运用实验室和医院信息系统监测临床标本质量和危急值处置效果

目的分析运用实验室信息系统(laboratory information system, LIS)和医院信息系统(hospital information system, HIS)监测临床标本质量和危急值处置效果与产生质量问题的原因，针对性地改进和提高医院临床与实验室有关试验工作质量。 方法运用LIS-HIS进一步优化泰安市中心医院临床和实验室的检验流程包括退还标本和自动审核功能，不合格标本、标本周转时间(turnaround time, TAT)统计功能，危急值LIS-HIS反馈和危急值统计功能]后，采用回顾性研究，用其比对分析评价本院2013年7月至12月未用HIS-LIS监测191 719份临床标本采集的不合格率、TAT时间和5987份标本的血常规、生化、凝血、血气危急值处置与2014年1月至6月用HIS-LIS监测（161 308份标本和5082份危急值标本）的3项质量指标的运行效果和产生质量问题的原因以及分布状况。 结果成功建立了LIS-HIS标本质量和危急值监测系统，2014年1月至6月，共接收标本161 308份，成功退回标本1356份，报送危急值5082份。LIS-HIS标本质量和危急值监测系统使用前（2013年7月至12月）标本不合格率为1.31%（2511/191 719），血常规24项TAT为25.9 min,血常规、生化、凝血、血气危急值处置率为95.6%；使用LIS监测和改进干预后（2014年1月至6月）标本不合格率为0.84% (1356/161 308），下降0.47%(χ²=6.03，P<0.05)；血常规24项平均TAT为18.6 min，缩短7.3 min (U=0.98, P>0.05)，生化报告56项平均TAT由156 min缩短至72 min时，生化报告改进前后TAT显著缩短(U=12.9，P<0.01)；通过HIS-LIS的改进，医院危急值报告时间由11.2 min降低到7.5 min，危急值报告一致性由98.8%提高到100%，医生危急值处置及时性由95.2%提高到98.2%。 结论LIS-HIS系统可及时、准确监测临床和实验室的标本运行质量；运用血常规、生化自动审核可以缩短TAT，同时提高了血常规、生化、凝血和血气的危急值监测处置效果，改进了临床与实验室的有关试验信息运用质量和管理水平。

Monitoring the quality of clinical specimens and the critical value by using laboratory-hospital information system

ObjectiveMonitor the quality of clinical specimens and the critical value by using laboratory-hospital information system, finally improve the laboratory quality. MethodThe Taian City Center Hospital clinical and laboratory testing process were further optimized, including returns and defective specimens statistics, automatic review and turnaround time (TAT) statistics and directly reported critical values by LIS-HIS system. A retrospective study were proceed to monitored the quality of clinical specimens and the critical value. One comparison analysis was between 191 719 clinical specimens (from July to December 2013) and 161 308 clinical specimens (from January to June 2014), the rate of unqualified specimen, reason of unqualified specimen and turnaround time was recored. Another comparison analysis was between 5987 critical values (from July to December 2013) and 5082 critical values (from January to June 2014), including blood routine, biochemical examination, blood coagulation experiments, and blood gas. ResultsThe monitoring system was established successfully. From January to June 2014, 161 308 clinical specimens were accepted with 1356 send-back and 5082 pushed critical values. After the establishment of the monitoring system, the unqualified rates of specimens dropped from the original 1.31% (2511/191 719) to 0.84% (1356/161 308) significantly (χ²=6.03, P<0.05); the average TAT time of routine blood report reduced from 25.9 min to 18.6 min and the biochemical examination report reduced from 156 min to 72 min significantly (U=12.9, P< 0.01). Meanwhile, the critical value report time dropped from 11.2 min to 7.5 min, critical value reporting consistency increased from 98.8% to 100%, the timeliness of doctor’s disposal in critical values increased from 95.2% to 98.2%. ConclusionsLIS-HIS system can monitor the laboratory specimens timely and accurately; the automatic review can reduce TAT time, meanwhile the LIS-HIS monitoring critical values can improve the timeliness of clinical disposal. In a word, the system improved the quality and management level of clinical laboratory.