A&T : Lab. Reports | Gifu University Hospital

Constructing GPILS with Quality Assurance in Laboratory Testing

* Name of facility and titles are from the time of visit.

Contents

III. Construction and operation of GPILS

I. Preface

Gifu University Hospital was newly built when they moved to the current location in June, 2004. As a "total intelligence hospital", they operate an advanced critical care center that is the largest nationwide, adapting high performance electronic medical charts with optical fiber running throughout the hospital reaching every patient's bedside. Designated as an Intractable Diseases Hospital, Gifu University Hospital was nominated as the Central Hospital of Prefectural and City Governmental Coalition for Cancer Care.

<Gifu University Hospital>
Address: 1-1 Yanagido, Gifu City,
Gifu-ken, Japan 501-6000
TEL: 058-230-6000
URL: http://hosp.gifu-u.ac.jp/
No. of Dept.: 28
No. of Beds: 606
No. of Staff: 855

II. Overview of Laboratory

**Hospital Staff** (as of Dec.1, 2006)
Physicians	2 (Director, Asst. Director)
Medical Technologists	19 (2 assigned to Pathology)
Contract Staff	11 (1 assigned to Pathology)

No. of samples tested in-house (2005)

	Inpatient	Outpatient	Total
Urinalysis	23,020	47,015	70,035
Hemato.	142,462	133,546	276,008
Biochem.	807,487	872,926	1,680,413
Endocrino.	12,187	26,714	38,901
Immuno.	88,324	100,665	188,989
Microbio.	27,334	10,286	37,620
Pathology	93,731	108,753	202,484
		Total	2,494,450

Gifu University Hospital laboratory has been operating under the clinical testing information system CLINILAN LRP Suite and Open LA21 Module System (CLINILOG Ver.3) since they moved to their current location in June 2004.

III. Construction and operation of GPILS

Construction of GPILS
(Interview: Director Mitsuru Seishima)
In building our new hospital, we found it necessary for our laboratory to have key functions: complete electronic medical charts, excellence in cost efficiency, management in prevention of medical malpractice and other areas, and contribution to the advancement of medicine such as providing additional information for tests. In 2002, we started working on the next generation testing system, GPILS as part of an industry-university joint research.

The following report takes a closer look at GPILS which is based on the key idea, Quality Assurance in Testing.

Application of clinical testing navigation system
During rush hours (8:30 - 12:30) when collected blood samples from the wards and outpatients arrive, our 2 vice chief technicians (Mr. Marumoto and Mr. Furuta) act as navigators taking turns in managing data uniformly and monitoring sample receiving through measurement and result report process. They also check questionable results which do not pass conditions set and instruct technicians through the intercom for retests with dilution or to confirm results.
Other responsibilities include assigning staff depending on how busy the central blood collection room is, handling questions from departments and outside of the hospital, receiving additional orders of assay items, and contacting doctors in charge of panic values. This setting has enabled technicians to focus on tests they are in charge of. In the future, we want to strengthen the service we provide such as informing expected result report time to HIS.



Confirm test progress, check images on Web camera and notify staff of delays		Receive instructions from navigator through intercom

Testing Information System TAT Graph Display Screen

Time form sample receiving to result report is monitored and managed since TAT is considered one of the important test qualities.

Sample Receiving Confirmation
In quality assurance, traceability is critical. Before this system was constructed, we had problems with whether a sample was sent or not. But now because who delivers samples at what time is kept in a log, we can prevent trouble in sending and receiving samples.


Sending and receiving samples

Goods Management
More and more reagents and consumables are bar-coded EAN128 due to demand in lot and expiry management of goods for quality assurance. To get a head start in in-house distribution system, we implemented the Laboratory Management Support System (CLINILAN LM) before moving to our new location and have been running under optimal supply and control.


Delivery operation		Reagent stockyard where location of goods are managed

Cost Reduction

Changes in Cost of Laboratory Materials and No. of Tests

When we relocated, we reviewed our testing devices and test items inside and out and integrated pre-examination testing done as routine with emergency testing which had high running cost. Overstocking decreased as we implemented a goods management system which raised the cost awareness of each staff. These have enabled us to cut cost.

Reference Data Base (RefDB)
As a tool to provide information from the laboratory to department and patients, we introduced RefDB. For medical staff, we offer notices and assay references, list of sample collection containers, search for ICD10 disease names, and others. For patients, some of the things we offer include test item results and standard values authorized by the doctor in charge, and description of test items prepared for patients specifically. Because it is linked directly from the test items displayed on order entries and electronic medical charts, not only doctors and nurses use this service, but medical students as well. In the future, we are planning to set up a computer in the central blood collection room so that patients waiting to have their blood drawn can browse through test information freely while they wait.


[for medical staff] RefDB displayed from order entry window		[for inpatients] RefDB displayed from patient's bedside

Expanding Operation and Service Improvement
Effective operation including laborsaving has lead to the expansion in operation and service improvement. We increased emergency testing items from 22 items to 80 items when we relocated and all patient samples are now treated with urgency. Also by changing work shifts from holiday/evening duties to day/evening duties for laboratory staff, we are now able to provide 24-hour prompt service. In addition, we successfully expanded operation by incorporating blood collection and urinalysis tasks in the laboratory without increasing the number of staff.

IV. From the director

Director Seishima

The 5 targets we aimed at in constructing GPILS, 1) Rapidness 2) accuracy 3) economic efficiency 4) operational expansion by laborsaving and 5) advanced medical technology, have shown successful results exceeding our initial expectations. The positive results are reflected in the "Very satisfied" answers in the questionnaire completed by the clinical side. As RefDB is utilized by many medical staff, we would like to improve the service even better by providing more valuable information. Recently, with the improvement in IT environment in other hospitals, we are working on setting standard values and commoditizing data for the whole Gifu region by holding periodical meetings at our laboratory. From here on, we will continue to fulfill our duty as a hospital laboratory and at the same time contribute to community health care.

Laboratory staff
(center: Chief Technologist Iida, 2nd from right: Asst. Chief Technologist Furuta)

V. From other department staff

Hospital management
strategy conference room

Electronic Medical Chart
(Interview: Medical Information Department/ Assistant Director Yoshimune Shiratori)
As we considered digitalization as a key in hospital management strategy, we manage all digitalized data in the hospital including everything from management of each goods to dinner menu of inpatients, achieving a film less and paperless environment. In building a hospital environment convenient for patients, currently the next generation digitalization planning which would enable commoditizing medical care data throughout the entire prefectural area is underway.

Incoming ambulance helicopter

Advanced Critical Care Center
(Interview: Advanced Critical Care Center/ Director Shinji Ogura)
For patients in Gifu prefecture requiring advanced medical care, time is a critical factor as 90% of the prefecture is consisted of communities in mountainous areas where there are many difficulties to overcome when providing emergency medical care. Our heliport set up on the hospital roof which is directly connected to the intensive care unit is based on our motto we've had since building our new hospital, "Advanced medical care for everyone, anytime." The emergency care center is staffed with top-level medical personals proving 24-hour advanced critical care. The agreement arranged with Gifu prefecture disaster-prevention helicopters enables us to cover the entire prefecture within 1 hour.

We thank Director Seishima and all staff at Gifu University Hospital for their cooperation and support.

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