Driessen Julia, Limula Henry, Gadabu Oliver J, Gamadzi Gervase, Chitandale Edwin, Ben-Smith Anne, Alide Noor, Douglas Gerald P
Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, United States.
Kamuzu Central Hospital, Ministry of Health, Lilongwe, Malawi.
Afr J Lab Med. 2015 Jun 11;4(1):1-7. doi: 10.4102/ajlm.v4i1.176. eCollection 2015.
There has been little formal analysis of laboratory systems in resource-limited settings, despite widespread consensus around the importance of a strong laboratory infrastructure.
This study details the informational challenges faced by the laboratory at Kamuzu Central Hospital, a tertiary health facility in Malawi; and proposes ways in which informatics can bolster the efficiency and role of low-resource laboratory systems.
We evaluated previously-collected data on three different aspects of laboratory use. A four-week quality audit of laboratory test orders quantified challenges associated with collecting viable specimens for testing. Data on tests run by the laboratory over a one-year period described the magnitude of the demand for laboratory services. Descriptive information about the laboratory workflow identified informational process breakdowns in the pre-analytical and post-analytical phases and was paired with a 24-hour sample of laboratory data on results reporting.
The laboratory conducted 242 242 tests over a 12-month period. The four-week quality audit identified 54% of samples as untestable. Prohibitive paperwork errors were identified in 16% of samples. Laboratory service workflows indicated a potential process breakdown in sample transport and results reporting resulting from the lack of assignment of these tasks to any specific employee cadre. The study of result reporting time showed a mean of almost six hours, with significant variation.
This analysis identified challenges in each phase of laboratory testing. Informatics could improve the management of this information by streamlining test ordering and the communication of test orders to the laboratory and results back to the ordering physician.
尽管人们普遍认同强大的实验室基础设施的重要性，但在资源有限的环境中，对实验室系统进行的正式分析却很少。
本研究详细阐述了马拉维一家三级医疗机构卡穆祖中央医院实验室所面临的信息挑战；并提出了信息学可提高资源匮乏的实验室系统效率和作用的方法。
我们评估了之前收集的关于实验室使用三个不同方面的数据。对实验室检测订单进行了为期四周的质量审核，以量化与采集可用于检测的有效标本相关的挑战。关于实验室在一年期间进行的检测数据描述了对实验室服务的需求规模。关于实验室工作流程的描述性信息确定了分析前和分析后阶段的信息流程故障，并与一份关于结果报告的24小时实验室数据样本相结合。
该实验室在12个月期间进行了242242次检测。为期四周的质量审核发现54%的样本无法检测。在16%的样本中发现了令人望而却步的文书工作错误。实验室服务工作流程表明，由于未将样本运输和结果报告任务分配给任何特定员工队伍，可能导致流程故障。对结果报告时间的研究显示，平均时间近6小时，且差异很大。
该分析确定了实验室检测每个阶段的挑战。信息学可通过简化检测订单以及将检测订单传达给实验室并将结果反馈给开单医生来改善这些信息的管理。
