Continuous improvement in the evaluation of medical laboratory critical value reports
There is a certain regularity in the departments, projects and occurrence times with high incidence of critical value reports. The processing effects of each department are basically the same, and they still need to be carried out regularly. Analyze data and provide targeted continuous improvement measures to improve the quality of clinical work.
[Abstract]
Objective: To analyze the critical value report of the medical laboratory department of our hospital and explore its continuous improvement direction. Methods: 6481 critical value reports in the laboratory information management system (LIMS) of our hospital in the past 2 years were selected and evaluated in terms of department distribution, test items, occurrence time and treatment effects, and the clinical role of critical value report evaluation was summarized. , and elaborate on its continuous improvement content. Results In this study, critical value reports were most commonly reported in ICU departments, hematology departments, and hepatology and renal medicine departments. The most common test items were serum potassium, platelet count, and white blood cell count. Critical values ??were reported every Monday, Thursday, and every day from 9:00 to 13:00. The reported incidence rate is the highest, and the treatment effects of each department are basically the same, with the ICU and oncology departments having the highest treatment rates. Conclusion There is a certain regularity in the departments, projects and occurrence times with high incidence of critical value reports. Data analysis needs to be carried out regularly and targeted continuous improvement measures should be given to improve the quality of clinical work.
[Keywords]
Clinical chemistry experiment; clinical laboratory information system; critically ill patient care/organization and management; patient safety; reference value; clinical decision-making
Clinical test critical value mainly refers to the situation where the test results obviously deviate from the normal standard range and endanger the patient's life safety [1]. It has a decisive effect on the level of clinical medicine. Therefore, after obtaining the critical value report, relevant first aid measures must be implemented in a timely manner to ensure Avoid serious consequences[2]. In the early 1970s, foreign scholars first proposed the concept of critical value. The "2007 Patient Safety Indicators" published by the my country Medical Association also stated that medical institutions need to improve medical safety guidelines based on their actual conditions and establish a system related to critical value reporting [ 3]. In order to further clarify the implementation status of critical value reporting, this study conducted a retrospective analysis of the critical value reporting situation in our hospital in the past two years. The report is as follows.
1 Objects and Methods
1.1 Objects
Our hospital received 367,289 laboratory test specimens from January 2014 to December 2015***. According to the critical value registration, there were 6,481 critical value reports, with an incidence rate of 1.8%, including 3,427 male patients and 3,054 female patients, involving 21 critical value items and 15 departments.
1.2 Methods
1.2.1 Critical Value Items and Scope
Integrate 6481 critical value report departments, projects, occurrence time and processing effect, specific time The overall planning is based on the review time in the LIMS report of our hospital. The definition of critical value items is based on the safety standards of the National Health and Family Planning Commission of my country. The necessary items include blood sugar, blood potassium, blood calcium, blood gas, platelet count, white blood cell count, activated thromboplastin time and prothrombin time. According to authoritative reports and the same time Commonly used items for hospital assessment and analysis include serum sodium, chloride, creatinine, urine glucose, urea nitrogen, hemoglobin, procalcitonin, D-dimer, amylase, high-sensitivity troponin T, carbon dioxide binding capacity, and C reaction. Protein and plasma fibrinogen, a total of ***21 critical value items. The scope of critical value items and critical value specifications are based on the "On-site Assessment Indicators for Inspection Quality", "National Clinical Inspection Operating Standards" and the International Organization for Standardization (ISO) 15189 relevant regulations on critical values ??in medical experiments [4], and are provided by our hospital The laboratory department, medical department, clinical department and ethics committee experts discussed and formulated the specific content.
1.2.2 Critical value reporting process and processing method
When critical values ??occur in clinical testing, the instrument and operation review work must be carried out first, and a critical value report shall be issued after confirming that there are no quality control influencing factors [4 ], quickly contact the relevant department staff and record them in parallel. The department doctor will review the patient's condition. If he thinks the critical value report result is inappropriate, he will conduct a reexamination.
The daily critical work content of our hospital mainly includes basic patient information, declared departments, inspection time, reporting time, critical value items, treatment results and treatment effects, etc. After being integrated into a report form, regular return visits will be carried out every week, and regular visits will be carried out every month. supervision.
2 Results
2.1 Distribution of critical value reporting departments
In this study, critical value reporting was most commonly found in the ICU department, hematology department and hepatorenal medicine department, and 3 Among all departments, critical value reports account for the highest proportion of the total number of tests.
2.2 Distribution of critical value reporting items
The top three critical value reporting items in this study are serum potassium, platelet count and white blood cell count, while critical value items account for the rest. The first three items in the proportion of the total number of tests are platelet count, high-sensitivity troponin T and white blood cell count.
2.3 Time distribution of critical value reports
According to the distribution of dates, it can be seen that critical value reports are most common on Mondays and Thursdays, while the incidence rates are lowest on Tuesdays and Sundays; according to the daily time distribution, it can be seen Critical value reports are most common in four time periods: 9:00?10:00, 10:00?11:00, 11:00?12:00 and 12:00?13:00***.
2.4 Critical Value Report Processing Effect
According to the critical value report processing results, it can be seen that the ICU department and the Oncology Department have the highest processing rates, while the Neurology Department, Oncology Surgery Department, Hepatobiliary Surgery Department, and Urology Department have the highest processing rate. The treatment rate of surgery and orthopedics is relatively low.
3 Discussion
3.1 Evaluation and analysis of the critical value report of medical examinations in our hospital in the past 2 years
This study was conducted on the critical value report of our hospital in the past 2 years. Retrospective analysis showed that among the clinical examinations of 367,289 patients, 6,481 cases had critical value reports, and the incidence rate was approximately 1.8%. Wang Wei et al. [5] reported that the incidence rate of critical value reports in their cancer hospital was 0.43%. , and the study by Chen Guangyi et al. [6] showed that the incidence rate of critical illness in their hospital was 12.9%, which was still far behind the situation in our hospital. According to the evaluation of the distribution of critical value reporting departments, it was found that the ICU department, hematology department and hepatorenal medicine department accounted for the highest proportion of the total number of critical value reporting and the total number of examinations in the department. Among them, the conditions of patients in the ICU department are usually more serious, and thus they are more likely to have critical value situations. , and the critical value items for patients in the Department of Hematology and Hepatology and Nephrology are mainly distributed in tests such as platelet count, white blood cell count, creatinine and urea nitrogen. In the study, the top five items with the highest incidence of critical value reporting items were serum potassium, platelet count, white blood cell count, creatinine and blood sugar. However, the hospital has now revised the critical value range of platelet count, and the creatinine and urea nitrogen levels of uremic patients have been revised. It is excluded from the critical value report to enhance the guiding role of the report and avoid the waste of clinical medical resources. Summarizing the time distribution of critical value reporting, it can be seen that Monday is a period of high incidence of critical values. The author believes that there is a close relationship with the higher number of emergency visits on Mondays, and 9:00 to 13:00 every day is the most intensive period of critical value reporting, prompting laboratory physicians and clinicians At this stage, it is necessary to pay more attention to the critical value. Comprehensive evaluation of the processing results of critical value reports in each department found that the processing rates of ICU and medical oncology are slightly higher, which is related to the severity of the patients in their departments, while the processing rates of most surgical departments are low, and most of them are ongoing observation measures in the perioperative period of surgical operations. Caused by.
3.2 Analysis of continuous improvement of critical value reports in medical examinations
Although the implementation of critical value reports can improve the quality of clinical medical care and reduce the clinical risks of critically ill patients, looking at the critical value theory, its The importance is not limited to the report release stage, but also requires in-depth understanding in each operation link [7, 8]. In the process of critical value supervision, our hospital fully incorporates many departments such as the laboratory department, medical department, clinical department and nursing department, regularly organizes and analyzes the periodic critical value reports, and coordinates the staff of each department to actively participate in the critical value processing plan. , in order to ensure the timeliness and reliability of critical value application. The laboratory department is responsible for issuing the critical value report. When submitting the report, it is necessary to accurately indicate the test time, project and department. After receiving the report, the clinical department communicates with the laboratory personnel in a timely manner and quickly carries out relevant first aid treatment, while the medical department staff must continue to identify the critical value. The reasonableness of the report and the processing method [9] will be given the most appropriate standards to ensure the most appropriate application of the critical value report.
In summary, there is a certain regularity in the departments, projects and occurrence times with high incidence of critical value reports. The processing effects of each department are basically the same. Regular data analysis is still needed to provide targeted continuous improvement measures. To improve the quality of clinical work.
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