Revista del Hospital Materno Infantil Ramón Sardá 01/2010;
Source: DOAJ

ABSTRACT Introducción. La calidad de una gestión planificada debe residir tanto en el resultado del servicio brindado como en su proceso de prestación. La misión del laboratorio de urgencia es proporcionar el informe de los resultados a la mayor brevedad posible (menor TAT -turn around time-), con la máxima eficiencia, calidad, responsabilidad, ética y profesionalidad, proporcionando al médico un apoyo importante en el diagnóstico y tratamiento. El error en las fases pre y posanalíticas es superior a la analítica. Los tiempos consumidos en estas etapas son los que ocasionan mayores aumentos en el tiempo de respuesta. Los ciclos de mejora deben orientarse a acciones que aumenten el control sobre las mismas. Objetivos. Evaluar errores preanalíticos (administrativos -EA- y técnicos -ET-) y posanalíticos (EPoA) que impactan en la calidad de la atención. Implementar las acciones correctivas convenientes y evaluar la mejora implementada. Materiales y métodos. Se midieron indicadores para evaluar los EA, ET y EPoA durante cuatro semanas. Al mes de implementada la acción correctiva se monitoreó la mejora durante igual tiempo. Resultados. Se obtuvo una clara disminución en los errores pre y posanalíticos luego de implementadas las acciones de mejora, un significativo acortamiento en los tiempos de respuesta y un aumento de la percepción de la calidad en los clientes internos. Conclusiones. El monitoreo de las etapas pre y posanalíticas reveló una disminución del error luego de implementada la mejora. Es importante continuar con las actividades de capacitación para que las mejoras alcanzadas sean sustentables en el tiempo.

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    ABSTRACT: Application of Total Quality Management concepts to laboratory testing requires that the total process, including preanalytical and postanalytical phases, be managed so as to reduce or, ideally, eliminate all defects within the process itself. Indeed a "mistake" can be defined as any defect during the entire testing process, from ordering tests to reporting results. We evaluated the frequency and types of mistakes found in the "stat" section of the Department of Laboratory Medicine of the University-Hospital of Padova by monitoring four different departments (internal medicine, nephrology, surgery, and intensive care unit) for 3 months. Among a total of 40490 analyses, we identified 189 laboratory mistakes, a relative frequency of 0.47%. The distribution of mistakes was: preanalytical 68.2%, analytical 13.3%, and postanalytical 18.5%. Most of the laboratory mistakes (74%) did not affect patients' outcome. However, in 37 patients (19%), laboratory mistakes were associated with further inappropriate investigations, thus resulting in an unjustifiable increase in costs. Moreover, in 12 patients (6.4%) laboratory mistakes were associated with inappropriate care or inappropriate modification of therapy. The promotion of quality control and continuous improvement of the total testing process, including pre- and postanalytical phases, seems to be a prerequisite for an effective laboratory service.
    Clinical Chemistry 09/1997; 43(8 Pt 1):1348-51. · 7.77 Impact Factor
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    ABSTRACT: The problem of medical errors has recently received a great deal of attention, which will probably increase. In this minireview, we focus on this issue in the fields of laboratory medicine and blood transfusion. We conducted several MEDLINE queries and searched the literature by hand. Searches were limited to the last 8 years to identify results that were not biased by obsolete technology. In addition, data on the frequency and type of preanalytical errors in our institution were collected. Our search revealed large heterogeneity in study designs and quality on this topic as well as relatively few available data and the lack of a shared definition of "laboratory error" (also referred to as "blunder", "mistake", "problem", or "defect"). Despite these limitations, there was considerable concordance on the distribution of errors throughout the laboratory working process: most occurred in the pre- or postanalytical phases, whereas a minority (13-32% according to the studies) occurred in the analytical portion. The reported frequency of errors was related to how they were identified: when a careful process analysis was performed, substantially more errors were discovered than when studies relied on complaints or report of near accidents. The large heterogeneity of literature on laboratory errors together with the prevalence of evidence that most errors occur in the preanalytical phase suggest the implementation of a more rigorous methodology for error detection and classification and the adoption of proper technologies for error reduction. Clinical audits should be used as a tool to detect errors caused by organizational problems outside the laboratory.
    Clinical Chemistry 06/2002; 48(5):691-8. · 7.77 Impact Factor


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