I, the acquisition of instruments
1, the collection of information: according to the number of hospital beds, outpatient clinic volume / day, the setup of clinical departments and the number of patients in various specialties, the amount of specimens / day, as well as the original configuration of the instrument, and to consider the 3-5 years after the Department of business development, combined with the economic strength of the initial selection of the three brands of instruments, for a comprehensive comparison: mainly in the performance characteristics of the instrument, such as accuracy, precision, Detection speed, barcode system, automatic detection function, automatic retesting function, a variety of prompts, refrigerated reagent room, emergency specimen insertion, 24-hour standby status, supporting the Chinese software system, calibration solution, quality control substances, reagents and domestic reagents can be applied on the machine, price and performance ratio, the manufacturer's after-sales service, the strength of the agent and the credibility of the comparison.
2, site visits: through the comparison of the above information, a rational understanding of the relevant instruments. Then to the same type of instrument in the hospital for inspection, mainly to watch the physical, ask the use of the instrument, the performance of the instrument, the problems and precautions. The selection of instruments should also be combined with the clinical department settings, the price of the instrument and whether to increase the additional burden on patients and other factors for comprehensive consideration. For example, the white blood cell classification result of blood cell counter is "primary screening" regardless of whether it is a triple group or a quintuple group, while the price of quintuple group blood cell counter is twice or even higher than that of triple group, and the cost of its consumable reagents is also much higher than that of triple group blood cell counter. Obviously, in small and medium-sized hospitals that do not have a hematology department, it is more reasonable to choose a triple-group blood cell counter.
Two, the management of the instrument
Instrumentation installed, good management, can give full play to its role, reduce the labor intensity of the test personnel, improve work efficiency and test quality, for clinicians and patients to provide accurate and effective information. On the contrary, not only can not improve work efficiency, but also increase the trouble of the test personnel, and even mislead doctors and patients. How to manage the instrumentation, give full play to its role?
1, personnel training: more than 50,000 yuan of imported instruments, many of which are high-tech products, technology content, relatively high requirements for the level of operators, and many instruments such as automatic biochemical analyzer, blood counting, coagulation and electrochemiluminescence immunoassay analyzers and other instruments are to be done in the emergency test, so all the Department of all the laboratory staff to participate in the operation of the machine training. Training includes instrument manufacturers to the Department of training and internal organization of the Department of training. The content of the training includes the basic principles of the instrument, basic operation, precautions, routine maintenance and so on. Through the training and assessment before the use of the relevant instruments, you can avoid the operator is not familiar with the instrument and downtime or can not be used properly and affect the work.
2, the instrument before the application of assessment: In addition to the information provided by the manufacturer, we also need to instrumentation for precision, accuracy, linear range, reference value assessment. Such as high, medium and low fixed-value serum to do intra-batch, day-to-day precision and accuracy determination, coagulation instrument to make the laboratory reference value as well as 20 copies of normal medical examiner plasma mixed to do the control test and repeatability of the test; instrumentation of various parameters without the consent of the department director shall not be modified. Develop the operation flow chart of the instrument to standardize the use of the instrument.
3, update the concept of clinical services: the development of medical testing to test medicine, the test personnel will not only be required to operate a variety of instruments to obtain data, but also know some clinical knowledge, familiar with the results of the clinical significance of the results and the impact of the test results of the interfering factors, the application of evidence-based test medicine methodology to provide effective information to the clinic. Such as the introduction of instruments and equipment, the Department of Laboratory Medicine to the clinical departments to disseminate information to promote the instruments and equipment, including the basic principles, measurement items, clinical significance, the reference range, the time of the report, the type of specimen and the amount of specimens, fees and so on. And cancel the original biochemistry emergency check only sixteen items of regulations. All biochemical items done on the automatic biochemical analyzer, as long as the clinical requirements of urgent investigation, the Department of Laboratory Medicine is to do with the arrival. Coagulation meter on the PT, APTT, TT, Fbg and electrochemiluminescence meter on the HCG, TNT, Myo, CK-MB, etc. are listed as emergency projects, with the arrival of the do.
For example, the earlier the diagnosis of acute myocardial infarction, the better, because thrombolytic therapy is optimal within 6 hours after infarction. In the past, clinicians used to use cardiac enzymes five (CK, CK-MB, LDH, HBDH, AST) to assist in the diagnosis, its positive results appear late, and the specificity is also poor. In contrast, the positive results of the three cardiac infarction items (Myo, TNT, CK-MB) of electrochemiluminescence instrument appeared 10 hours earlier than the five cardiac enzymes, and the specificity was higher. By doing the experiment, the results of infarction three items and cardiac enzyme five items of patients with acute myocardial infarction and stable angina pectoris should be made into curve graphs and provided to clinicians, and it is recommended to choose appropriate items for testing according to the length of time of the appearance of chest pain, which not only helps in the diagnosis and differential diagnosis, but also reduces the cost of examination for the patients.
4, improve the utilization rate of the instrument, increase the economic benefits of the instrument: the laboratory can daily routine biochemical specimens about 50, about 40 tests. In general, before 12:30 pm can be completed. General Laboratory will also have a larger physical examination tasks, physical examination tasks usually have time, and the hospital will not be in order to physical examination and then purchase a fully automated biochemical analyzer, if the department for this purpose and increase the number of test personnel, both to increase the cost of expenditures, but also to cause the usual situation of people floating in the matter. Therefore, the method of resting people do not rest machine, physical examination during the increase of a mid-shift and a half-night shift, the use of midday and evening time to do physical examination surgery, to do the test results in the specified time to the hands of the examining doctor.
5, choose a high amount of reagents to ensure that the results are accurate and reliable: the accuracy of the test results is related to the quality of reagents. In general, the use of matching reagents and calibrators with the instrument to ensure accurate and reliable results. However, the original supporting reagents are very expensive, and the charges for each test are set by the Price Bureau, can not be changed arbitrarily, especially the biochemical program, each test charges 5 yuan / times, very few items for 10 yuan / times or 20 yuan / times. The biochemical reagents, calibrators and rinsing solutions used by the Laboratory Section are Beckman original reagents, which have a higher cost. According to the actual situation of the department, by doing parallel comparison reagents, high, medium and low value fixed value serum repetition test and Guangdong Province inter-office quality assessment activities for testing, it can be found that certain brands of reagents to test serum glucose, total protein, albumin, cholesterol, triglyceride, and other items are very good in terms of accuracy and precision, and they can completely replace the original supporting reagents, so as to make the cost lower. Through the experiment, it makes the blood cell testing reagents have been completely localized.
6, instrument maintenance to the implementation of people: Although the laboratory personnel are trained to operate before the machine, can skillfully use the instrument, but due to the need for rotation, and to be on duty at night and go out for physical examination, often not in the class time. In view of the above situation, we according to the personnel specialties and relative stability and other factors, the maintenance of the instrument to the implementation of the implementation of a fixed person responsible for the greater maintenance of the instrument, the director of the department under the guidance of the calibration of the instrument and quality control, to ensure that the instrument operates normally.
In short, through the above management, reduce the staff's labor intensity, improve work efficiency, and more fully play the social and economic benefits of the instrument.