以六西格玛方法提升临床实验室检验效率

An improvement of the turnaround time in clinical laboratories by using the Six Sigma concept

目的统计实验室报告周期（TAT），寻找有效缩短TAT的环节和方法。方法收集2011年1月1日至12月31日门诊及病房患者生化心肌损伤相关项目（肌酸激酶、肌钙蛋白I和肌红蛋白）的原始数据，其中门诊患者数据19906个／年，病房患者数据22973个／年。与实验室向临床承诺的TAT相比较，计算检验时效相关质量指标的中位数、平均中位数，并将相应数值转换为西格玛（O-）表示。流程中质量指标的σ≥4表示质量控制较好。根据对实验室流程分析结果，以质量工作会或临床座谈会的形式确定实验室对关键流程的TAT改进方案。通过2011至2012年度对门诊患者及临床医生的TAT满意度调查结果验证改进方案的效果。结果2011年门诊患者实验室外（标本采集-接收）超时报告平均中位数2．78％（3．5σ），病房患者实验室外（标本采集一接收）超时报告平均中位数17．82％（2．5σ）。门诊患者实验室内（标本接收-结果报告）超时报告平均中位数3．39％（3．4σ），病房患者实验室内（标本接收一结果报告）超时报告平均中位数2．96％（3．4σ）。门诊患者总TAT（标本采集一结果报告）超时报告平均中位数3．93％（3．3σ），病房患者总TAT（标本采集-结果报告）超时报告平均中位数12．18％（2．7σ）。2011和2012年度门诊患者TAT满意度调查结果显示分别为78％和79％，无明显变化。2011和2012年度临床医生TAT的满意度由80％提升至90％，其中非常满意选项由75％提升至79％。结论延迟TAT的关键环节是病房患者实验室外TAT。实施十项缩短TAT的改进建议，可合理有效地缩短TAT。

Objective To analyze laboratory turnaround time （TAT） and find effective ways to shorten TAT. Methods Data associated with cardiac panel （CK, cTnI and Mb） were collected in 2011 including 19 906 outpatient data and 22 973 inpatient data. The medians and the average medians of the quality indicators on TAT were calculated and the results were transformed to the Six Sigma scale to estimate the degree of control over related process. Processes were considered well controlled when σ≥4. Based on the results of data analysis, an improvement plan was decided by laboratory quality management meeting and clinical communication meeting. The effect of the improvement plan was evaluated through 2011-2012 satisfaction storeys of outpatients and clinicians. Results The average median of overtime reports for outpatient from specimen collection to reception was 2. 78% （3.5（r）, and 17.82% （2. 5（r） for inpatients. The average median of overtime reports for outpatient from specimen reception to result reporting was 3.39% （3.4σ）, and 2.96% （3.4σ） for inpatients. The average median of overtime reports for outpatient from specimen collection to result reporting was 3.93% （3.3σ） , and 12. 18% （2. 7σ） for inpatient. The results of TAT satisfaction surveys for outpatients from 2011 to 2012 were similar, which were 78% in 2011 and 79% in 2012 ; the results for clinicians showed an increase from 80% in 2011 to 90% in 2012, including an increase from 75% to 79% for very satisfaction choice. Conclusions Outside the laboratory TAT is a key step in sickroom patients delay TAT. The implementation for ten imp,＇ovement suggestions enabled to shorten TAT effectively.