導入全面實驗室自動化系統效益探討

動機背景：檢驗數據報告對於病人病症的判斷及預後治療至為重要，檢驗醫學隨著科技與資訊的進步，儀器設備也不斷進步。全面實驗室自動化系統在臨床實驗室中有顯著的幫助，加快了生產效率，減少了人工操作。本篇研究對象是中部某區域醫院檢驗部門於2018年1月導入全面實驗室自動化系統，研究目的要分析臨床醫檢師使用的狀況，再以作業基礎成本制度分析導入自動化系統的成本。研究材料與方法：研究內容分成兩個部分，第一個部分訪談五家醫院導入全面實驗室自動化系統，了解五家醫院臨床醫檢師使用系統的流程，來分析目前本次研究對象所面臨的問題。第二個部分成本分析採取作業基礎成本法實施步驟，來分析導入自動化系統前後成本差異。結果與討論：與其他醫院使用自動化系統流程作比較後可以發現由於各家醫院在組織配置、政策與空間上考量的不同，故工作內容、檢體檢驗流程與儀器設備上的設置會大不相同。本此研究對象是屬於中規模的實驗室，工作人力會希望發揮最大效能，所以會安排臨床醫檢師負責多項儀器或檢驗項目檢測，與身兼行政業務，故醫檢師因為需要兼顧臨床工作與其他業務，會認為自動化系統並沒有改善工作負擔。且本次研究對象醫院有兩個院區，礙於空間考量，只能將自動化系統放置於一個院區，檢體採取傳送的方式，有部分檢體由另一院區儀器檢驗，未完成檢體再擇時傳送，同樣也無法達成自動化最大效能。成本分析：在分析直接成本與間接費用之後，可以獲知使用TLA系統確實會減少成本的支出，分析最大原因是因為導入TLA系統後所需要的醫檢師人力的需求減少，所帶來人力成本的減少。此外在各項成本比例分析上，導入自動化系統前後人力成本的需求都是佔總成本內比例最高的。

關鍵字

全面實驗室自動化系統；作業基礎成本制度；效益探討

並列摘要

Background: Laboratory result is vital for clinical diagnosis and prognosis. Automation system has made significant improvement in clinical laboratory, which accelerates production of result and decrease manual operation. TLA system in clinical biochemistry has been introduced to Taiwan several year ago but still remaining some problems. The aim of this study was to compare workflow processes between objective hospital located in central Taiwan and other five hospitals to solve utilizing issues in objective hospital and evaluate benefit of TLA system. Material and Method: First of all, to approach problems of TLA system in the laboratory, this author collected utilizing issues of TLA system in objective hospital through observing medical technicians operation process , interviewed to staff working in other five hospitals and also compared differences of testing cascades between hospitals. Secondly, author analyzed cost and benefit before and after implementation of TLA system in the object of this study. Result and Discussion: The workflow processes of hospitals are different and incomparable depending on facility arrangement, policy, space application and the amount of samples.The result demonstrate TLA system in the object of this study doesn’t decrease loading of staffs because employer wants medical technicians performing multiple tasks including clinical examination, paper work or managing various machines to maximize human resource. Additionally, TLA system was only installed in one of two regions of the object of this study. Hence, samples are transported between two regions, which decreases maximum performance of TLA system: No matter implementing TLA system or not, labor cost accounts for biggest proportion of total cost. Therefore, TLA system does reduce total cost, especially expenditure on labors.