PDCA循环在优化感染性疾病核酸检测TAT时间中的应用

Application of PDCA cycle in optimizing Turn⁃Around⁃Time(TAT)of nucleic acid detection for infectious diseases

目的应用PDCA循环管理缩短感染性疾病核酸检测报告TAT时间。方法利用PDCA循环方法,分析影响核酸检测TAT时间的原因,制定改进目标,本次PDCA改进目标确定为TAT时间≤6小时,制定人员、工作模式、仪器配置、试剂四个方面的改进措施并执行,利用改进前后TAT数据进行效果分析,评价改进措施的有效性。结果执行改进措施后病原体核酸检测TAT时间低于改进前,差异有统计学意义(Z=-76.53,P<0.05)。执行改进措施前后样本TAT达标率比较,差异有统计学意义(χ^(2)=3116.557,P<0.05)。2021年11月~12月改进后,仍然有8593份样本TAT时间超过6小时,其中样本多、样本复查是造成TAT超时的主要原因,分别占超时原因比例的60.53%和28.60%。计划阶段制定的改进措施有效。样本多造成的超时主要反映的是工作人员数量及设备不足、送样不及时造成样本堆积的问题。样本复查的原因主要是异常扩增曲线及内标扩增曲线阴性样本的复查,造成这两种扩增结果的原因较多,其中人员操作熟练程度及对整个检测过程质控点的把控程度是重要原因。结论应用PDCA循环管理从核酸检测人员、工作模式、仪器配置、检测试剂四个方面进行改进,可以有效缩短核酸检测TAT时间。

Objective To apply PDCA cycle management to shorten the Turn⁃Around⁃Time of infectious disease nucleic acid test.Methods The PDCA cycle method was used to analyze the reasons that affect the TAT of nucleic acid detection and establish improvement goals.The PDCA improvement goal is determined to be TAT≤6 hours.The improvement measures from four aspects of personnel,working mode,instrument configuration and reagent were formulated and implemented.Results After the improvement measures were implemented,the TAT time of pathogen nucleic acid detection was lower than that before the improvement,and the difference was statistically significant(Z=-76.53,P<0.05).There was a statistically significant difference in the TAT compliance rate of samples before and after implementing the improvement measures(χ^(2)=3116.557,P<0.05).After the improvement from November to December 2021,there are still 8593 samples whose TAT time exceeds 6 hours.Among them,the large number of samples and sample re⁃examination are the main reasons for TAT overtime,accounting for 60.53%and 28.60%of the overtime reasons respectively.The improvement measures formulated in the planning phase are effective.The overtime caused by too many samples mainly reflects the problem of accumulation of samples caused by insufficient number of staff and equipment,and the untimely delivery of samples.The main reasons for sample re⁃examination are the re⁃examination of abnormal amplification curves and internal standard amplification curves of negative samples.There are many reasons for these two types of amplification results,among which the operational proficiency of the personnel and the degree of control over the quality control points of the entire detection process is an important reason.Conclusion Applying PDCA cycle management to improve the four aspects of nucleic acid testing personnel,working mode,instrument configuration,and testing reagents can effectively shorten the TAT time of nucleic acid testing.