Haglund Sofie, Transö Bente, Persson Lars-Göran, Zafirova Tamara, Grodzinsky Ewa
Division of Laboratory Medicine, Deparment of Research and Development in Laboratory Medicine, Clinical Chemistry, Ryhov Hospital, Jönköping County Council, Swenden.
J Eval Clin Pract. 2009 Apr;15(2):227-33. doi: 10.1111/j.1365-2753.2008.00944.x.
Technological development has progressed towards point-of-care testing (POCT) at primary health care centres (PHCs). However, to our knowledge, there has been no extensive evaluation of the effects on patient and clinical logistics when an extended laboratory service (ELS) is offered.
Questionnaires were used to evaluate patient logistics before the introduction of ELS and after 6 months, as the proportion of consultations completed within one visit. That is, the patient is sampled, the test result is made available, and the patient is informed of the clinical decision. After 3 years of ELS, clinical logistics were followed up using questionnaires and by measuring turnaround time (TAT) from sampling to available test result (TATa) and from sampling to a clinical decision (TATd), and the proportion of laboratory test results reported back to the patient on the day of sampling (TATi).
After 6 months of ELS, the theoretical proportion of consultations which could be completed within 1 day had increased from 20% to 68%, while the proportion of patients desiring this situation had increased from 72% to 85%. After 3 years of ELS, the TATi was 56%. However, the majority of these tests were from the menu available before ELS. While 66% of patients wished to receive the laboratory test results at the consultation, this was achieved in 42% of cases. Patients below 65 years of age were more anxious than older patients to complete the consultation within a single PHC visit.
The clinical logistics concerning TATi did not correspond to the patients' wishes. When the consultation was completed within 1 day, the majority of the laboratory analyses were from the menu available before ELS. An ELS alone cannot deliver all the desired benefits of POCT.
技术发展已朝着在初级卫生保健中心（PHC）开展即时检验（POCT）的方向推进。然而，据我们所知，对于提供扩展实验室服务（ELS）时对患者及临床后勤的影响，尚未进行广泛评估。
采用问卷调查评估ELS引入前以及引入6个月后的患者后勤情况，以单次就诊内完成会诊的比例作为指标。即患者接受采样、获得检测结果并被告知临床决策。在ELS开展3年后，通过问卷调查以及测量从采样到可获得检测结果的周转时间（TAT）（TATa）、从采样到做出临床决策的周转时间（TATd），以及采样当天向患者反馈实验室检测结果的比例（TATi）来跟踪临床后勤情况。
ELS开展6个月后，理论上1天内可完成会诊的比例从20%增至68%，而希望这种情况出现的患者比例从72%增至85%。ELS开展3年后，TATi为56%。然而，这些检测大多来自ELS开展前的检测项目清单。虽然66%的患者希望在会诊时收到实验室检测结果，但只有42%的情况能够实现。65岁以下的患者比年长患者更急于在单次初级卫生保健中心就诊内完成会诊。
关于TATi的临床后勤情况与患者意愿不符。当会诊在1天内完成时，大多数实验室分析来自ELS开展前的检测项目清单。仅靠ELS无法带来POCT所有期望的益处。
