Saxena S, Wong E T
Department of Pathology and Laboratory Medicine, University of Southern California School of Medicine.
Am J Clin Pathol. 1993 Dec;100(6):606-10. doi: 10.1093/ajcp/100.6.606.
Using the principles of continuous quality improvement (CQI), the authors conducted a study in response to a request from the Department of Emergency Medicine, Los Angeles County, and University of Southern California Medical Center, Los Angeles, for a dedicated stat laboratory in the emergency department. The stat orders to test serum electrolyte, glucose, blood urea nitrogen, creatinine, amylase, and lipase levels, prothrombin time, and complete blood count (CBC) were evaluated. The study was done in two phases. First, a baseline on stat laboratory test turnaround time was established, and problems were identified. Then, the authors reexamined the turnaround after problems were addressed and a new laboratory information system was installed. In the first phase, median within-laboratory turnaround for chemistry tests was 61 minutes from the time the specimens arrived in the laboratory and 70 minutes for CBCs from the time of accessioning. Delay in physician review of the results (45 minutes) was the longest component of overall turnaround. The second phase of the study found that the median within-laboratory turnaround had improved to 36 minutes for chemical and 55 minute for hematologic tests. However, other preanalytic factors outside the control of the laboratory, such as collecting blood and sending the specimens to the laboratory, and postanalytic delays in physician acknowledgment of the results remained the major components of the perceived turnaround delays. In conclusion, stat laboratory service for the emergency department improved with CQI. The study suggested that resources required to establish a dedicated stat laboratory in the emergency department would be more beneficial if directed toward reducing the preanalytic delays. Further, CQI has great potential as a management tool for the clinical laboratory.
作者运用持续质量改进（CQI）原则，应洛杉矶县急诊医学部以及洛杉矶南加州大学医学中心的要求，针对急诊科设立专门的急诊检验实验室展开了一项研究。对检测血清电解质、葡萄糖、血尿素氮、肌酐、淀粉酶和脂肪酶水平、凝血酶原时间以及全血细胞计数（CBC）的急诊检验医嘱进行了评估。该研究分两个阶段进行。首先，确定急诊检验实验室检测周转时间的基线，并找出问题所在。然后，在问题得到解决且安装了新的实验室信息系统后，作者重新审视了周转时间。在第一阶段，化学检验在实验室内部的周转时间中位数为自标本送达实验室起61分钟，CBC自登记起为70分钟。医生查看结果的延迟时间（45分钟）是总周转时间中最长的部分。研究的第二阶段发现，化学检验在实验室内部的周转时间中位数已改善至36分钟，血液学检验为55分钟。然而，实验室无法控制的其他分析前因素，如采血和将标本送往实验室，以及分析后医生确认结果的延迟，仍然是导致感知周转延迟的主要因素。总之，通过CQI，急诊科的急诊检验实验室服务得到了改善。该研究表明，如果将用于在急诊科设立专门急诊检验实验室的资源用于减少分析前延迟，可能会更有益。此外，CQI作为临床实验室的管理工具具有巨大潜力。
