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Holmes R, Wirka KA, Catherino AB, Hayward B, Swain JE. Comparison of electronic versus manual witnessing of procedures within the in vitro fertilization laboratory: impact on timing and efficiency. F S Rep 2021; 2:181-188. [PMID: 34278352 PMCID: PMC8267391 DOI: 10.1016/j.xfre.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the impact of an electronic witnessing system (EWS) on witnessing standard operating procedures and to assess embryologist perceptions of the EWS. Design Prospective cohort study. Setting Private in vitro fertilization laboratory network. Patient(s) None. Intervention(s) None Main Outcome Measure(s) The time difference between manual and electronic double-witnessing procedures, and embryologist perceptions of the EWS. Result(s) From 342 witnessing times analyzed (114 EWS, 114 manual, and 114 interruptions to witnesses), the EWS reduced mean (SD) total witnessing time (in seconds) by 91.5 (23.6) for intracytoplasmic sperm injection, 62.0 (17.9) for Day 3 embryo assessment, 58.3 (18.9) for fresh embryo transfer, and 59.4 (13.3) for frozen embryo transfer. This time reduction significantly decreased the overall time required for double-witnessing by 3.1- to 5.2-fold. A survey with 50 embryologists within the laboratory network indicated that most embryologists considered the EWS to improve sample traceability (78.3%), reduce errors in labeling issues (80.4%), and reduce the risk of sample mismatch errors by minimizing disruptions (60.9%). Furthermore, 82.6% thought that visual completion of the EWS dashboard provided peace of mind when leaving work and 84.8% were more confident knowing that all procedures were completed according to the EWS. Conclusion(s) An EWS can improve laboratory efficiency by significantly decreasing the time required for witnessing procedures and by minimizing interruptions. The EWS was well perceived by embryologists and laboratory managers and enhanced their confidence and peace of mind with regard to witnessing compliance and safety/accuracy.
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Affiliation(s)
| | - Kelly Athayde Wirka
- EMD Serono, Inc. (a business of Merck KGaA, Darmstadt, Germany), Rockland, Massachusetts
| | | | - Brooke Hayward
- EMD Serono, Inc. (a business of Merck KGaA, Darmstadt, Germany), Rockland, Massachusetts
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Cassim N, Tepper ME, Coetzee LM, Glencross DK. Timely delivery of laboratory efficiency information, Part I: Developing an interactive turnaround time dashboard at a high-volume laboratory. Afr J Lab Med 2020; 9:947. [PMID: 32391244 PMCID: PMC7203318 DOI: 10.4102/ajlm.v9i2.947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mean turn-around time (TAT) reporting for testing laboratories in a national network is typically static and not immediately available for meaningful corrective action and does not allow for test-by-test or site-by-site interrogation of individual laboratory performance. OBJECTIVE The aim of this study was to develop an easy-to-use, visual dashboard to report interactive graphical TAT data to provide a weekly snapshot of TAT efficiency. METHODS An interactive dashboard was developed by staff from the National Priority Programme and Central Data Warehouse of the National Health Laboratory Service, Johannesburg, South Africa, during 2018. Steps required to develop the dashboard were summarised in a flowchart. To illustrate the dashboard, one week of data from a busy laboratory for a specific set of tests was analysed using annual performance plan TAT cut-offs. Data were extracted and prepared to deliver an aggregate extract, with statistical measures provided, including test volumes, global percentage of tests that were within TAT cut-offs and percentile statistics. RESULTS Nine steps were used to develop the dashboard iteratively with continuous feedback for each step. The data warehouse environment conformed and stored laboratory information system data in two formats: (1) fact and (2) dimension. Queries were developed to generate an aggregate TAT data extract to create the dashboard. The dashboard successfully delivered weekly TAT reports. CONCLUSION Implementation of a TAT dashboard can successfully enable the delivery of near real-time information and provide a weekly snapshot of efficiency in the form of TAT performance to identify and quantitate bottlenecks in service delivery.
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Affiliation(s)
- Naseem Cassim
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Manfred E. Tepper
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Lindi M. Coetzee
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah K. Glencross
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cassim N, Coetzee LM, Tepper MEE, Perelson L, Glencross DK. Timely delivery of laboratory efficiency information, Part II: Assessing the impact of a turn-around time dashboard at a high-volume laboratory. Afr J Lab Med 2020; 9:948. [PMID: 32391245 PMCID: PMC7203269 DOI: 10.4102/ajlm.v9i2.948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 11/04/2019] [Indexed: 11/05/2022] Open
Abstract
Background In South Africa’s National Health Laboratory Service, ad hoc mean turn-around time (TAT) reporting is an important indicator of performance. However, historic static TAT reporting did not assess very long or very short times. An interactive TAT dashboard was developed using the following TAT measures; (1) median, (2) 75th percentile and (3) percentage of within cut-off TAT to allow for improved differentiation of TAT performance. Objectives The objective of our study was to demonstrate increased efficiency achieved by using an interactive TAT dashboard. Methods A retrospective descriptive study design was used. Creatinine TAT outcomes were reported over 122 weeks from a high-volume laboratory in Gauteng, South Africa. The percentage of within cut-off and 75th percentile TAT were analysed and reported using Microsoft Excel. A focus group session was used to populate a cause and effect diagram. Results The percentage of within cut-off TAT increased from 10% in week 4 to 90% and higher from week 81. The 75th percentile decreased from 10 hours in week 4 to under 5 h from week 71. Component TAT analysis revealed that the 75th percentile testing was 5 h or longer for weeks 4, 5 and 48. The 75th percentile review TAT ranged from 1 h to 15 h. From week 41, the review TAT was under 1 h. Conclusion Our study demonstrated that the use of an interactive TAT dashboard coupled with good management can dramatically improve TAT and efficiency in a high-volume laboratory.
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Affiliation(s)
- Naseem Cassim
- National Health Laboratory Service (NHLS), Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lindi M Coetzee
- National Health Laboratory Service (NHLS), Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Louella Perelson
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Deborah K Glencross
- National Health Laboratory Service (NHLS), Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Paattiniemi EL, Karumaa S, Viita AM, Kärpänoja P, Mäkelä M, Isojärvi J, Sarkkinen H. Analysis of the costs for the laboratory of flow cytometry screening of urine samples before culture. Infect Dis (Lond) 2016; 49:217-222. [PMID: 27766919 DOI: 10.1080/23744235.2016.1239028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Urine culture samples comprise a large proportion of the workload in clinical microbiology laboratories, and most of the urine samples show no growth or insignificant growth. A flow cytometry-based analyzer (Sysmex Corporation, Japan) has been used to screen out negative urine samples prior to culture in the Päijät-Häme district. We applied decision analytic modelling to analyze, from a laboratory perspective, the economic feasibility of the screening method as compared to culture only (conventional method) for diagnosis of urinary tract infection. Our model suggests that the least costly analytical strategy is the conventional method. The incremental cost of screening is €0.29/sample. Although laboratory costs are higher, considerable savings on workload can be achieved. Furthermore, screening has numerous benefits on the treatment process of a patient that well warrant the use of the screening method. We conclude that the incremental cost of screening the samples is worth the expense.
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Affiliation(s)
- Eeva-Liisa Paattiniemi
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
| | - Santra Karumaa
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
| | | | - Pauliina Kärpänoja
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
| | - Marjukka Mäkelä
- c National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Jaana Isojärvi
- c National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Hannu Sarkkinen
- a Department of Clinical Chemistry and Microbiology , Päijät-Häme Centre for Laboratory Services, Päijät-Häme Social and Health Care Group , Lahti , Finland
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Lu Y, Leong W, Wei B, Yu P, Wang C, Ying Y, Wang T, Tong J, Zhu D, Ye J. An Evaluation of Laboratory Efficiency in Shanghai Emergency by Turn Around Times Level. J Clin Lab Anal 2014; 29:334-41. [PMID: 25130759 PMCID: PMC6807059 DOI: 10.1002/jcla.21775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022] Open
Abstract
Objective China launched a health care reform policy due to the aging population and rapid urbanization. However, emergency overcrowding is not improved. We assessed the laboratory efficiency of emergency department (ED) in Shanghai hospitals. Methods We recorded the turn around times for processing laboratory biomarkers to assess laboratory efficiency at 17 EDs in national/regional hospitals. We compared TAT between national and regional hospitals and between central and ED laboratories to analyze the relationship between the laboratory efficiency and the ED overcrowding. Results All the participating hospitals have an emergency laboratory. The median TAT for c‐TNT was 61 min (46–76 min) at regional EDs compared with 64 min (46–87 min) at national EDs; therefore, the TAT at regional EDs were more efficient (P < 0.05). The TAT were longer (65 min (53–85 min)) at ED labs than (60 min (42–83 min)) at central labs (P < 0.05), independent of the hospital tier and working period. We discovered that only 9% of investigated samples at Tier II EDs and 5% at Tier III EDs were assayed by point‐of‐care (POC) instruments. Conclusion Our TAT level is approaching the recommended international standard. However, the TAT evaluation from ED laboratories demonstrates that their existence does not decrease the waiting time for laboratory reports compared to central laboratory. Thus, they have not yet approached a level to share the burden of the ED overcrowding. Further arrangement should be assigned to separate the function of emergency laboratory and central laboratory. It is worth deploying the POC assay in the ED, which will save twice the TAT level. The idea of evaluating routine laboratory efficiency by TAT at ED is fast, convenient, although it does not represent the general level of laboratory efficiency.
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Affiliation(s)
- Yiming Lu
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Waiian Leong
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bohua Wei
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ping Yu
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cuicui Wang
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yilin Ying
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tingsong Wang
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianjing Tong
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dingliang Zhu
- Joint laboratory of Vascular Biology of Health Science Center and Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Ye
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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