住院患者血乳酸和血氨的检测流程优化及质量提升

Process optimization for determining blood lactic acid and ammonia in inpatients and its quality improvement

目的探讨同济大学附属同济医院住院患者乳酸和血氨项目检测结果阳性率高的原因,并制定改进措施,提高乳酸和血氨检测的准确性。方法以乳酸>2.2 mmol/L或血氨>30μmol/L为阳性,分别统计同济大学附属同济医院2019年1—6月门诊、急诊、住院和住院急诊患者样本乳酸及血氨项目的总检测数、检测结果阳性率以及检验流程各节点的耗时。随机收集40份临床样本,分别在样本采集后的15、30、45、60、90、120、180 min检测乳酸和血氨,以15 min检测结果为基准值,分别计算后续时间点检测结果与基准值之间的偏差。制定改进措施并实施后,分别统计乳酸和血氨项目检测结果的阳性率及检测流程各节点耗时的变化。结果2019年1—6月,门诊、急诊、住院急诊和住院患者样本乳酸项目检测结果的阳性率分别为36.87%、50.73%、58.28%、84.44%,血氨项目的阳性率分别为14.68%、13.48%、34.04%、72.67%。门诊、急诊、住院和住院急诊样本从样本采集到上机检测的中位时间分别为35、32、130和83 min。40份临床样本乳酸和血氨项目各时间点检测结果与基准值之间的偏差随时间的延长逐渐增大。检验流程改进后,住院患者样本乳酸和血氨项目检测结果的阳性率分别下降至32.59%、22.65%,住院患者样本从样本采集到上机检测的耗时缩短至43 min。结论改进检验前流程有效缩短了住院患者样本从样本采集到上机检测的耗时,降低了乳酸和血氨项目检测结果的阳性率,提高了准确性。

Objective To find out the reasons for high positive rate of blood lactic acid and ammonia determination results among the inpatients in Tongji Hospital affiliated to Tongji University,and to take measures to improve the accuracy of blood lactic acid and ammonia determination results.Methods With blood lactic acid>2.2 mmol/L and blood ammonia>30μmol/L indicating positive results,the total number and positive rate of blood lactic acid and ammonia determinations and the time used for each link in the determination process in the outpatient,emergency,inpatient and inpatient emergency departments were calculated from January to June 2019.Totally,40 clinical samples were collected randomly,and blood lactic acid and ammonia were determined at 15,30,45,60,90,120 and 180 min after sample collection.With the results at 15 min as the baseline values,the deviation between the means of the results at the subsequent time points and the baseline values was calculated.After improvement measures were formulated and implemented,the positive rate of blood lactic acid and ammonia determination results was calculated,and the changes in the time used for each link in the determination process were compared.Results The positive rates of blood lactic acid determinations were 36.87%,50.73%,58.28%and 84.44%,and those of blood ammonia determinations were 14.68%,13.48%,34.04%and 72.67%in the outpatient,emergency,inpatient and inpatient emergency departments from January to June 2019,respectively.The median times from sample collection to determination on machines were 35,32,130 and 83 min in the outpatient,emergency,inpatient and inpatient emergency departments,respectively.The deviations between the results and the baseline values of blood lactic acid and ammonia determination increased gradually over time in the 40 clinical samples.After the improvement of determination process,the positive rates decreased to 32.59%and 22.65%for blood lactic acid and ammonia determination results,respectively.The time used from sample collection to determination on machines was shortened to 43 min.Conclusions Through the optimization of pre-determination process,the time used from sample collection to determination on machines can be reduced effectively,so that the positive rates of blood lactic acid and ammonia determination results are decreased with improved accuracy.