南台灣某放射免疫分析科檢體退件探討與改善

Analysis and Improvement of Specimen Rejection at a Radioimmunoassay Laboratory in Southern Taiwan

林燕秀(Yen-Hsiu Lin) ； 詹承儒(Cheng-Ju Chan) ； 王玫瓔(Mei-Ing Wang) ； 廖佳玲(Chin-Ling Liao) ； 李碧芳(Bi-Fang Lee) ； 邱南津(Nan-Tsing Chiu)

《核子醫學雜誌》 23卷2期 (2010/06) Pp. 71-76

https://doi.org/10.6332/ANMS.2302.002

摘要

背景：臨床檢驗室之報告是醫師評估患者病情的重要依據之一，其準確性、時效性之重要可見一斑。影響檢驗報告準確性之因素可依檢驗流程區分爲三個階段：分析前、中及後。大部分檢體錯誤都發生在分析前階段，尤其是檢體採集及運送過程。本研究針對南台灣某放射免疫分析科檢體退件原因進行分析，並透過'Plan, Do, check, Action' (PDCA)技法針對主要退件原因進行持續改善，以期提升報告準確性與時效性。
方法：分析2007年8月至2008年12月間檢體退件紀錄。針對宣導前（2007年8月至2008年3月）檢體退件紀錄，進行檢體退件原因分析，統計退件原因所佔比率，進而以'Plan, Do, check, Action '(PDCA)技法針對主要原因進行持續改善。
結果：病房退件率1.39%、門診退件率0.0l%、急診退件率0%，可知病房退件爲本科檢體退件之大宗，其中以檢體逾時送達(44%)爲主要退件原因。因此我們以PDCA技法降低病房退件率，減少對於檢驗報告準確性的影響，以達到全面品質管制的目標。
結論：經向原因分析與PDCA技法，本研究確實降低了病房因檢體逾時送達造成的退件數（宣導前，4.5 件／月，宣導後：0.6 件／月），進一步降低本科總退件率（宣導前，0.16%，宣導後：0.13%）。

關鍵字

放射免疫分析 ； 分析前檢驗流程 ； 檢體退件率 ； Plan ； Do ； check ； Action PDCA技法

並列摘要

Background: Report of clinical laboratory is an important reference for clinical diagnosis. The accuracy of laboratory reports depends on multiple factors at three phases: pre-analysis, analysis, and post-analysis. Most of errors take place at the pre-analytical phase, especially when performing the collection of the specimens and its transportation to the laboratory. In this study we analyzed specimen rejections by a radioimmunoassay (RIA) laboratory in southern Taiwan and reduced the main factor of specimen rejection through Plan-Do-Check-Action technique (PDCA technique).
Methods: Records of specimen rejection from August 2007 to December 2008 were analyzed. We evaluated the factors of specimen rejection before education guidance (from August 2007 to March 2008) and then designed plan to reduce the major factor based on PDCA technique.
Results: Specimen of wards showed the highest rejection rate (1.39%). The rejection rates of the outpatient department and the emergency department were 0.01% and 0%, respectively. Specimen transfer delay was the major cause of rejection (44%). Based on these data, PDCA technique was used to reduce the rejection rate of wards and gain the comprehensive quality control.
Conclusion: Through PDCA technique we reduced specimen delay of wards (pre-education guidance: 0.16%, post-education guidance: 0.13%) and the RIA specimen rejection (pre-education guidance 4.5 cases/month; post- education guidance 0.6 cases/month).

並列關鍵字

radioimmunoassay ； pre-analytic phase ； specimen rejection rate ； Plan ； Do ； Check ； Action PDCA technique