Dolci Alberto, Giavarina Davide, Pasqualetti Sara, Szőke Dominika, Panteghini Mauro
Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy.
Clinical Chemistry and Hematology Laboratory, "San Bortolo" Hospital, Vicenza, Italy.
Clin Biochem. 2017 Jul;50(10-11):605-611. doi: 10.1016/j.clinbiochem.2017.04.002. Epub 2017 Apr 5.
During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.
在过去几十年中，医疗保健系统发生了迅速变化，如今医院护理主要针对重症患者和急性治疗，对于这些情况，实验室检测结果至关重要，并且需要始终在可预测的短周转时间（TAT）内报告。医院环境中的实验室可以通过将其组织从分隔的实验室部门转变为基于决策的实验室部门来应对这一挑战。这需要实施一个核心实验室，该实验室利用分析平台、轨道系统和信息技术（包括中间件）中的技术创新实现全实验室自动化（TLA），以及一些与护理团队合作处理特定医疗状况的卫星专业实验室科室。在这种实验室部门模式中，核心实验室通过TLA进行的所有一线检测的短TAT代表了关键范例，即不再需要加急检测，因为所有样本都实时处理，（自动）验证后的结果在满足临床需求的时间内发送。为了最佳地实现这一目标，实验室应积极参与管理涵盖整个检查过程的所有步骤，同时加快实验室外阶段的速度，例如样本运送。此外，为了确保有效性而非仅仅是效率，所有流程，例如标本完整性检查，应由中间件根据临床管理中定义的一组预定义规则进行管理。
