Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency.
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引用次数: 0
Abstract
Objectives: This study aimed to develop and implement autoverification (AV) system for routine coagulation assays, specifically prothrombin time (PT) and activated partial thromboplastin time (APTT), in tertiary care hospital. The efficiency, accuracy, and impact on turnaround time (TAT) were evaluated.
Methods: AV rules were developed using historical data from 70,865 coagulation test results. The rules included pre-analytical, analytical, and post-analytical checks. The system underwent validation through data simulations, pilot phase, go-live implementation. Performance metrics included sensitivity, specificity, predictive values, passing rates, error rates, TAT.
Results: The AV system achieved 63.3 % overall passing rate (analyzed from 159,183 data), with outpatient settings showing higher rate (69.2 %) than inpatient settings (56.3 %). Final performance evaluation showed sensitivity, specificity, PPV, and NPV of 93.0 , 65.0, 59.7, and 94.4 %, respectively. Manual verification was required for 36 % of cases, mainly due to defective sample volumes (21.5 %). False negatives, primarily from partial clots, occurred in 0.1 % of cases. Integrating CBC clot alerts into AV rules halved the errors. The system increased tests completed within guaranteed TAT of 90 min by 2.4 %, from 89.7 to 92.1 % and reduced median TAT by 5 min. Outpatient TAT improved significantly, with a reduction over 19 min.
Conclusions: The AV system for APTT and PT tests was successfully implemented, reducing manual verification, improving TAT, particularly in outpatient settings. This study highlights AV systems' potential to enhance laboratory performance for routine coagulation panels, which rely only on APTT and PT assays. Ongoing rule refinement and monitoring remain crucial for enhancing system accuracy and effectiveness.
期刊介绍：
Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality. Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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