19975份不合格标本原因分析及持续改进措施探讨  

Cause analysis of 19975 unqualified specimens and discussion on continuous improvement measures

作　　者：蒋伟燕[1] 李绵绵[1] 舒旷怡[1] 宓恬[1] 陈小剑[1] JIANG Wei-yan;LI Mian-mian;SHU Kuang-yi;MI Tian;CHEN Xiao-jian(The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325027,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院临床检验中心,浙江温州325027

出　　处：《中国卫生检验杂志》2020年第18期2300-2302,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的通过对19975份实验室不合格标本的原因及分布情况分析,探讨持续改进措施,以提高标本的送检质量及检验结果的准确性。方法采用医院LIS系统导出2016年9月-2018年8月实验室不合格标本19975份,其中住院组17252份、门诊组2703份;改进前5724份、改进后14251份,利用统计软件进行分析。结果门诊组的不合格率明显低于住院组(P<0.01);不合格标本的主要原因是抗凝标本凝固(29.82%)和标本采集量错误(28.72%),其余依次为病区/患者要求作废/医嘱重复(17.98%)、标本容器/类型错误(6.48%)、严重溶血/脂浊(5.43%),标本污染(4.41%)和空管(3.31%);不合格标本主要分布在门急诊检验实验室(78.73%),其余依次为临床微生物检验实验室(9.15%)、临床免疫检验实验室(5.77%)和临床生化检验实验室(5.03%)、临床血液检验实验室(1.10%)和临床分子生物学检验实验室(0.23%);改进后的不合格率低于改进前(P<0.05)。结论通过加强医护人员宣教,增强临床医师、护理和检验的不断沟通和积极配合,优化标本采集和运输流程,从而不断降低标本不合格率,是提高标本的送检质量及检验结果准确性的关键所在。Objective By analyzing the causes and distribution of 19975 cases of unqualified specimens in laboratory and discussing the continuous improvement measures to improve the quality of specimens and the accuracy of test results.Methods A total of 19975 cases of laboratory unqualified specimens were exported by the hospital LIS system from September 2016 to August 2018,including 17252 cases in the inpatient group and 2703 cases in the outpatient group.There were 5724 cases in the pre-improvement group and 14251 cases in the post-improvement group,which were analyzed by statistical software.Results The unqualified rate of outpatient specimens was obviously lower than that of inpatient specimens.The main reasons for unqualified specimens were coagulation of anticoagulant specimens(29.82%)and wrong amount of specimens collected(28.72%),followed by invalidation of the disease area or patient’s request and duplication of medical treatment(17.98%),wrong container/type of specimens(6.48%),severe hemolysis/lipid turbidity(5.43%),Specimen contamination(4.41%)and blank tubes(3.31%).Unqualified specimens were mainly collected in the laboratory of outpatient and emergency medicine(78.73%),followed by clinical microbiology laboratory(9.15%),clinical immunology laboratory(5.77%)and clinical biochemistry laboratory(5.03%),and then clinical blood laboratory(1.10%)and clinical molecular biology laboratory(0.23%).The unqualified rate of the post-improvement group was lower than that of the pre-improvement group(P<0.05).Conclusion The key to improving the quality of specimen submission and the accuracy of test results lies in strengthening the education of medical staff,enhancing the continuous communication and active cooperation between clinicians,nursing staff and laboratory staff,and optimizing the procedures of specimen collection and transportation,so as to continuously reduce the unqualified rate of specimens.

关 键 词：不合格标本 原因 持续改进 分析前质控 

分 类 号：R446[医药卫生—诊断学]