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PubMed2003

Productivity of Veterans Health Administration laboratories: a College of American Pathologists Laboratory Management Index Program (LMIP) study.

CONTEXT: The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. OBJECTIVE: To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. DESIGN: Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. RESULTS: Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P <.001). Technical staff at the median VA facility were paid more than at non-VA facilities (28.11/h dollars vs 22.60/h dollars, salaries plus benefits; P <.001), VA laboratories employed a smaller percentage of nontechnical staff (30.0% vs 41.9%; P <.001), and workers at VA laboratories worked less time per hour paid (85.5% vs 88.5%; P <.001). However, labor productivity was significantly higher at VA than at non-VA facilities (30 448 test results/total full-time equivalent (FTE)/y vs 19 260 results/total FTE; P <.001), resulting in lower labor expense per on-site test at VA sites than at non-VA sites (1.79 dollars/result vs 2.08 dollars/result; P <.001). Veterans Health Administration laboratories paid less per test for consumables (P =.003), depreciation, and maintenance than their non-VA counterparts (all P <.001), resulting in lower overall cost per on-site test result (2.64 dollars vs 3.40 dollars; P <.001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P <.001) and non-VA (P =.02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P <.001), while in non-VA facilities the corresponding ratios showed no significant change. CONCLUSIONS: Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.

Efficiency, Organizational↗

PubMed2004

Cost analysis of laboratory tests: a study of the Central Laboratory of King Chulalongkorn Memorial Hospital.

OBJECTIVES: To present cost analysis on laboratory management of laboratory tests provided by the Central Laboratory of King Chulalongkorn Memorial Hospital (KCMH). MATERIAL AND METHOD: The expenditure and income of the laboratory were studied using a descriptive design. RESULTS: The Central Laboratory provided routine hematology, urinalysis, and chemistry tests, and performed 2,157,275 tests in year 2002. The expenditure of the Central Laboratory was 32,094,960.24 baht, while the income was 97,393,244.40 baht. The average calculated profitability ratio for all parameters was 3.03. CONCLUSION: The authors concluded that the Central Laboratory is a good Revenue Producing Cost Center (RPCC) for the hospital. To improve the laboratory efficiency, the data needed for laboratory management should be easily available to the laboratory manager. In addition, the authors strongly suggest that the organization structure and the data management system of the hospital and the faculty should be simplified for future management. In addition, all laboratories should perform their own cost analysis.

Clinical Laboratory Techniques↗

PubMed1997

Log-in/log-out time: a quality factor for a reference laboratory--prolonged times for skin pathology processing in managed care-authorized laboratories.

Managed care organizations may divert skin biopsy specimens to commercial laboratories selected on a cost basis. Diversion to these laboratories could result in service of decreased quality for the patient and referring physician. Log-in/log-out dates were collected for all specimens submitted to managed care-authorized laboratories either from a university-based clinic or from a private practitioner's office for a period of 18 months and compared with data obtained from a local dermatopathology laboratory. A subgroup of specimens containing inflammatory diagnoses or nondiagnostic changes was also examined. Mean log-in/log-out times were 1.338 days in the dermatopathology laboratory, 6.123 days in managed care-authorized laboratories from the university site, and 7.798 days in managed care-authorized laboratories from a practitioner's office. The differences between the dermatopathology laboratory log-in/log-out times and those of the managed care-authorized laboratories were statistically significant (p < 0.0001). The conclusion from this study is that a quality indicator defined as time from log in to log out revealed a significant increase in interpretation time at managed care-designated laboratories. Although managed care plans can decrease their financial risk by contracting with national laboratories to provide all services for a set fee, a decreased quality of service can be demonstrated.

Biopsy↗

PubMed1993

Does the emergency department need a dedicated stat laboratory? Continuous quality improvement as a management tool for the clinical laboratory.

Using the principles of continuous quality improvement (CQI), the authors conducted a study in response to a request from the Department of Emergency Medicine, Los Angeles County, and University of Southern California Medical Center, Los Angeles, for a dedicated stat laboratory in the emergency department. The stat orders to test serum electrolyte, glucose, blood urea nitrogen, creatinine, amylase, and lipase levels, prothrombin time, and complete blood count (CBC) were evaluated. The study was done in two phases. First, a baseline on stat laboratory test turnaround time was established, and problems were identified. Then, the authors reexamined the turnaround after problems were addressed and a new laboratory information system was installed. In the first phase, median within-laboratory turnaround for chemistry tests was 61 minutes from the time the specimens arrived in the laboratory and 70 minutes for CBCs from the time of accessioning. Delay in physician review of the results (45 minutes) was the longest component of overall turnaround. The second phase of the study found that the median within-laboratory turnaround had improved to 36 minutes for chemical and 55 minute for hematologic tests. However, other preanalytic factors outside the control of the laboratory, such as collecting blood and sending the specimens to the laboratory, and postanalytic delays in physician acknowledgment of the results remained the major components of the perceived turnaround delays. In conclusion, stat laboratory service for the emergency department improved with CQI. The study suggested that resources required to establish a dedicated stat laboratory in the emergency department would be more beneficial if directed toward reducing the preanalytic delays. Further, CQI has great potential as a management tool for the clinical laboratory.

Emergency Medical Services↗

PubMed1994

Comparison of the clinic microscopy laboratory with the cytopathology laboratory in the detection of malignant cells in body fluids.

The clinical microscopy (fluids) laboratory evaluates almost every body fluid that is obtained in the hospital. Because the fluids laboratory functions at all hours, it is often the first laboratory to receive a body fluid. In addition to its primary purpose of quantitating categories of cells, the medical technologist in this laboratory has an opportunity to identify malignant cells. To our knowledge, no formal study has ever been undertaken to evaluate the performance of the fluids laboratory in detecting malignancy. The authors therefore retrospectively identified 928 body fluids (pleural, peritoneal, cerebrospinal, and miscellaneous) over a 2-year period that had undergone simultaneous cytologic examination in our cytopathology laboratory and body fluid analysis in our fluids laboratory. Of these, a cytologic diagnosis of malignancy was made by the cytopathology laboratory in 107 cases; 821 were considered to be benign. No false-positive results were rendered by the fluids laboratory (100% specificity), but only 26 of the 107 malignant cases were identified (24% sensitivity); the overall accuracy was 93%. Factors contributing to the inability of the fluids laboratory to identify malignant cells included (1) too few cells to warrant a cytocentrifuge preparation, especially in cerebrospinal fluid specimens; (2) differences in the processing of specimens; (3) differences in staining procedures; and (4) differences in the training of personnel. The authors conclude that although the fluids laboratory correctly identifies neoplastic cells in approximately one fourth of the cases in which they are present, it should not be expected to detect malignant cells in every cytologically malignant case.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Fluids↗

PubMed2000

[Evidence-based laboratory medicine--a new trend in laboratory medicine].

The most important target of "evidence-based laboratory medicine(EBLM)", based on the fundamental concept of evidence-based medicine(EBM) is to improve appropriate, effective utilization of laboratory tests through close communication between clinical laboratories and clinicians. It is mandatory for clinicians to know of analytical uncertainty for better utilization of laboratory tests in clinical practice. Furthermore, the improvement of clinical utilization and interpretation of laboratory tests can be expected by supplying the evidences obtained through systematic reviewing or meta-analysis of laboratory tests. In order to pursue these purposes, closer communication and cooperation between laboratories and clinicians are important to obtain an effective consensus. Clinical laboratory must work together with interested clinician(s) for systematic review of laboratory tests. Construction of the ways of better laboratory-clinician communication should be an important paradigm for EBLM which will be an important factor for new revolution of laboratory medicine in future.

Clinical Laboratory Techniques↗

PubMed1989

Infectious hazards in the clinical laboratory: a program to protect laboratory personnel.

The increasing risk of exposure to blood-borne pathogens in the health care setting makes the development of effective infection control programs in the laboratory workplace critical. Central to such programs is the concept of universal precautions. The program described here relates the level of protection or precaution to the potential danger for infection, given the laboratory workstation and task which is to be performed. Four Levels of Protection are described. Implementation of this program requires that each workstation and procedure in each laboratory section be reviewed by the laboratory director and supervisory personnel for risk of exposure. Implementation additionally requires that provisions be made for both the initial and continuing education of laboratory employees. Laboratory directors and supervisors should also monitor the program to ensure compliance. There will certainly be situations unique to individual institutions or laboratory settings that may require precautions or policies over and above those described by universal precautions. Laboratory policies will not gain acceptance if they are developed and implemented without the advice and cooperation of the hospital medical staff. Employee acceptance of infection control policies will be greater if actual development and implementation actively involves the laboratory personnel who will practice them. The program described here is but one approach to the problem. Employers and laboratory directors must understand that it is their responsibility to develop a program that provides appropriate safeguards for workers who may be exposed to infectious agents in the laboratory workplace and to ensure that employees are properly trained and educated in the proper use and application of those safeguards.

Acquired Immunodeficiency Syndrome↗

PubMed1998

[Effective use of a laboratory database: quality assurance and laboratory workflow applications].

Recent laboratory information systems have usually adopted a client server system. Computing tools which can provide easy access to a database using simple language are now strongly needed. These functions are provided in an End User Computing (EUC) system. An EUC is defined as follows: 1) General end users can easily access the database of the laboraotry system and extract objective data stored in database. 2) The extracted data will be easily converted to files that can be processed by commercially available software. In this paper, we demonstrate the examples how to use the EUC for a quality assurance system and analyses of laboratory workflow. In the case of quality assurance, we demonstrate the setting of reference intervals from stored laboratory data concerning health care examination programs at our university. Secondly, we developed a system of monitoring quality control data, and set parameters for delta checking and actual zone QC method. We can estimate and design an outline of laboratory workflow from extraction of the time currently required for each task. We can measure the turn-around time for laboratory testing and rate of requests for laboratory tests received from physicians via order entry system. Moreover, we can estimate and simulate the waiting time and time required for analyses by outpatient clinics. These time monitoring systems reflect the design of laboratory workflow such as the labor and equipment time required in laboratory work. These uses of laboratory data are currently expanding further and further in the fields of education and laboratory research. We believe that information technology will facilitate future advances of laboratory medicine.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

A model to begin reengineering the laboratory. How do you change an outmoded laboratory structure?

If a traditionally structured laboratory cannot incorporate new technologies efficiently and can no longer meet its changing service demands, it may require reengineering. A model is presented that can be followed by the laboratory director and a small group of planning colleagues to begin the process. The model was effectively used at British Columbia's Children's and Women's Hospitals (BCCH/WH) to review their laboratory structure and redraft it for the future. The model considers the external and internal pressures facing the laboratory. Technological trends, which have significant impact on laboratory service, are also incorporated into the model. The current list of services, staff expertise, and laboratory specialties is used as the base in the model to formulate the opportunities for improvements and identify the future direction of the laboratory. These opportunities are the context for the vision of the future laboratory. With this vision in mind and a creative planning approach, a new optimum laboratory structure can be outlined. This model begins the reengineering process and can be applied to any laboratory where there is the need for dramatic improvements to accommodate the changes in today's rapidly evolving health-care environment.

British Columbia↗

PubMed2004

Laboratory tests used in US public health laboratories for sexually transmitted diseases, 2000.

BACKGROUND AND OBJECTIVES: Public health laboratories are a critical component of sexually transmitted disease (STD) control in the United States. GOAL: The goal of this study was to describe the types and volume of STD tests performed in U.S. public health laboratories in 2000. STUDY DESIGN: A survey was mailed to 123 members of the Association of Public Health Laboratories. RESULTS: Eighty-one percent of 100 laboratories responded. Overall, 3294739 chlamydia tests and 3088142 gonorrhea tests were done; 62.4% of chlamydia tests and 63.6% of gonorrhea tests were DNA probes. Fifty-six percent of laboratories performed rapid plasma reagin (RPR) tests and 55% performed Venereal Disease Research Laboratory (VDRL) tests; the number of RPR tests performed was twice that of VDRL tests. Few laboratories used new technologies for bacterial vaginosis and trichomoniasis. Eighteen percent of laboratories performed herpes simplex virus serology; however, most used inaccurate tests. No laboratories performed human papillomavirus tests. CONCLUSIONS: This survey documents for the first time STD tests performed in U.S. public health laboratories.

Centers for Disease Control and Prevention, U.S.↗

PubMed2000

Use of the National Committee for Clinical Laboratory Standards guidelines for disk diffusion susceptibility testing in New York state laboratories.

Accurate antimicrobial susceptibility testing is vital for patient care and surveillance of emerging antimicrobial resistance. The National Committee for Clinical Laboratory Standards (NCCLS) outlines generally agreed upon guidelines for reliable and reproducible results. In January 1997 we surveyed 320 laboratories participating in the New York State Clinical Evaluation Program for General Bacteriology proficiency testing. Our survey addressed compliance with NCCLS susceptibility testing guidelines for bacterial species designated a problem (Staphylococcus aureus and Enterococcus species) or fastidious (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae) organism. Specifically, we assessed compliance with guidelines for inoculum preparation, medium choice, number of disks per plate, and incubation conditions for disk diffusion tests. We also included length of incubation for S. aureus and Enterococcus species. We found overall compliance with the five characteristics listed above in 80 of 153 responding laboratories (50.6%) for S. aureus and 72 of 151 (47.7%) laboratories for Enterococcus species. The most common problem was an incubation time shortened to less than 24 h. Overall compliance with the first four characteristics was reported by 92 of 221 (41.6%) laboratories for S. pneumoniae, 49 of 163 (30.1%) laboratories for H. influenzae, and 11 of 77 (14.3%) laboratories for N. gonorrhoeae. Laboratories varied from NCCLS guidelines by placing an excess number of disks per plate. Laboratories also reported using alternative media for Enterococcus species, N. gonorrhoeae, and H. influenzae. This study demonstrates a need for education among clinical laboratories to increase compliance with NCCLS guidelines.

Anti-Bacterial Agents↗

PubMed2003

[Laboratory medicine in the obligatory postgraduate clinical training system--common clinical training program in the department of laboratory medicine in our prefectural medical university hospital].

I propose a postgraduate common clinical training program to be provided by the department of laboratory medicine in our prefectural medical university hospital. The program has three purposes: first, mastering basic laboratory tests; second, developing the skills necessary to accurately interpret laboratory data; third, learning specific techniques in the field of laboratory medicine. For the first purpose, it is important that medical trainees perform testing of their own patients at bedside or in the central clinical laboratory. When testing at the central clinical laboratory, instruction by expert laboratory technicians is helpful. The teaching doctors in the department of laboratory medicine are asked to advise the trainees on the interpretation of data. Consultation will be received via interview or e-mail. In addition, the trainees can participate in various conferences, seminars, and meetings held at the central clinical laboratory. Finally, in order to learn specific techniques in the field of laboratory medicine, several special courses lasting a few months will be prepared. I think this program should be closely linked to the training program in internal medicine.

Education, Medical, Graduate↗

PubMed1986

Teaching laboratory medicine. The clinical laboratory experience.

A medical student's introduction to the clinical laboratory often sets the tone for the relationship that will exist between him or her and the laboratory throughout medical practice. As part of the sophomore pathology and laboratory medicine course at the University of South Alabama, Mobile, groups of seven or eight medical students spend one hour in each of ten different areas of the clinical laboratory. This experience acquaints the students with laboratory personnel, organization, and procedure, and emphasizes the importance of communication between clinicians and the laboratory staff. Consequently, our students have greater awareness of the capabilities and limitations of laboratory testing. This has, in turn, resulted in more efficient use of laboratory resources by clinicians and fewer complaints about laboratory service. The relatively small size of the classes in our institution enables us to schedule these sessions effectively. However, schools with larger classes could use a similar system since many of these schools have access to laboratories at more than one hospital.

Alabama↗

PubMed1955

Laboratory technicians; the Clinical Laboratory Law and its meaning to private physicians.

The present laws and regulations relating to clinical laboratories in California are the outcome of over a quarter century of cooperative development. The medical profession, public health department, laboratory workers, and the legislature have worked together in this development.At first the system of certifying technicians and laboratories was on a voluntary basis. The clinical laboratory law in effect legalized and made generally applicable a system which had already been accepted voluntarily. The application of the clinical laboratory law provides physicians a reasonable assurance that competence and reliability will prevail in clinical laboratory operation. Of great importance is the conduct of proper training programs by approved laboratories. Since modern medical practice is so dependent on accurate clinical laboratory work it is essential that special effort be directed by physicians toward influencing young people to enter the profession of medical technology.

Biomedical Technology↗

PubMed1995

A multimedia-based histology laboratory course: elimination of the traditional microscope laboratory.

UNLABELLED: We have developed a multimedia-based laboratory course which has enabled us to eliminate the microscope and traditional microscope laboratory that have been mainstays of our histology course and histology courses at almost all institutions where histology is taught. The multimedia laboratory uses a library of histology images (approximately 24,000) stored on videodisc ( HISTOLOGY: A Photographic Atlas, by S. Downing) as its microscope slide collection and accesses those images through barcode and computer interfaces. The laboratory workstations consist of a videodisc player, videodisc monitor, computer, and computer monitor. One workstation is available for every 4-students, and our students are encouraged to work together in groups of four or five. In our current set-up, the students are introduced to and instructed in the basic principles of histology using a computer program that interfaces with the videodisc images. The computer program is divided into 19 chapters (the chapters are typical of the chapters found in a normal histology textbook) and has: (1) a laboratory component that covers the material traditionally covered in the microscope laboratory, and (2) a lecture component that enables the students to evaluate their understanding of the lecture material in a non-punishing way. The laboratory section of each chapter is divided into a "MicroLab" section, an "InFo Time" section, and a "Quiz Time" section. Each of these sections interfaces with histological images stored on the videodisc. The students are encouraged to work through the "MicroLab" section of each chapter before moving on to the "InFo Time" and "Quiz Time" sections. The "MicroLab" sections introduce the students to the various tissues and organs of the body and is interfaced with the videodisc player and the histology images stored on the videodisc. These sections describe the basic histological features of the various tissues and organs and give the students access to multiple examples of what they are studying. The "InFo Time" sections bring up specific images and ask the students to think about the images. Information about the images being observed is available if the students want it and the students can flag those images that they found difficult. The Quiz Time section of the program is also interfaced with the videodisc player and provides access to a large number of histology images stored on the videodisc. The "Quiz Time" sections provide non-punishing review questions that the students can study after she has worked her way through the "MicroLab" and "InFo Time" sections. In addition to the use of a computer program to access the histology images stored on videodisc, we use barcodes that address specific images on the histology videodisc in a variety of ways to augment the students' laboratory and lecture experience. The benefits of using multimedia in place of the traditional microscope and microscope slide collection are numerous and include the speed at which specific histological images can be accessed and reviewed (when compared to finding a structure on a glass slide), a significant reduction in the amount of laboratory time needed by the student to learn the same amount of information, the ease of tutoring on a large monitor screen (when compared to trying to discuss a histological structure with a student through the eyepiece of a microscope), the encouragement of group study (which is difficult to do when a student is working 1-on-with a microscope), and the reduction of the number of faculty necessary to cover a typical histology laboratory session. The use of barcodes that address specific videodisc histology images has greatly changed our examination procedures and has significantly expanded the usefulness of the traditional lecture note handouts given to our students.

Computer-Assisted Instruction↗

PubMed2004

[Quality management system in the medical laboratory--ISO15189 and laboratory accreditation].

Medical laboratory services are essential to patient care and therefore should meet the needs of all patients and clinical personnel responsible for human health care. Recently, ISO15189, the first quality management ISO system for medical laboratories, has attracted the attention of all medical laboratories. ISO 15189:2003, Medical laboratories--Particular requirements for quality and competence, provides a framework for the design and improvement of process-based quality management systems by medical laboratories. It is based on ISO17025:1999, General requirements for the competence of testing and calibration laboratories, but provides specific requirements for implementation in medical laboratories. This will help medical laboratories to comply with regulatory requirements, to meet the expectations of their clients and, most importantly, to improve and maintain their service to patients. ISO15189 will be an important template for assessing and recognizing the competence of medical laboratories in their technical capacity and the effective quality management of a professional service and its staff--with or without the aim of accreditation.

Accreditation↗

PubMedDate not supplied

Animal procedure laboratory surveys: use of the animal laboratory to improve physician confidence and ability.

Animal laboratories have been used for many years to teach procedures. Our department has a weekly swine laboratory devoted to training residents, interns and students in resuscitative procedures. Physicians who participated in our swine procedure laboratory over the past three years were queried as to their prelaboratory and postlaboratory comfort levels with six different resuscitative procedures, and 57 (76%) physicians responded. Statistical analysis of the data showed significant improvement in comfort levels for all six procedures. Every responder felt the swine laboratory helped or will help them perform the procedures on humans. We also surveyed all U.S. emergency medicine residency program directors from established programs regarding the status of their animal procedure laboratories, and 67 of the 68 (98%) directors responded. Of these responders, 62% offer an animal procedure laboratory. Overall, 97% of the residency directors rated the laboratory successful, and 97% of the residents rated the laboratory successful. Therefore, we conclude that an ongoing emergency medicine animal procedure laboratory is a valuable tool for improving physician-in-training ability and confidence.

Animals↗

PubMed1996

The impact of selective laboratory evaluation on utilization of laboratory resources and patient care in a level-I trauma center.

BACKGROUND: Routine laboratory evaluation of preoperative patients has not been shown to be cost effective when a detailed history and physical examination are performed. However, since such a detailed history is not possible in trauma patients, the time-honored approach has been for laboratory evaluation to be protocol driven. The cost-benefit ratio of this practice has never been evaluated. METHODS: Trauma patients who underwent routine laboratory evaluation (n = 552; group I) were compared with patients who had laboratory evaluation based on clinical need (n = 603; group II). A concurrent review of each case in group II was conducted every day while a retrospective review of charts was conducted for patients in group I to determine patient care issues and identify abnormal trauma center test results. RESULTS: The number of patients with laboratory tests decreased from 97% in group I to 27% in group II (P < 0.0001). Positive chemistry profiles increased (55% versus 92%; P < 0.0001) as did coagulation profiles (8% versus 33%; P < 0.0001). There were no differences in the percentage of patients receiving intervention based on laboratory data (7% in group I versus 8% in group II). No adverse effect on patient care was identified as a result of absent laboratory information in group II. Mortality, length of stay, and intensive care unit days were statistically unchanged. There was an annualized savings of $1.5 million in billed trauma center laboratory charges in group II. CONCLUSION: Selective laboratory evaluation of trauma patients can greatly reduce medical cost and does not adversely affect care.

Adult↗