Impacto de la informatización de procesos del Laboratorio Clínico ICS Lleida en seguridad del paciente

El objetivo del presente trabajo fue valorar el impacto de la informatización del proceso de solicitud analítica sobre la seguridad del paciente, en el laboratorio clínico del ICS de Lleida, a partir de indicadores de calidad preanalíticos. Se trata de un estudio descriptivo y transversal que se desarrolló en dos partes: En una primera se llevó a cabo un análisis descriptivo de la población a estudio y en la segunda parte, un estudio analítico de la muestra, en que se estudió la asociación entre los indicadores de calidad del proceso preanalítico antes, inmediatamente después, al año y a los tres años de la implantación de la petición electrónica en grupos independientes. El periodo inmediatamente posterior a la implantación presentó en conjunto el mayor número de errores preanalíticos, para descender en los años siguientes. El impacto de la informatización de la solicitud analítica fue positivo para la seguridad del paciente una vez consolidado el proceso, pero otros factores como la formación del personal extractor y la comunicación bidireccional con el laboratorio deben ser considerados.L’objectiu d’aquest treball fou valorar l’ impacte de la informatització del procés de sol•licitud analítica sobre la seguretat del pacient, al laboratori clínic del ICS de Lleida, en base indicadors de qualitat preanalítics. Es tracta d’un estudi descriptiu i transversal desenvolupat en dues parts: En una primera es va dur a terme una anàlisi descriptiva de la població a estudi i a la segona part, un estudi analític de la mostra, es va estudiar l’associació entre els indicadors de qualitat del procés preanalític abans, immediatament després, a l’any i als tres anys de la implantació de la petició electrònica en grups independents. El període immediatament posterior a la implantació va presentar en conjunt el major nombre d’errors preanalítics, per a disminuir els anys següents. L’impacte de la informatització de la sol•licitud analítica va ser positiu per a la seguretat del pacient un cop consolidat el procés, però cal considerar altres factors com la formació del personal extractor i la comunicació bidireccional amb el laboratori.The aim of this study was to assess analytical request computerization impact on patient safety using quality preanalytical indicators, in a Lleida laboratory belonging to the Catalonian Health Institute (ICS). This is a descriptive cross study developed in two parts. In the first, a population descriptive analysis was carried out. In the second part, a sample analytical study, the association between preanalytical quality indicators was studied before, immediately after, one year after and three years after of the implementation of the computerized system in independent groups. Period immediately after implementation was the worst in terms of preanalytical errors. Errors decrease in subsequent years. The impact of computerization of analytical request was positive for patient safety once the process was consolidated, but other factors such as phlebotomy staff training and bidirectional communication with laboratory specialists must also be taken into account

Managing inappropriate utilization of laboratory resource

Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources

Elimination of Vitamin D Signaling Causes Increased Mortality in a Model of Overactivation of the Insulin Receptor: Role of Lipid Metabolism

Vitamin D (VD) deficiency has been associated with cancer and diabetes. Insulin signaling through the insulin receptor (IR) stimulates cellular responses by activating the PI3K/AKT pathway. PTEN is a tumor suppressor and a negative regulator of the pathway. Its absence enhances insulin signaling leading to hypoglycemia, a dangerous complication found after insulin overdose. We analyzed the effect of VD signaling in a model of overactivation of the IR.We generated inducible double KO (DKO) mice for the VD receptor (VDR) and PTEN. DKO mice showed severe hypoglycemia, lower total cholesterol and increased mortality. No macroscopic tumors were detected. Analysis of the glucose metabolism did not show clear differences that would explain the increased mortality. Glucose supplementation, either systemically or directly into the brain, did not enhance DKO survival. Lipidic liver metabolism was altered as there was a delay in the activation of genes related to -oxidation and a decrease in lipogenesis in DKO mice. High-fat diet administration in DKO significantly improved its life span. Lack of vitamin D signaling increases mortality in a model of overactivation of the IR by impairing lipid metabolism. Clinically, these results reveal the importance of adequate Vitamin D levels in T1D patients

State of affairs and future challenges in laboratory medicine in Spain : an analysis of the Spanish Society of Laboratory Medicine (SEQC ML)

Objectives: Laboratory Medicine is a crucial discipline that contributes to the diagnosis, management and monitoring of patients. This branch of medicine faces two major challenges: New technologies and increased demand. There is limited information available of the state of affairs in Laboratory Medicine in Spain. This study provides a picture of clinical laboratories and clinical laboratory professionals. Methods: The Spanish Society of Laboratory Medicine distributed a questionnaire among the 250 most representative centers (the ones with the largest volume of determinations and training programs), of which 174 (69.6%) returned the questionnaire providing data for 2019. Results :Laboratories were classified according to the number of determinations. In total, 37% identified themselves as small (5 million determinations). The level of specialization of laboratory physicians and laboratory performance were higher in large laboratories. Most requests (87%) and determinations (93%) corresponded to biochemistry and hematology. As many as 63% of physicians had an indefinite contract, and 23% were older than 60 years. Conclusions: Laboratory medicine is a consolidated discipline that is gaining relevance in Spain. It adds value to the diagnosis, prognosis and follow-up of diseases, and to treatment response monitoring. The results of this study will help us address challenges such as the need for specialized training for laboratory professionals; the emergence of technological innovations; exploitation of Big Data; optimization of quality management systems and patient safety

Harmonization of quality indicators in laboratory medicine. A preliminary consensus

Quality indicators (QIs) are fundamental tools for enabling users to quantify the quality of all operational processes by comparing it against a defined criterion. QIs data should be collected over time to identify, correct, and continuously monitor defects and improve performance and patient safety by identifying and implementing effective interventions. According to the international standard for medical laboratories accreditation, the laboratory shall establish and periodically review QIs to monitor and evaluate performance throughout critical aspects of pre-, intra-, and post-analytical processes. However, while some interesting programs on indicators in the total testing process have been developed in some countries, there is no consensus for the production of joint recommendations focusing on the adoption of universal QIs and common terminology in the total testing process. A preliminary agreement has been achieved in a Consensus Conference organized in Padua in 2013, after revising the model of quality indicators (MQI) developed by the Working Group on “Laboratory Errors and Patient Safety” of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). The consensually accepted list of QIs, which takes into consideration both their importance and applicability, should be tested by all potentially interested clinical laboratories to identify further steps in the harmonization project527951958sem informaçã

Laboratory sample stability. Is it possible to define a consensus stability function? An example of five blood magnitudes

Background: The stability limit of an analyte in a biological sample can be defined as the time required until a measured property acquires a bias higher than a defined specification. Many studies assessing stability and presenting recommendations of stability limits are available, but differences among them are frequent. The aim of this study was to classify and to grade a set of bibliographic studies on the stability of five common blood measurands and subsequently generate a consensus stability function. Methods: First, a bibliographic search was made for stability studies for five analytes in blood: alanine aminotransferase (ALT), glucose, phosphorus, potassium and prostate specific antigen (PSA). The quality of every study was evaluated using an in-house grading tool. Second, the different conditions of stability were uniformly defined and the percent deviation (PD%) over time for each analyte and condition were scattered while unifying studies with similar conditions. Results: From the 37 articles considered as valid, up to 130 experiments were evaluated and 629 PD% data were included (106 for ALT, 180 for glucose, 113 for phosphorus, 145 for potassium and 85 for PSA). Consensus stability equations were established for glucose, potassium, phosphorus and PSA, but not for ALT. Conclusions: Time is the main variable affecting stability in medical laboratory samples. Bibliographic studies differ in recommedations of stability limits mainly because of different specifications for maximum allowable error. Definition of a consensus stability function in specific conditions can help laboratories define stability limits using their own quality specifications