住院患者血标本分析前质量控制与不合格标本原因分析

Pre-analysis quality control of inpatients′ blood samples and the cause analysis of unqualified specimen

目的对住院患者血标本进行分析前全程监控和定期分析,探讨不合格标本发生原因,为制定改进措施提供依据,以提高分析前检验质量。方法采用调查性研究设计。以血标本唯一性条形码建立全程监控标本流程的信息系统,比较分析2012年1至6月与实施全程监控的2013年同期浙江大学医学院附属第二医院检验科收集的本院住院患者血标本的丢失率、标本超时送检率、标本不合格率,并对科室分布情况及其原因进行分析与评价。结果 2013年1至6月共收到501 135份住院患者血标本,标本丢失0.006‰(3/501 135份),标本超时送检率1.64%(8195/501 135份),标本不合格率为3.676‰(1842/501 135份);而未采取监控措施的2012年同期共收集血标本为450 463份,标本丢失率为0.053‰(24/450 463份),标本超时送检率为6.50%(29 280/450 463份),标本不合格率为7.830‰(3527/450 463份),两年同期数据比较,差异均有统计学意义(χ2值分别为18.7、14839.9、729.7;P均<0.01)。标本凝块[28.3%(521/1842份)]、标本溶血[27.6%(508/1842份)]及标本量少[24.8%(456/1842份)]是标本不合格的三大主要原因。不合格标本主要分布在中心ICU1、2病区,外科ICU、脑科ICU、急诊ICU和心内科ICU 6个监护病房。2013年1至6月,6个科室不合格标本数占全院不合格标本总数的比例分别为32.6%(118/362份)、39.3%(87/221份)、35.0%(112/320份)、32.7%(113/354份)、32.2%(98/306份)和22.5%(63/279份)。结论专职部门运用信息系统对标本分析前阶段全程监控,及时追踪可有效提高标本送检及时率、减少标本丢失率;对不合格标本发生原因及分布科室进行分析,可与临床进行有效沟通,有助于提高分析前血标本检验质量。

Objective To unveil the causes of unqualified specimens and provide basis for improvement so as to make progress in the pre-testing quality by overall tracing of inpatients＇ blood specimens and periodical analysis. Methods The entire process monitoring information system based on blood sample barocode was adopted to compare the rate of specimen loss overdue transportation and rejection between January to June 2012 and January to June 2013 in the Second Affiliated Hospital, Zhejiang University School of Medicine. The distribution of unqualified specimen and causes were luther analyzed. Results Totally 501 135 in patients blood samples were received with 0.006‰ （3/501 135 specimens） sample loss rate, 1.64% （8195/501 135 specimens） specimen transportation overtime rate, 3.676‰ （1842/501 135 specimens） specimen unqualified rate from January to June 2013; otherwise, 450 463 specimens with 0.053‰ （24/450 4630 specimens） loss rate, 6.50% （29 280 / 450 463 specimens） transportation overtime rate, 7.830‰ （3527/450 463 specimens） unqualified rate without control measures during the first half year of 2012 were received, differences were statistically significant （;（2=18.7, 14839.9, 729.7, P〈0.01） between those two periods; the clotted, haemolysed and insufficient volume were the three main rejection reasons which accounts for 28.3% （521/1842 specimens）, 27.6% （508/1842 specimens） and 24.8% （456/1842specimens） respectively. Unqualified specimens are mainly distributed in six intensive care units （center ICU 1/2, surgical ICU, neurology ICU, emergency ICU and heart ICU） ,which accounts for 32.6% （118/362 specimens）, 39.3% （87/221 specimens）, 35.0% （112/320 specimens）, 32.7% （113/354 specimens）, 32.2% （98/306 specimens） and 22.5% （63/27 specimens） of total reject ratio from January to June 2013. Conclusions Full monitoring of specimens in the pre-analysis by Laboratory Information Systems can improve the timely rate of specimens transportation and reduce the rate of the lost and unqualified specimens. Analysis of the occurrence rate of unqualified specimens and effectively negotiating with relevant departments can make great progress in pre- analytical quality control of blood specimens.