急诊实验室自动化流水线系统的建设与优化

Construction and improvement of lab automation system in emergency lab

目的通过探索一套适用于急诊实验室自动化流水线系统(TLA)的建设及优化体系,提升实验室自动化流水线项目实施的成功率及医疗资源的有效利用。方法首先通过对设备升级前,即2019年12月16—22日急诊组的工作流程和工作数据进行分析,明确当前短板并确定流水线配置(前后处理单元及分析仪器数量);而后确定方案设计的基本原则并基于此原则进行方案设计,并对不同方案进行数据模拟,通过对不同方案的样本周转时间(TAT)进行对比分析确定最终方案;在方案实施后,对项目实施前后的TAT进行比对分析,评估方案实施效果。结果通过在原场地进行系统升级实现了流水线系统自动化程度和单机检测速度的提升。凝血样本实现了在线检测及存储;在线离心机由1套增加至2套,在线冰箱存储量由9000份样本增加至15000份样本;单机检测速度提升约1倍,生化由2500个测试/h增加至5400个测试/h,免疫由668个测试/h增加至1320个测试/h。在工作量增长9%的情况下,生化免疫急诊样本P95 TAT由96 min缩短至64 min(样本签收至结果审核),下降幅度达33%;且与数据模拟结果保持了高度一致(数据模拟得出的P95 TAT为67 min)。结论在方案设计阶段有效运用数据分析及数据模拟进行方案的设计和评估,可有效降低项目实施失败的风险,确保医疗资源的有效利用。

Objective By exploring a construction and improvement system for total lab automation in emergency lab,this work aims to improve the success rates of project implementation and the effective utilization of medical resources.Methods Firstly,clarify the short board of current solution and determine the configuration of the TLA solution which include the number of pre-analytic,post-analytic modules and analyzers by workflow and data analysis which based on the data from 16th to 22nd September 2019.Secondly,define the basic principles and design the optional solutions.Thirdly,determine the final solution based on the simulation results.Fourthly,evaluate the effectiveness of the solution by comparing the turnaroud time(TAT)before and after implementation.Result We upgrade the system to improve the automation level of the track by add 1 online centrifuge module and upgrade the capacity of online storage module from 9000 samples to 15000 samples,and increase the throughput of the clinical chemistry analyzers form 2500 tests/h to 5400 tests/h and immunoassay analyzers from 668 tests/h to 1320 tests/h with no more space.The 95th percentile TAT(from sample check in to validation)have 33%reduction on the premise of 9%increase on the workload of clinical chemistry and immunoassay,and it is highly consistent with the results obtained by data simulation whose 95th percentile TAT is 67 min.Conclusion Good uasge of workflow and data analysis in the stage of solution design can help to ensure that the result can meet the expectations of the clinicians and effective utilization of medical resources.