James David, Truman Derek
Southwest Pathology Service, Lisieux Way, Taunton TA1 2LB, UK.
Pract Lab Med. 2015 Mar 4;1:2-4. doi: 10.1016/j.plabm.2015.02.002. eCollection 2015 Apr 1.
The relative merits of hub and spoke models of service delivery are often debated, but accessing data on how they may benefit service delivery can be difficult, and may hinder the adoption of a model which can benefit the health community. Our aim was to provide objective data that would either support or refute one potential benefit of service redesign, namely the effect on turnaround times within the acute hospital.
Data on turnaround times for sequential requests containing creatinine as a request item received from inpatient locations at two acute hospitals were extracted from the laboratory computer system. Monthly data was collected for a period of 5 months prior to and the same 5 month period following the service redesign. Data was subjected to statistical process control (SPC) analysis.
There was a statistically significant reduction (<0.05) in the average turnaround time of at least 29% for routine requests and 22% for urgent requests, accompanied by a statistically significant reduction (<0.05) in upper control limits of least 46% - improving the predictability of result availability and reducing the 95% confidence interval for turnaround times.
Adoption of a "hub and spoke" model has the potential to support laboratories in improving both urgent and non-urgent turnaround times in a cost-efficient manner within acute hospitals, and reduce the variability in turnaround time.
服务提供的“中心辐射”模式的相对优点常常引发争论，但获取有关其如何有益于服务提供的数据可能存在困难，这可能会阻碍采用一种能使医疗界受益的模式。我们的目的是提供客观数据，以支持或反驳服务重新设计的一个潜在益处，即在急症医院内对周转时间的影响。
从实验室计算机系统中提取两家急症医院住院部接收的包含肌酐作为申请项目的连续申请的周转时间数据。在服务重新设计之前的5个月期间和之后相同的5个月期间收集月度数据。对数据进行统计过程控制（SPC）分析。
常规申请的平均周转时间有统计学意义的降低（<0.05），至少降低了29%，紧急申请降低了22%，同时，上控制限有统计学意义的降低（<0.05），至少降低了46%，这提高了结果可得性的可预测性，并缩小了周转时间的95%置信区间。
采用“中心辐射”模式有可能支持实验室在急症医院内以具有成本效益的方式改善紧急和非紧急情况的周转时间，并减少周转时间的变异性。
