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PubMed1999

Requirements for accreditation by the College of American Pathologists Laboratory Accreditation Program.

The College of American Pathologists Laboratory Accreditation Program expects a participant laboratory or laboratory section to be able to demonstrate that it is in compliance with the Standards for Laboratory Accreditation. The program expects laboratories to demonstrate that they are continually taking steps to identify and correct deficient areas and improve performance, in compliance with the Clinical Laboratory Improvement Amendments of 1988 regulatory requirements, particularly those pertaining to proficiency testing performance, and participating as inspectors in the accreditation process.

Accreditation↗
PubMed1979

Use of laboratory tests in a teaching hospital: long-term trends: reductions in use and relative cost.

We have assessed long-term trends in the use of laboratory tests among patients hospitalized on the medical service of a large teaching hospital. A significant decline in numbers of chemistry tests and no growth in numbers of microbiology or hematology tests or roentgenograms were noted between 1970 and 1977. Per-patient increases in laboratory costs and charges were considerably less than increases in total hospitalization costs and charges. These findings contrast to an average increase of 13.8% per year in numbers of laboratory tests for hospital laboratories in this country between 1970 and 1975. Factors responsible for the observed stability in numbers of laboratory tests per patient per hospitalization included, but were not limited to, increased reliance on test batteries as opposed to individual tests; changing patterns of care leading to decreased use of nonautomated tests; and the impact of administrative and educational strategies directed toward optimum use of the laboratory.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Utilization management in hospital clinical laboratories: a local analysis.

As hospital clinical laboratories position themselves for increasing involvement in managed care plans and for dealing with increasing cost containment, laboratory managers need to produce and assess data on the use of their testing services. The purpose of this study was to answer questions about the relationship between several dependent variables and the laboratory utilization management (UM) processes currently in place. An investigator-designed questionnaire was used to gather data on hospital bed size, availability of pathologists, involvement in managed care plans, and the types of laboratory information systems in use. The questionnaire was sent to the managers of all acute care hospital laboratories in the greater Houston metropolitan area. Although the total number of responses was small, the results showed that there is very little UM activity in Houston acute care hospital laboratories. This lack of sophisticated UM procedures may be consistent with the immature and evolving managed care environment in Houston.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Using clinical laboratory specialists for in-service education: an important aspect of cross training.

Cross training of clinical laboratory professionals is on the rise because of hospital mergers and downsizing. Confusion and uncertainty during mergers, plus the added stress of cross training or learning a new "bench" can be overwhelming. Utilizing clinical laboratory specialists to provide continuing education as support for cross training laboratorians can be beneficial to both the laboratory employee and to management. This manuscript describes a model for continuing education support for laboratory personnel returning to the hematology "bench" after many years away from the high complexity level tests in this area of the clinical laboratory. The article addresses the cross-functioning role of laboratory specialists as educators as well as high-level bench technologists. This model for in-service education may serve several purposes, such as documentation for continuing education and personnel competency testing, while giving other laboratorians support for learning new tasks and enhancing their resume.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Proactive detection of cryptosporidiosis by clinical laboratories. Working Group on Waterborne Cryptosporidiosis.

Laboratories can play a critical and preemptive role as a community's first line of surveillance in detecting waterborne outbreaks when they are aware of increased numbers of stool specimens and suspect or identify Cryptosporidium as the cause of illness. In addition, strong working relationships between clinical laboratories and local or state public health laboratories or agencies can facilitate a meaningful and rapid response related to potential outbreaks. Clinical and public health laboratories potentially play a key role in adding to the limited knowledge of the endemicity and ultimately the natural history of Cryptosporidium. This article addresses the early detection of waterborne outbreaks of cryptosporidiosis and some strategies that could be used to determine endemic levels of Cryptosporidium infections unrelated to outbreaks: to detect Cryptosporidium outbreaks by causes other than potable waterborne sources, e.g., food, surface or recreational waters, pets or farm animals, or sexual contact; or to determine outbreak or endemic levels of other infectious diseases. Strategies for clinical laboratories, which include proactive external and internal planning and a brief overview of laboratory methodologies as they relate to the detection of waterborne cryptosporidiosis, are included.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Laboratory cross training needs assessment.

OBJECTIVE: To define the continuing education topics and methods in the area of chemistry and hematology, that if developed, would best support the cross-training needs of hospital based laboratories in the State of Georgia. DESIGN: A cross sectional study of hospital based laboratories in Georgia was completed using surveys sent to 181 hospital laboratory managers and administrators. Descriptive statistics were used to evaluate the survey results. SETTING: Department of Medical Technology, Medical College of Georgia, Augusta GA. PARTICIPANTS: Laboratory managers and administrators. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: Four descriptive outcome measurements were requested from each participant: 1) demographic questions, 2) cross-training topics desired, 3) training material desired, and 4) computer literacy and equipment assessment. RESULTS: Sixty-six surveys were completed and returned in a usable form (36% return rate). Demographically, the respondent group is a representative sample of hospital based laboratories in the State of Georgia with 46% of the respondents from facilities of 100 hospital beds or less. Respondents desired that case study training topics be developed using paper and computer assisted instruction mediums. Additionally, respondents desired that Professional Acknowledgement for Continuing Education (P.A.C.E.) be associated with the training material. They were willing to pay for this administrative service. CONCLUSION: This cross sectional study assessed the cross-training needs of hospital based laboratories in Georgia. Findings will allow educators to focus and develop continuing education packages that best meet the needs of the laboratorian workforce.

Chemistry, Clinical↗
PubMedDate not supplied

Turnaround times in the laboratory: a review of the literature.

OBJECTIVE: To conduct a review of the literature for current information pertaining to turnaround times in the clinical laboratory. To evaluate the methods previously used for improving turnaround times and provide a reference for laboratories. DESIGN: The literature was reviewed for information related to turnaround times in the laboratory. Information was limited to literature published from 1989 to present in order to cover the more technological innovations. RESULTS: Several methods have been used in recent years for the improvement of turnaround times in the clinical laboratory. Among these are pneumatic tubing systems, satellite laboratories, point-of-care testing, and computer technology. CONCLUSIONS: There is still the need for faster turnaround times. Technological advances are enabling laboratories to better meet these needs leading to improved user satisfaction.

Efficiency, Organizational↗
PubMed1999

[The important role of the microbiology laboratory in treating patients with infectious diseases and in controlling hospital infections].

It is very important for the microbiology laboratory to provide the clinician with information about microbiology laboratory tests results as soon as possible, since this data is strongly connected to treating patients with infectious diseases appropriately, as well as with performing adequate hospital infection control. Therefore, the microbiology laboratory should always have a good relationship and good communication with the clinician and infection control practitioner. For this purpose, it would be beneficial for the microbiology laboratory staff to attend the doctor's round to see patients with infectious diseases, or to attend the patients management conferences in the wards. In most hospitals in Japan, microbiology laboratories are closed on holidays. But the microbiology laboratory should be available for at least some important tests, such as the identification and susceptibility testing of blood cultures isolates on holidays in order to facilitate treatment of patients with serious infectious diseases by appropriate antimicrobial therapy.

Bacterial Infections↗
PubMed1999

Laboratory services in health centres within Amhara region, north Ethiopia.

OBJECTIVE: To identify current problems in laboratory services and elicit suggestions from the technicians aimed at improving the services in health centres within Amhara region, north Ethiopia. DESIGN: Cross-sectional study using a pre-tested questionnaire. SETTINGS: Twenty seven health centres in Amhara region, north Ethiopia. PARTICIPANTS: Twenty seven laboratory technicians. RESULTS: Physical facilities were seriously lacking, consisting of only one room in 85.2% of the health centres. Supply of electricity was never continuous. Whereas virtually all the health centres had up to five medical doctors each, laboratory manpower was grossly below the ideal requirement. Over half of the health centres had only one technician each, resulting into heavy workload. Laboratory reagents were insufficient, equipment lacking, and maintenance and repair were not accorded adequate attention. Eighty different tests were offered by the health centres in various combinations. Twenty categories of suggestions were advanced by the respondents. CONCLUSION: There is a great shortage of manpower, equipment, chemicals and other supplies to provide adequate laboratory services in the health centres within the region. Consequently, the laboratories are functioning below capacity.

Adult↗
PubMed1999

Plan and process for hematology laboratory standard in Thailand.

In Thailand, there are around 2,000 clinical laboratories in private and government hospitals, By the end of year 2004, all of these laboratories are required to use the same or comparable standard nationwide. Many laboratories are in the process of starting ISO/IEC Guide 25 for the fulfillment of laboratory accreditation. To run the standard system of hematology laboratories in Thailand, we have considered three main aspects: standard in process, method selection and academic interpretation. Because of the wide spectrum of blood diseases in Thailand: thalassemia, iron deficiency anemia and G6PD deficiency hemolytic disease, the analysis and interpretation of laboratory results using different technology are of great importance. National plan has thus set up in two direction, one for standard process and another for academic approach.

Accreditation↗
PubMed2000

Survey of mycobacteriology laboratory practices in an urban area with hyperendemic pulmonary tuberculosis.

SETTING: Rio de Janeiro, Brazil, where 10210 cases of tuberculosis (TB) were reported in 1997, 86.2% of them with pulmonary TB. OBJECTIVE: To assess laboratory resources, practices, biosafety measures and training needs relative to the volume of work required for the TB control program and implementation of directly observed therapy, short course (DOTS). DESIGN: A cross-sectional survey of laboratories that receive funds from the public sector and work with mycobacteria, using a structured questionnaire and onsite visits to collect data. The main outcome measure of interest was processing > or = 20 specimens per week. RESULTS: More than half (56.5%) of the laboratories reported performing < 20 specimens per week, a level at which it is difficult to maintain proficiency in mycobacteriologic techniques. The demand for sputum smear microscopy was not met. Working conditions such as shared laboratory and air space, inadequate ventilation, accidents with biological specimens, and inadequate disposal of biological waste present risks of TB transmission to laboratory workers and other staff. CONCLUSION: Training and supervising laboratory workers in good technique and biosafety practices and providing the necessary organization, resources and working conditions will strengthen TB control and facilitate implementation of DOTS. Several simple interventions are proposed.

Brazil↗
PubMed2000

A method for the automated mapping of laboratory results to LOINC.

LOINC is emerging as the standard for laboratory result names, and there is great interest in mapping legacy terms from laboratory systems to it. However, the mapping task is non-trivial, requiring significant resource commitment and a good understanding of the LOINC identifying attributes for the laboratory result names. Because the number of results in a laboratory system may range from around 500 to 2000 or more, manual, one-by-one matching, even with the aid of the RELMA matching tool provided by LOINC, is time consuming and laborious. Moreover, human variation may introduce mapping inconsistencies or errors. Through our experience mapping the results from a variety of laboratory systems to LOINC, an automated mapping method has been developed and is described in this paper. This method allows for data from the laboratory information system to be provided in a manner familiar to the submitting technician, and makes use of parsing and logic rules, combined with synonyms, attribute relationships and mapping frequency data, to perform automated matching to LOINC.

Classification↗
PubMed2000

[Laboratory system to support liver transplantation].

It is beyond doubt that clinical examination is one of the essential issues in(living-related) liver transplantation as well as other clinical cases. To support liver transplantation, our laboratory has prepared efficient systems and has been trying to improve these systems as follows. 1) We need to construct a system to be able to comply with clinical requests. Thus, we need to know what kinds of laboratory examinations are likely to be required before, during, and after transplant surgery. In general, common laboratory examinations are sufficient to support liver transplantation. The most important thing is whether all the clinical examinations required can be assayed anytime. However, only general biochemical tests and complete blood count are provided outside standard laboratory hours by the medical technologist on duty because of staffing limitation and differences in each specialty. Therefore, we recently introduced a 24-hour on-call system in addition to the system described above. Actually, five persons in charge from each of the five groups divided by each specialty carry the pocket-bells in turns. 2) We supply a report to support the diagnosis and treatment. The report should include opinions and suggestions. A supplementary examination would be recommended if considered necessary. 3) To supply effective comments, we must improve our abilities to understand pathologic findings obtained from laboratory data. Especially, timely biopsy for the diagnosis of rejection depends on a proper interpretation of laboratory tests. Therefore, we need to investigate past cases after liver transplantation using statistical estimations and advanced examinations.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Clinical laboratory test menu changes in the Pacific Northwest: an evaluation of the dynamics of change.

To characterize changes in on-site test volumes and test menus and to identify the factors influencing these changes, we gathered information from a network of clinical laboratories in the Pacific Northwest in 1996 and again in 1999. The two studies allow for a snapshot of these changes for specific periods and also an evaluation of the dynamics of change in clinical laboratory practices between 1994 and 1999. Throughout this 5-year span, business-related decisions have had the primary influence in determining where testing is performed. The overwhelming factor in deciding to retain certain tests on-site is whether the patient test volume is adequate to be cost-effective. Decisions to add or delete tests also are closely tied to marketplace competition, costs of testing equipment and supplies, and ability to obtain adequate reimbursement. Laboratory regulations have had a decreasing influence on on-site test menus in the network laboratories and particularly in physician office laboratories (POLs). The use of waived tests has increased dramatically, with POLs accounting for the majority of laboratories that added waived tests.

Clinical Laboratory Techniques↗
PubMed2002

Use of a standardised checklist to assess peripheral sputum smear microscopy laboratories for tuberculosis diagnosis in Uganda.

SETTING: TB diagnostic units in Uganda. OBJECTIVES: To assess and improve the supervision and performance of sputum smear microscopy in the peripheral diagnostic units in Uganda using a standardised laboratory checklist. DESIGN: A standardised checklist was developed and used during the quarterly supervisory visits of the District TB and Leprosy Supervisors for five quarters from the fourth quarter of 1997 until the last quarter of 1998. Individual peripheral laboratory performance was monitored during the study period. RESULTS: Forty-eight of 304 TB diagnostic units in six of the 45 Ugandan Districts were supervised using the checklist. A total of 208 checklists were analysed. The situational analysis of the peripheral diagnostic units at the beginning and at the end of the study showed a marked improvement in laboratory performance in all aspects related to sputum smear microscopy. Individual laboratory performance was monitored over five quarters, and timely response to shortcomings was provided. CONCLUSION: The systematic use of a standardised laboratory checklist can be considered an important step forward in improving the performance of the peripheral laboratories in Uganda through on-the-spot correction of any identified shortcomings.

Bacteriological Techniques↗
PubMedDate not supplied

Utility scores for dimensions of clinical laboratory testing services from two purchaser perspectives.

Information is critical for making health-care purchasing decisions. Identifying the importance of dimensions and criteria used by purchasers of clinical laboratory testing services is the second step in the development of a report card to evaluate such services. The purpose of this study was to quantify the utility--the importance of four dimensions: access, cost, quality, and service--for two stakeholders of clinical laboratory testing services. Data were collected using a survey of hospital laboratories, as well as independent practice associations (IPAs) and preferred provider organizations (PPOs) that purchase clinical laboratory testing services. Although valued differently with respect to the magnitude of the utility score, both stakeholders rate quality and cost as first and second in importance. Managed-care organizations rate access and service as third and fourth in importance. Hospital laboratories consider service third in importance, yet with a similar utility score as that for managed-care organizations. Ten of 19 criteria (52.6%) were rated differently by the stakeholders. Using these utility scores for the dimensions and the criteria serves as a preliminary scoring system for a report card to evaluate clinical laboratory testing services.

Clinical Laboratory Techniques↗
PubMed1964

COMMERCIALLY ORIENTED CLINICAL LABORATORIES.

Out-of-state flat-rate mail order contract laboratories operating from states which have little or no legal control over them can do business in California without obedience to regulations that govern laboratories located within the state. The flat-rate contract principle under which some out-of-state laboratories operate is illegal in California. The use of such laboratories increases physician liability. Legislation for the control of these laboratories is difficult to construct, and laws which might result would be awkward to administer. The best remedy is for California physicians not to use an out-of-state laboratory offering contracts or conditions that it could not legally offer if it were located in California.

California↗
PubMed2003

[Undergraduate education of laboratory medicine in Hirosaki University School of Medicine].

The Department of Laboratory Medicine is responsible for the several undergraduate educational programs in Hirosaki University School of Medicine. We describe here how these programs are taken place. The staffs of the department participate in premedical lectures for the first grade students under the name of "21st century education" to introduce the medical english, human science, health and disease. As an early clinical exposure, the first grade medical students spend half day to make rotational visit to major clinical departments in the University Hospital once a week. We show them how each section of the Department of Clinical Laboratory works. At Year 4 during preclinical courses, 15 credit lectures of laboratory medicine based on clinical core are provided by our staffs and invited lecturers. Year 4 students can also choose one of elective research courses. This year, 5 students studied three topics of diagnostic testing and derivative research in the setting of an academic clinical laboratory. The core clerkship in laboratory medicine includes the necessary skills for acquiring a blood sampling and performing core laboratory examination. Emphasis is placed on interpretation of the data as well as the sampling and examination. We have played some role in the introduction of tutorial learning methods into preclinical courses in the year of 2003. Although we need supply of directors manpower, we hope that all of the students can acquire quality of the generally permissive six year of medical school and prepare postgraduate educational programs through our education courses.

Clinical Laboratory Techniques↗