急诊生化检验结果回报时间的调查分析

Survey on the turn-around time of emergency biochemical laboratory tests

目的调查现有工作流程下急诊生化检验结果回报时间(TAT),探讨实验室内影响急诊生化检验TAT的因素,根据临床需要,优化工作流程,改进服务质量。方法记录临床科室急诊生化检验样本送实验室至检验结果回报临床过程中的一些时间点,分析样本构成、实验室接收急诊样本至上机分析(阶段一)、上机分析至检验结果回报(阶段二)的时间和总的TAT及影响各阶段时间的因素,通过问卷调查获得临床医生对实验室急诊生化检验TAT的满意度和期望值。结果急诊生化检验记录1 063例中,样本构成前四位:心血管内科22.52%、急诊内科20.64%、ICU17.07%和内分泌科8.94%。急诊生化检验阶段一、阶段二和总的TAT3个时间段各自的中位数、第90百分位数分别为30 min、66 min,17 min、36 min及50 min、90 min。阶段一与TAT高度正相关(r=0.853,P<0.001),阶段二与TAT相关性下降(r=0.549,P<0.001)。临床医生对目前急诊生化检验TAT (≤120 min)满意度占63.63%,90.91%的医生希望此时间能缩短到60 min内。结论当前本实验室急诊生化检验TAT满足科室现行的规定要求,但未能很好满足临床的需要,急诊生化样本检验过程中第一阶段较长,但此阶段仍有改善空间,通过加强人力和岗位培训、优化工作流程、临床沟通、提高前处理阶段信息化程度等改进措施,可望把急诊生化检验结果TAT缩短到60 min内,更好地为临床和患者服务。

Objective To investigate the turnaround time （TAT） in current workflow, explore the intra-laboratory influential factors for emergency biochemical laboratory tests, so as to optimize the workflow and improve the service quality according to the clinical requirements. Methods We recorded the time points at which laboratories received samples, the samples being analysed and the results being reported, then calculated the time intervals： samples receipt to analysis as phase Ⅰ , analysis to results report as phase Ⅱ , and receipt to report as total intra-laboratory TAT. The sample distribution, time intervals and their influential factors in each phase were analyzed, and the clinicians＇ satisfaction and expectation to the TAT were surveyed by questionaires. Results The department distribution of 1 063 tested samples were as follows： Department of Cardiology 22. 52%; Emergency Department 20.64% ; ICU 17.07% and Department of Endocrinology 8. 94%. The median and 90th percentile TAT were respectively 30 min and 60 min in phase Ⅰ , second phase 17 min and 36 min in phase Ⅱ , 50 min and 90 min in total TAT. The phase Ⅰ was highly Positive correlated to the total TAT （r=0. 853, P〈0. 001）, and the correlation was a little decreased between phase Ⅱ and TAT （r= 0. 549, P〈 0. 001）. The clinicians＇ satisfactory rate with current TAT （4120 min） was 63.63%, and 90.91% clinicians hoped the TAT could be decreased to less than one hour. Conclusion Although the TAT basically meets the current rule of laboratories, it is beyond the clinicians＇ demands in current workflow. The pre-analytical phase （phase Ⅰ ） is too long, some measures should be taken, such as strengthening the personnel and post training, optimizing workflow, communication with clinicians, improving the application of information system in the pre analytical phase. It is possible to reduce the emergency TAT to less than one hour and meet the clinicians and patients＇ needs.