Optimizacija primene principa Lean upravljanja u kliničkim laboratorijama u pre-analitičkoj fazi

Pablo Letelier,Pamela Huencho,Ismael Riquelme,Belén Herrera,Jonathan Mora,Cristóbal Reyno,Jorge Jara,Martín San,Neftalí Guzmán,Jorge Farías,Priscilla Brebi,Francisco Quiñones,Luis Calcumil,Gustavo Medina

doi:10.5937/jomb0-26055

Abstract

BackgroundThe application of the Lean methodology in clinical laboratories can improve workflow and user satisfaction through the efficient delivery of analytical results. The purpose of this study was to optimise delivery times of the test results at a clinical laboratory, using Lean management principles in the pre-analytical phase.MethodsA prospective study with a quasi-experimental design was implemented. Staff functions were restructured and sample flows were modified. Delivery times of clinical results (glucose and haematocrit; 6648 data) from the Medicine and Adult Emergency services for years 2017 and 2018 were compared.ResultsA reduction (p < 0.05) in turnaround times in the delivery of glucose test results at the adult emergency service was observed (84 to 73 min, 13%, pre and post). In addition, there was a non-significant reduction in the turnaround times for glucose (Medicine) and haematocrit in both services. In the analytical and post-analytical phase (not intervened), an increase in turnaround times was observed in some cases.ConclusionsOther studies have indicated that the application of the Lean methodology in clinical laboratories improves workflow, increasing effectiveness and efficiency. This study showed an improvement in the delivery time of test results (glucose - Emergency), giving rise to a culture of cooperation and continuous improvement. It would, however, be essential to address the management model integrating the analytical and post-analytical phases.

Highlights

A clinical laboratory is a fundamental unit in the support of diagnostic, prognostic, treatment control and prevention of different human pathologies
This study showed an improvement in the delivery time of test results, giving rise to a culture of cooperation and continuous improvement
The pre-analytical phase is associated with a greater number of errors [5, 6], constituting one of the most complex phases to control because it has a series of variables and several critical points that require improvement [7].This phase can be divided into an extra-laboratory stage [6] and an intra-laboratory stage [7, 8]

Summary

Introduction

A clinical laboratory is a fundamental unit in the support of diagnostic, prognostic, treatment control and prevention of different human pathologies. Lean is a management model derived from the Toyota Production System, first implemented at the Toyota Japanese car factory [9, 10], which emphasizes the elimination of waste and non-value-added steps in a setting of limited resources, maintaining patient satisfaction [11]. The pillars of this model are continuous improvement and respect of individuals, and its work philosophy aims at using human staff and available resources to improve user services. With regard to improvement models incorporated into the pre-analytical phase, there is currently scant evidence to support that the models have had much impact on the reduction of turnaround times in the delivery of clinical test results

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