基准医学实验室性能:欧洲、中东和非洲的调查验证和结果

W. Huf, Mike Mohns, Zoe Bünning, Rebecca Lister, T. Garmatiuk, C. Buchta, Brigitte Ettl
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引用次数: 1

摘要

目的医学实验室绩效是一个相对的概念,医学质量和安全也是一个相对的概念。因此,反复制定基准似乎对保健的可持续改进至关重要。这种方法的总体思路是建立一个参考水平,在此基础上进行改进并进行量化。虽然实验室界传统上高度意识到实验室绩效的必要性,而且由于SARS-CoV-2大流行,公众监督比以往任何时候都更加强烈,但很少有举措跨越全球。本研究的目的是为医学实验室绩效的三个关键维度建立一个高抽象水平的基准测试的良好实践方法,对欧洲、中东和非洲(EMEA)地区目前的技术状况进行初步概述,从而为全球后续研究奠定基础。方法使用和先前发布的调查问卷由50个项目组成,大约一半涉及一般的实验室操作,另一半涉及更具体的主题。在训练有素的专业人员的帮助下,接触了来自EMEA的国际实验室样本,以获得高保真度的反应。单项结果采用标准描述性统计进行分析。采用探索性因子分析对特定项目进行降维,并采用验证性因子分析进行评估,得出“运营绩效”、“综合临床护理绩效”和“财务可持续性”三个子量表的单个实验室得分。结果共有773间化验室参与调查,其中484间为政府医院化验室,129间为私立医院化验室,146间为商业化验室,14间为其他类型化验室(例如研究化验室)。受访者表示需要数字化(例如使用IT进行订单管理、自动验证)、自动化(例如预分析、自动样品运输)和建立正式的质量管理体系(例如ISO 15189、ISO 9001),并将其可持续地嵌入实验室操作的结构中。向医生提供的服务也存在相当大的增长空间,例如“诊断途径指导”、“对复杂病例的主动咨询”和“实时决策支持”,这些服务由不到三分之二的实验室提供。同时,对于临床医生来说,最重要的周转时间(TAT),即样本到结果的TAT,只有40%的应答者进行了监测。总之,加强实验室与临床护理过程整合的必要性已变得明显,并应成为未来实验室管理的主要方向。因子分析证实了问卷设计阶段的理论结构,从而产生了一个合理有效的工具,用于进一步对三个目标关键维度进行基准测试。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Benchmarking medical laboratory performance: survey validation and results for Europe, Middle East, and Africa
Abstract Objectives Medical laboratory performance is a relative concept, as are quality and safety in medicine. Therefore, repetitive benchmarking appears to be essential for sustainable improvement in health care. The general idea in this approach is to establish a reference level, upon which improvement may be strived for and quantified. While the laboratory community traditionally is highly aware of the need for laboratory performance and public scrutiny is more intense than ever due to the SARS-CoV-2 pandemic, few initiatives span the globe. The aim of this study was to establish a good practice approach towards benchmarking on a high abstraction level for three key dimensions of medical laboratory performance, generate a tentative snapshot of the current state of the art in the region of Europe, Middle East, and Africa (EMEA), and thus set the stage for global follow-up studies. Methods The questionnaire used and previously published in this initiative consisted of 50 items, roughly half relating to laboratory operations in general with the other half addressing more specific topics. An international sample of laboratories from EMEA was approached to elicit high fidelity responses with the help of trained professionals. Individual item results were analyzed using standard descriptive statistics. Dimensional reduction of specific items was performed using exploratory factor analysis and assessed with confirmatory factor analysis, resulting in individual laboratory scores for the three subscales of “Operational performance”, “Integrated clinical care performance”, and “Financial sustainability”. Results Altogether, 773 laboratories participated in the survey, of which 484 were government hospital laboratories, 129 private hospital laboratories, 146 commercial laboratories, and 14 were other types of laboratories (e.g. research laboratories). Respondents indicated the need for digitalization (e.g. use of IT for order management, auto-validation), automation (e.g. pre-analytics, automated sample transportation), and establishment of formal quality management systems (e.g. ISO 15189, ISO 9001) as well as sustainably embedding them in the fabric of laboratory operations. Considerable room for growth also exists for services provided to physicians, such as “Diagnostic pathways guidance”, “Proactive consultation on complex cases”, and “Real time decision support” which were provided by less than two thirds of laboratories. Concordantly, the most important kind of turn-around time (TAT) for clinicians, sample-to-result TAT, was monitored by only 40% of respondents. Conclusions Altogether, the need for stronger integration of laboratories into the clinical care process became apparent and should be a main trajectory of future laboratory management. Factor analysis confirmed the theoretical constructs of the questionnaire design phase, resulting in a reasonably valid tool for further benchmarking activities on the three aimed-for key dimensions.
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