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| * Name of facility and titles are from the time of visit. |
Contents
I. Preface
Tazuke Kofukai Medical Research Institute Kitano Hospital was established
in 1928 in partnership with Kyoto University Graduate School of Medicine
as a general hospital with the capacity of conducting research and development
for medical treatment. Located in the center of Kita ward in the
city of Osaka, it plays a central role in community health care.
 <Kitano Hospital>
Address: 2-4-20 Ohgimachi, Kita-ku, Osaka-shi, Osaka-fu, Japan 530-8480
TEL: 06-6312-1221
URL: http://www.kitano-hp.or.jp/
No. of Dept.: 26
No. of Beds: 741
No. of Staff: 1,014
II. General Information of Laboratory
Hospital Staff (as of Dec. 13, 2005)
| Physician (Director of Laboratory) |
1 |
| Medical Technologists (Sample testing/ Physio. testing/ Comp. Med. Exam) |
32 |
| Clerk |
3 |
No. of Samples tested In-house (2004)
| Bio-chem. |
2,243,174 |
Serolo.(Immu.) |
182,054 |
TDM |
3,698 |
| Urine-chem. |
42,982 |
Serolo.(Infec.) |
72,087 |
Microbiology |
39,531 |
| Hemato. |
170,676 |
Virology |
7,863 |
Tuberculosis |
6,304 |
| Coag. |
52,135 |
Endocrino. |
39,144 |
|
|
| Urinalysis |
130,609 |
Tumor Marker |
38,712 |
|
|
| |
|
|
|
TOTAL |
3,028,969 |
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| Kitano Hospital has been operating with our Laboratory Information System
CLINILAN since 1997 and Laboratory Automation System which was implemented
in December, 2004. The following is an interview with Chief Technologist
Tabata on why they implemented LIS and LAS and the advantages brought upon
the laboratory. |
III. LAS - Laboratory Automation System
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| (from left) Unloading and Sorting Module, Sample Loading Module, Centrifuge,
De-capper, Aliquot Module (2 units) |
 Catalyst of LAS implementation
When we relocated to the new hospital back in 2001, LAS mainstream was
rack type transportation system and single line transportation type was
rare. Although rack type transportation system is most capable of
handling mass samples, we felt that it was not suited for us considering
the size of our hospital. Soon after that, we learned about Open
LA21 Module System (CLINILOG Ver.3) which operates like a single analyzer
with a single line transportation capable of the kind of operation we were
looking for and decided to implement the system.
Our Aim
Currently, there are 3 to 4 staffs for sample testing: 1 for bio-chemistry,
1 for serology (immunology), and 2 for transportation, manual handling,
and reception. Decreased to almost a half from 6 before implementing
the system. Sometimes implementation of LAS is reflected to cutback
in staff, but not in our case. The basic number of staff at our laboratory,
32, has not changed; we have decreased the amount of responsibilities put
on each staff and promoted an environment where staff are encouraged to
learn new information and technology.
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| (left) 504X and (right)TBA-200FR connected to LAS |
Flexible Staff Assignment
Before the implementation of LAS, each analyzer was operated individually
by an assigned personnel performing specific tasks which were time consuming,
especially with pre-processing and post-processing. Before we had
problems with complicated tasks of placing samples in order before storing
and misplacing samples when setting them in analyzer. Because analyzers
are connected in a single line and operate as a single instrument, we were
able to eliminate these troublesome tasks. Although the least amount
of technicians are assigned for physiological testing, depending on the
time of the day or increased number of test orders received, staff from
sample testing can help out while they still perform their main jobs.
Reduction in Reporting Test Results Time
Soon after 8:30, out-patient STAT samples begin to arrive. Before we used
to have to interrupt routine sample testing to load STAT samples but with
Open LA21 system we no longer have to since urgent samples are automatically
prioritized. Now the time it takes to receive results for routine
and STAT samples are basically the same so there is no concept of urgency
with in-patients in our hospital wards. By 10:00, most of the test
results are reported.
Simplification of Additional Testing
Recently, the number of test items each patient is tested on has decreased
from 20 items down to 10 items in bio-chemistry. Before implementing
LAS, finished samples had to be manually placed in a number order, from
which additional testing samples had to be found when necessary. But
now because each sample has a storing position, relevant samples are found
quickly and loaded onto LAS. This was one of the great features that LAS
implementation has provided the laboratory.
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| View of Laboratory |
In Search of an Effective Operation
Over 1,000 samples are loaded onto LAS everyday with results reported in
40 minutes from the time samples are received. An assigned staff watches
the entire flow in the laboratory and controls the amount of samples loaded
since loading them all at once would only cause congestion. We also assign
a fully knowledgeable staff so that when problems occur they are dealt
with immediately. When a problem occurs with an analyzer, the assigned
staff is expected to make decisions quickly to either load only the samples
that do not need to be tested on it or load all samples and retest samples
that are detected as error. You may wonder why we need people to make decisions
after installing an automation system. But this in fact maximizes the full
capability of LAS.
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| Central Blood Collection Room |
Automated Analyzer 504X
Complicated urinalysis was automated by implementing 504X exquisitely for
urine testing since there is no change of throughput in sample dilution.
Our demands for LAS
After DPC takes effect in April 2006, the number of initial test items
will decrease but instead the number of additional tests ordered after
reviewing initial test results will increase. We are planning a new
operation where laboratory technicians decide whether additional tests
are necessary based on test results before data is sent to physicians.
In order to operate this way, it is best for samples to be stored
in a refrigerator after analysis and automatically sent back for rerun.
It would also be ideal to have a function where serum volume is automatically
checked.
IV. LIS - Laboratory Information System
Installation and Update History of CLINILAN
1997 Introduction of CLINILAN (OS2) after comparing with competitors'
LIS
2000 In-patient ordering began, connected with LIS
2001 Updated to CLINILAN NT at the time of relocation, connected
with out-patient ordering
2004 Updated to CLINILAN Ver.8
Implementation of CLINEEL (Zonal Verification Method)
We do not feel that it is necessary for technicians to check all test data
but rather important that data entry be done with as little manpower as
possible. For example, why not have half the data be entered automatically
by Zonal Verification Method? Verification by technicians may
be considered more reliable but there are times when samples are retested
merely by chance or not retested because it went unnoticed. Implementation
of CLINEEL enabled us to retrieve data that need to be checked. Also
because entering hundreds and thousands of data all day is an strenuous
task where one can overlook data, we add some variations to the staff's
daily responsibilities such as assigning staff to perform other tasks (e.g.
physiological testing in the afternoon).
V. Working Together with Clinical Side
Gaining Understanding of Testing
Doctors and nurses are not too familiar with testing since they do not
learn much about it in school. So we provide 3 day training for interns
where they learn from each section. Even for experienced doctors,
we explain laboratory operations so that they have an understanding of
what we do before they assume their positions. We cannot offer the
same for nurses since approximately 100 of them come and go every year
but instead a laboratory technician would give a lecture at their orientation
or participate in study groups on how to analyze data on demand. In
many hospitals, testing is not included in their education curriculum so
we make sure that everyone receives training on it when they go through
our hospital education curriculum. We also make sure that our technicians
visit doctors and nurses on a daily basis to understand and to better serve
their needs.
Answering Questions
Other than questions that only the technician who performed the test could
answer, all other questions are handled at the reception. Some of
the questions we receive are: How do I put in an order for an uncommon
test? How much time interval does this test need? Because this
is a pivotal job within the laboratory, we make sure that two specially
trained staff are present at all times who are normally also in charge
of LAS operations.
Support for Clinical Side
In addition to fulfilling our testing duties, we involve ourselves in a
committee for infections, NST, diabetes workshops and other hospital activities
and meetings in support of the clinical side.
VI. Future Vision
In our laboratory, we monitor skill improvement of our staff using a chart
with staff on the vertical axis and tasks on the horizontal axis. A
mark is placed next to each task that staff can perform such as bio-chemistry,
hematology, and echo. The final goal is to be able to perform all
tasks or increase the number of performable skills. Staffs are evaluated
on tasks they can perform. So the more they can do the easier it
is for me to assign them. I also encourage them to set personal goals such
as working towards giving a presentation at conferences. I believe
creating an environment where no one is overwhelmed with daily tasks would
improve the entire laboratory.
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| Chief Technologist Tabata |
Special thanks to Chief Technologist Tabata and the staff at Kitano Hospital.
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