Clinical laboratories for in vitro diagnostics are facing pressure to preserve cost control while providing better services through new initiatives. Laboratory automation is a partial answer to this problem, having come a long way from the early days of clinical laboratory testing. The journey and implementation of automation in the Singapore General Hospital's Clinical Biochemistry Laboratory has allowed for sustained performance in the light of increasing workload and service commitments amid an evolving healthcare environment. Key to realising predicted outcomes is the optimisation of workflow processes, reduction of errors, and spatial placement of specimen reception and analytical areas. This paper gives an overview of our experience with automation in the clinical laboratory and its subsequent impact on service standards.
Aged ; Automation, Laboratory ; Clinical Laboratory Information Systems ; organization & administration ; Clinical Laboratory Techniques ; Efficiency, Organizational ; statistics & numerical data ; Hospitals, General ; Humans ; Laboratories, Hospital ; organization & administration ; Middle Aged ; Quality of Health Care ; Singapore ; Tertiary Healthcare ; organization & administration ; User-Computer Interface ; Workload

BACKGROUND: Complete blood count (CBC) results play an important role in peripheral blood smear (PBS) examinations. Many descriptions in PBS reports may simply be translated from CBC parameters. We developed a computer program that automatically generates a PBS draft report based on CBC parameters and age- and sex-matched reference ranges. METHODS: The Java programming language was used to develop a computer program that supports a graphical user interface. Four hematology analyzers from three different laboratories were tested: Sysmex XE-5000 (Sysmex, Kobe, Japan), Sysmex XN-9000 (Sysmex), DxH800 (Beckman Coulter, Brea, CA, USA), and ADVIA 2120i (Siemens Healthcare Diagnostics, Eschborn, Germany). Input data files containing 862 CBC results were generated from hematology analyzers, middlewares, or laboratory information systems. The draft reports were compared with the content of input data files. RESULTS: We developed a computer program that reads CBC results from a data file and automatically writes a draft PBS report. Age- and sex-matched reference ranges can be automatically applied. After examining PBS, users can modify the draft report based on microscopic findings. Recommendations such as suggestions for further evaluations are also provided based on morphological findings, and they can be modified by users. The program was compatible with all four hematology analyzers tested. CONCLUSIONS: Our program is expected to reduce the time required to manually incorporate CBC results into PBS reports. Systematic inclusion of CBC results could help improve the reliability and sensitivity of PBS examinations.
Blood Cell Count* ; Clinical Laboratory Information Systems ; Delivery of Health Care ; Hematology ; Indonesia ; Information Storage and Retrieval ; Programming Languages ; Reference Values

Point-of-care (POC) testing is desirable because of both the ease with which it can be administered and its short turnaround time. However, because standard POC devices cannot transmit test results automatically to a laboratory information system (LIS), each result must be recorded by hand. This inconvenience not only increases the possibility of clerical errors, but also limits the proper use of test results. If POC test results are not saved in the LIS, it is hard to either monitor patients' health trends or to quality control (QC) the test results. In this paper, we describe how we have solved these problems by connecting 250 POC blood glucose test devices to the LIS via a local area network (LAN). After connecting the POC devices (we used the Accu-Chek Inform II; Roche Diagnostics, Germany) to a manufacturer-provided POC data management system (Roche's Cobas IT 1000; Roche Diagnostics), we developed our own interface program for delivering data from the Cobas IT 1000 system to the LIS. By installing a program to scan the identification barcode worn by patients on their wrists, network-connected POC devices enable users to omit extra ordering, receiving, and recording processes, and they also reduce the possibility of patient misidentification. Such a system also provides an effective way for physicians to follow both the current and accumulated test results of patients. We note that performing QC on glucometers and the sending of data via LAN to the LIS are necessary steps to monitor both patients' results and the QC of those results.
Blood Glucose* ; Clinical Laboratory Information Systems ; Glucose ; Hand ; Humans ; Local Area Networks ; Point-of-Care Systems ; Quality Control ; Wrist

No abstract available.
*Algorithms ; Automation ; Clinical Laboratory Information Systems/*standards ; Humans ; Immunoassay/*methods ; Indicator Dilution Techniques ; alpha-Fetoproteins/*analysis

OBJECTIVES: The purpose of this study was to design an integrated data management system based on the POCT1-A2, LIS2-A, LIS2-A2, and HL7 standard to ensure data interoperability between mobile equipment, such as point-of-care testing equipment and the existing hospital data system, its efficiency was also evaluated. METHODS: The method of this study was intended to design and realize a data management system which would provide a solution for the problems that occur when point-of-care testing equipment is introduced to existing hospital data, after classifying such problems into connectivity, integration, and interoperability. This study also checked if the data management system plays a sufficient role as a bridge between the point-of-care testing equipment and the hospital information system through connection persistence and reliability testing, as well as data integration and interoperability testing. RESULTS: In comparison with the existing system, the data management system facilitated integration by improving the result receiving time, improving the collection rate, and by enabling the integration of disparate types of data into a single system. And it was found out that we can solve the problems related to connectivity, integration and interoperability through generating the message in standardized types. CONCLUSIONS: It is expected that the proposed data management system, which is designed to improve the integration point-of-care testing equipment with existing systems, will establish a solid foundation on which better medical service may be provided by hospitals by improving the quality of patient service.
Clinical Laboratory Information Systems ; Database Management Systems ; Dietary Sucrose ; Hospital Information Systems ; Humans ; Information Systems ; Medical Order Entry Systems ; Point-of-Care Systems

BACKGROUND: Test results in a laboratory are simply relayed to the laboratory information system through the interface. Middleware facilitates and manages the interaction between applications across heterogeneous computing platforms. We applied middleware to automated hematology analyzers in a clinical laboratory. METHODS: We used HemLink (Beckman Coulter Korea, Korea) as middleware between the laboratory information system and hematology analyzers. It provides quality control programs including the Westgard multirule chart and moving averages. RESULTS: Unlike the previous system, middleware does not require manual input of the quality control results. Amendment of quality control, if necessary, could be done without the help of hospital information teams. Identification of abnormal results with patient information could be achieved with moving averages. Morphology flags and system flags are checked at remote computers. CONCLUSIONS: Management of quality control results of hematology analyzers was easy via middleware. Thus, middleware could be useful to connect proficiency testing programs with HemLink and to compare results from laboratories using the same middleware.
Clinical Laboratory Information Systems ; Hematology ; Humans ; Korea ; Quality Control

Carbapenem resistance in Acinetobacter baumannii has increased rapidly worldwide. It is generally assumed that carbapenem prescription in a hospital has a significant impact on imipenem resistance in A. baumannii. However, there are few studies validating these assumptions with statistical data. We performed a surveillance study to investigate the relationship between carbapenem prescription trends and the imipenem resistance rate of A. baumannii in an ICU. Carbapenem prescription data in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format for the period from 2006 to 2010 were obtained from the hospital electronic pharmacy records. In the same period, microbiologic data for the ICU were extracted from the laboratory information system. Imipenem resistance rates of A. baumannii increased from 4.3% in 2006 to 83.8% in 2010 (P <0.05; r2=0.85). Carbapenem prescription had increased from 19.71 DDD per 1,000 inpatient-days in 2006 to 36.99 DDD per 1,000 inpatient-days in 2010 (P <0.05; r2=0.95). Carbapenem prescription rate correlated with the imipenem resistance rate in A. baumannii (P <0.05; R=0.9). The results of our study demonstrated a correlation between carbapenem prescription trends and imipenem resistance in A. baumannii.
Acinetobacter ; Acinetobacter baumannii ; Clinical Laboratory Information Systems ; Dichlorodiphenyldichloroethane ; Electronics ; Electrons ; Imipenem ; Critical Care ; Intensive Care Units ; Pharmacy ; Prescriptions

The current 5 kinds of integrated solutions are analysed and compared to accomplish the connecting demand between laboratory small systems and LIS systems. According to different scenarios and specific needs, we have adopted suitable technical solution for the integration to complete connection requirements.
Clinical Laboratory Information Systems ; Computer Systems ; Systems Integration

BACKGROUND: When it comes to wasting blood components, it usually means wastage before transfusion due to several reasons such as improvement of the patient's condition, death of the patient, delay of blood returning, etc. Yet blood components can sometimes can be wasted after a transfusion is started and this is referred as residual blood wastage. In this study, we analyzed the rate and causes of discarded blood components that are not used and the residual blood wastage in order to help reduce the rate of blood component wastage. METHODS: From January 2009 to December 2010, the number of and the reasons for discarded blood components without use and residual blood wastage were analyzed by reviewing the laboratory information system and wastage statements at Soonchunhyang University Seoul Hospital. RESULTS: The number of blood components issued during the study period was 24,001 units. Among them, the number of units discarded without use was 162 units (0.7%) and the number of units of residual blood wastage was 115 units (0.5%). Among the reasons for the discarded blood component without use, improvement of the patient's conditions ranked as 1st with 80 units (49.5%) and death of the patient ranked as 2nd with 42 units (25.9%). The biggest reason for the residual blood wastage was transfusion-related side effects with as many as 52 units (45.2%). Other than side effects, the wastage of residue from pediatric transfusion were 48 units (41.7%), followed by delay of surgery with 5 units (4.3%) and patients' refusal with 4 units (3.5%). CONCLUSION: The wastage of residue from pediatric transfusion was the second most common cause of residual blood wastage in our hospital. According to this, we should evaluate the routine use of pediatric transfusion bags and their cost-effectiveness in our hospital.
Clinical Laboratory Information Systems ; Disulfiram ; Humans ; Korea

BACKGROUND: The Streptococcus pneumoniae urinary antigen test (SPUAT) (Binax Now, USA) was developed for detecting polysaccharide C in urine samples for rapid diagnosis of pneumococcal pneumonia, the most common cause of community-acquired pneumonia (CAP). To validate positive results of these tests, we retrospectively investigated all positive results obtained from the emergency room of a Korean university hospital among patients with suspected CAP. METHODS: One hundred twenty-three positive SPUAT results were abstracted and analyzed from the authors' laboratory information system among the SPUAT results performed from 1,143 pneumonic patients admitted from the emergency room of a university hospital between 2007 and 2008. Medical records, including conventional microbiologic analysis results, were reviewed in detail for all positive test results. RESULTS: Among 123 patients with the positive SPUAT results, 24 patients were excluded due to hospitalization history during the preceding month. Nine of 99 patients (9.1%) with suspected CAP had confirmed pneumococcal pneumonia upon conventional sputum or blood culture. Thirty-five positive results (35.4%) showed other microorganisms upon conventional methods, which might be due to possible cross-reactivity. Among those, 23 positive results were considered bacterial pneumonic agents, and 12 positive results were regarded as urinary tract infection strains or contaminating agents. Fifty-five positive SPUAT results (55.6%) showed negative conventional microbiologic growth, and some positive SPUAT results might be caused by true pneumococcal infection although without cultural evidence. CONCLUSION: Our retrospective study demonstrated that a positive SPUAT result typically does not agree well with conventional culture methods, suggesting that the value of a positive SPUAT result in etiology determination may be limited under practical conditions in a university hospital.
Antigens, Bacterial ; Clinical Laboratory Information Systems ; Emergencies ; Hospitalization ; Humans ; Medical Records ; Pneumococcal Infections ; Pneumonia ; Pneumonia, Pneumococcal ; Retrospective Studies ; Sputum ; Streptococcus ; Streptococcus pneumoniae ; Urinary Tract Infections