急诊凝血功能检测实验室内周转时间回归模型建立及危险因素的分析与干预
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江苏省中西医结合医院检验科

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Establishment of Logistic Regression Model of Laboratory TAT for Emergency Blood Coagulation Test as well as Analysis and Intervention on Risk Factors
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    摘要:

    目的:建立实验室内凝血功能检测周转时间回归模型,探讨影响实验室内周转时间的危险因素,并验证采取干预措施后的效果。方法 选取2018年10月至12月(干预前)及2019年3月至5月(干预后)凝血功能检测数据,分别为2383份和2687份,记录检测人员工龄、学历、性别;每份样本实验室内周转时间(TAT)、样本检测时段、各时间段样本负荷,分析不同员工间实验室内周转时间(TAT)差异、前后半夜TAT的差异及导致TAT超时的危险因素,进一步对不同人员干预前后三个月月均TAT进行聚类分析,并验证采取针对性干预措施后的效果。结果 1. 干预前,九名工作人员间凝血功能检测实验室内TAT存在显著差异,员工B、I实验室内TAT最短,而E最长,且仅5名人员TAT满足质量要求。干预后,4名员工(A、C、D、H)TAT显著缩短,7名人员TAT满足质量要求。2. 对前后半夜两个不同的检测时段标本实验室内TAT分析显示,5名工作人员(C、D、E、G、H)前半夜TAT时间显著短于后半夜;而干预后9名工作人员前半夜TAT时间均显著短于后半夜。3. 二元Logistic回归显示,工龄是TAT的有利因素,后半夜的检测时段则是TAT的不利因素;相对于C,员工B、F、G、H、I是有利因素,而员工E则是不利因素。4. 对干预前9名工作人员凝血功能检测实验室内TAT表现进行聚类分析,优良:员工B、F、G、I;及格:员工A、C、D、H;不及格:员工E,且员工A、C、D、H的TAT接近员工E;对比干预前,干预后9名工作人员聚类分析显示员工E的TAT远离其他员工,而其他8名员工TAT较干预前接近。结论 实验室管理者利用统计学方法建立模型,对实验室的质量指标进行分析,寻找其发生偏离的危险因素,从而针对性的采取纠正措施,可以达到精细化管理的目的。

    Abstract:

    Objective The Logistic regression model of laboratory turnaround time (TAT) of blood coagulation test was established to explore the risk factors that affect the turnaround time in the laboratory and to verify the effect of the interventions. Methods A total of 2383 pre-intervention blood coagulation test data from October to December in 2018 and 2687 post-intervention data from March to May in 2019 were included. Information including ages, gender as well as education background of operators, laboratory TAT, the period of samples testing as well as sample load in each period were recorded. Then, the difference of laboratory TAT timeouts,the difference between pre- and post-midnight, the related factors on TAT were analyzed. Furthermore, operators average monthly TAT of pre- and post-intervention were accessed by clustering analysis. Results 1. There was significant difference of TAT among nine operators and TAT for four operators was significantly shortened after intervention. After the intervention, 7 operators reached the quality index, compared with 4 before the intervention. 2. Compared to post-midnight, TAT for five operators was significant shorter than it in pre-midnight before intervention, however, so as all operators did after intervention. 3. The result of logistic regress indicated that years of working was the positive factors for the TAT, however, the post-midnight testing period was on the opposite. Compared to A, operator B, G, H and I were positive factors, however, operator E was a negative factor. 4. According to pre-intervention average monthly TAT data, 9 operators were divided into three grades by clustering analysis, excellent: operator B, F, G, I; pass: operator A, C, D, H; failing: operator E, and the TAT data of operator A, C, D and H were close to E, nevertheless, clustering analysis of post-intervention TAT data revealed that the operator E’ TAT data was far worse than the other operators’. Conclusions Statistical model could be used in laboratory indicators analysis and negative factors exploring. The laboratory director could take the corrective action according to the results and achieve refined management consequently.

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张静.急诊凝血功能检测实验室内周转时间回归模型建立及危险因素的分析与干预[J].临床检验杂志,2020,(10):795-797

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  • 收稿日期:2020-07-01
  • 最后修改日期:2020-11-17
  • 录用日期:2020-11-17
  • 在线发布日期: 2021-03-24
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