数据库的观察性分析。研究地点为一所城市学术性急诊科，年就诊量为38000人次。研究对象和干预措施包括在三个为期1个月的研究期间内接受实验室检测（血清钠水平、肌钙蛋白水平或全血细胞计数）的所有患者：在气动管道和计算机化医嘱管理之前（气动管道之前）、在有气动管道但在计算机化医嘱管理之前（气动管道之后）以及在有气动管道和计算机化医嘱管理之后（气动管道/计算机化医嘱管理之后）。主要结局指标是实验室周转时间的中位数，并报告四分位间距。其他指标包括急诊科就诊量以及每个研究期间所开具的实验室检测数量。

结果

在气动管道之前、气动管道之后以及气动管道/计算机化医嘱管理之后这三个时期，急诊科每月就诊量分别为3021人次、3428人次和3066人次。随着时间推移，每个时期以及每项检测的周转时间均显著缩短。对于血清钠检测，在气动管道之前、气动管道之后以及气动管道/计算机化医嘱管理之后这三个时期，实验室周转时间的中位数分别从55.9分钟降至46.7分钟，再降至37.2分钟。对于全血细胞计数检测，中位数时间分别从55.6分钟降至42.2分钟，再降至36.3分钟。对于肌钙蛋白I检测，中位数时间分别从52.8分钟降至41.8分钟，再降至30.6分钟。