Medical testing critical value report assessment of continuous improvement
Critical value report of the high incidence of departments, projects and the time of occurrence of a certain regularity, the departments in the treatment of the effect is basically comparable, but still need to regularly analyze the data to give targeted continuous improvement measures in order to improve the quality of clinical work.
[Abstract]
PurposeTo analyze the report of critical value of the hospital's medical laboratory and to explore the direction of its continuous improvement. Methods Selected 6481 cases of critical value reports in the laboratory information management system (LIMS) of this hospital in the past 2 years, and evaluated them in their departmental distribution, testing items, time of occurrence, and treatment effect, etc., summarized the clinical role of critical value report evaluation, and elaborated on the content of its continuous improvement. The most common tests were potassium, platelet count and white blood cell count, and the highest incidence of critical value reports was found on Mondays, Thursdays, and 9:00-13:00 every day. The treatment effects were basically comparable among departments, and the ICU and oncology department had the highest treatment rate.
[Keywords]
Clinical chemistry experiments; Clinical laboratory information system; Critical care / organization and management; Patient safety; Reference values; Clinical decision-making
Clinical test critical value mainly refers to the results of the test results are more obvious deviation from the normal standard range and endanger the patient's life and safety. The situation [1], the level of clinical medicine has a decisive role, so that after obtaining the report of the critical value need to give relevant first aid measures in a timely manner, in order to avoid the occurrence of serious consequences [2]. In the early 1970s, foreign scholars proposed the concept of critical value for the first time, and the 2007 Patient Safety Indicators published by China's Medical Association also indicated that medical institutions need to improve the medical safety guidelines according to their own actual situation and establish a system related to the reporting of critical value [3]. In order to clarify the current status of critical value reporting, this study retrospectively analyzes the critical value reporting situation in our hospital in the past 2 years, which is now reported as follows.
1 Objects and methods
1.1 Objects
Our hospital has received 367,289 laboratory test specimens since January 2014 to December 2015***, according to the critical value registration visible*** 6481 cases of critical value report, its incidence rate is 1.8%, of which male patients 3427 cases, 3054 cases of female patients, *** involved in the critical value of 21 items, 15 departments.
1.2 Methods
1.2.1 Critical value items and scope
Integration of 6481 cases of critical value report department, project, occurrence time and treatment effect, the specific time co-ordination to our hospital LIMS report in the audit time shall prevail. The definition of critical value items are based on the safety standards of China's Health Planning Commission, which must include blood glucose, potassium, calcium, blood gas, platelet count, white blood cell count, activated thromboplastin time and prothrombin time, and according to the authoritative reports and peer hospitals to assess and analyze the development of commonly used items are sodium, chloride, creatinine, urea sugar, urea nitrogen, hemoglobin, calcitoninogen, D-dimer, amylase, hypersensitivity, troponin T, carbon dioxide-binding capacity, and the number of cases in the hospitals. Troponin T, carbon dioxide binding capacity, C-reactive protein, and plasma fibrinogen, for a total of ***21 critical value items. The scope of critical value items and critical value specification are based on the "test quality field assessment indicators", "National Clinical Laboratory Practice Guidelines" and the International Organization for Standardization (ISO) 15189 medical laboratory critical value related regulations [4], etc., and the specific content of the hospital's Department of Laboratory Science, Department of Medical Science, Clinical Departments, and the Ethics Committee experts to discuss the formulation of the specific content.
1.2.2 Critical Value Reporting Process and Treatment Methods
Clinical laboratory critical value occurs when the first instrument, operation audit work, to confirm that there is no quality control factors affecting the release of the critical value report [4], and quickly contact the relevant department staff, and parallel records. Departmental doctors review the patient's condition, such as the critical value report results are not appropriate, and then review the work. The daily work of the hospital's critical value content mainly contains the patient's basic information, reporting department, test time, reporting time, critical value items, treatment results and treatment effects, etc., in the consolidation of the report form for regular weekly visits, and regular monthly supervision.
2 Results
2.1 Distribution of critical value reporting departments
In this study, critical value reports were most commonly found in ICU, hematology, and hepatorenal internal medicine, and the three departments had the highest proportion of critical value reports to the total number of tests.
2.2 Distribution of critical value reports
In this study, the top three critical value reports were potassium, platelet count, and leukocyte count, and the top three critical value reports as a percentage of the total number of tests were platelet count, ultrasensitive troponin T, and leukocyte count.
2.3 Time distribution of critical value reports
According to the distribution of the date, the high incidence of critical value reports can be seen on Mondays and Thursdays, while Tuesdays and Sundays have the lowest incidence; according to the distribution of the time of the day, the high incidence of critical value reports can be seen in the time periods of 9:00?10:00, 10:00?11:00, 11:00?12:00, and 12:00:13:00***4. time slots.
2.4 Effect of critical value report processing
According to the effect of critical value report processing results, it can be seen that the ICU department and medical oncology department have the highest processing rate, while neurology, surgical oncology, hepatobiliary surgery, urology and orthopaedics departments have relatively low processing rates.
3 Discussion
3.1 Analysis of the assessment of the critical value report of medical tests in our hospital in the past 2 years
The present study retrospectively analyzes the situation of the critical value report of our hospital in the past 2 years, and in the clinical tests of 367,289 patients*** there were 6,481 cases of critical value report, with an incidence rate of about 1.8%, Wang Wei et al [5] reported that the incidence of critical value reporting in their tumor hospital was 0.43%, and Chen Guangyi et al [6] indicated that the incidence of critical value in their hospital was 12.9%, both of which were somewhat different from the situation in our hospital. According to the assessment of the distribution of critical value reporting departments, it was found that ICU, hematology and hepatorenal medicine departments accounted for the highest percentage of the total number of critical value reports and the total number of tests in this department, among which, patients in ICU departments are usually in more serious conditions, which makes them more likely to have critical value, while the critical value items of hematology and hepatorenal medicine patients were mainly distributed in platelet counts, leukocyte counts, creatinine, urea nitrogen and other tests. In the study, the top 5 items of critical value report were potassium, platelet count, leukocyte count, creatinine and blood glucose. However, the critical value range of platelet count has been revised, and creatinine and urea nitrogen levels of uremic patients have been excluded from the critical value report, so as to enhance the guiding role of the report and avoid the waste of clinical medical resources. Summarize the distribution of critical value report time can be seen on Monday is a high incidence of critical value, the author believes that there is a close relationship with the Monday emergency volume, and daily 9:00?13:00 for the most intensive phase of the critical value report, suggesting that the examiner and the clinician need to raise the degree of concern for the critical value at this stage. Comprehensive assessment of the results of the critical value report processing of various departments found that the ICU and medical oncology processing rate is slightly higher, with the degree of seriousness of the patient's condition in their departments, while most of the surgical processing rate is low, mostly due to the perioperative perioperative surgical progressive observation measures.
3.2 Analysis of the continuous improvement of medical testing critical value report
Although the implementation of the critical value report can be a good way to improve the quality of clinical care and reduce the clinical risk of critically ill patients, but looking at the theory of critical value, the importance of its importance is not only confined to the release of the report stage, but also need to be given a deeper understanding of the various aspects of the operation [7, 8]. In our hospital, in the process of critical value supervision, we comprehensively incorporate the laboratory, medical, clinical and nursing departments and other departments, regularly organize and analyze the stage of critical value reports, and coordinate the active participation of staff from various departments in the critical value treatment program, in order to ensure the timeliness and reliability of the application of critical value. The Laboratory Department is responsible for the release of the critical value report, the report should accurately point out the time of the test, the project and the department, the clinical department to receive the report in a timely manner with the test personnel to communicate, and quickly carry out the relevant first aid treatment, and medical staff need to continue to identify the degree of reasonableness of the report of the critical value and the treatment method [9], to give the most appropriate standard specification to ensure that the report of the critical value to obtain the most appropriate application.
In summary, there is a certain regularity in the high incidence of critical-value reports in the departments, items, and time of occurrence, and the treatment effect is basically comparable among departments, but it is still necessary to regularly analyze the data and give targeted continuous improvement measures to improve the quality of clinical work.
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