全国范围内516家临床实验室血液学检验项目危急值的调查与分析

目的本研究针对我国临床实验室血液学危急值报告制度进行了全国性的现状调查,旨在了解目前国内这项质量指标的现状,并提供相关指标日常监督的建议。方法采用问卷调查的方式,向参与该中心全血细胞计数和凝血专业的实验室发出1 238份问卷。问卷分为两个部分,第一部分为一般信息调查;第二部分为血液学检验中危急值相关调查。实验室通过专门的网络平台在线填报信息,并使用专用统计软件来进行分析处理。结果 516家实验室报告了相关血液学危急值结果,调查中提交信息的大部分为三级综合医院。几乎所有的参与实验室都表明其已制定危急值结果报告制度。参与调查的实验室中,除了RBC的选择百分比在20%左右,其他5项:WBC、Hb、PT、APTT和Fbg都被70%左右的实验室视为门诊、急诊和危急值项目。危急值界限来源选择最多的为文献,尽管大部分项目的界限值在住院、门诊和急诊间没有明显差异,但仍有实验室的危急值界限与大多数实验室明显不同。结论我国血液学危急值报告制度在危急项目纳入和界限设定上尚存在一定问题,实验室应在参考国内外文献的基础上,与临床积极协商,制定出适合所在医院的危急值界限。

Investigation and analysis of critical values of hematological test items among 561 clinical laboratories in China

Objective To conduct a nationwide status quo survey on the status of the critical values reporting system of hemato‐logical test items in order to understand the current status of this quality index and to provide some suggestions on the related inde‐xes routine supervision .Methods The questionnaire survey mode was adopted to issue 1 238 questionnaires to the clinical laborato‐ries participating in the complete blood count (CBC) and coagulation EQA programs .The questionnaire included two major parts . The first part was about general information of participants and the second part was the critical value related survey in hematologi‐cal test .The related data was collected and analysis by special online system and analytic software .Results Totally 516 laboratories uploaded the related hematological critical values results and most of those participants were tertiary hospital .Almost all participant laboratories indicated that they had set up the critical value reporting system .Among all included laboratories ,only 20% of labora‐tories chose RBC as one of their critical value tests ,while WBC ,Hb ,PT ,APTT and Fbg were included in the critical value lists by about 70% of laboratories .The largest number of participant laboratories chose literature as their critical value limits sources .Al‐though the total critical limits were not significantly different among in‐patients ,out‐patients and emergency departments ,the data of inter‐laboratory varied vastly .Conclusion In the hematological critical values reporting system ,certain problems exist in the crit‐ical item inclusion and the limit setting .Laboratories should positively consult with clinicians to formulate the critical value limit suitable for all hospitals on the basis of reference literature at home and abroad .