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| * Name of facility and titles are from the time of visit. |
Contents
I. Preface
Kochi Medical School Hospital was established in October, 1981. As a pioneer
in the automation and systemization of laboratory testing field, they have
been performing tests using LAS (Laboratory Automation System) and LIS
(Laboratory Information System) the laboratory staff have built and constructed
on their own since the very beginning. With their motto "You never
know until you try. Be the first to try good ideas", Kochi Medical
School Hospital is actively trying new ideas and making improvements.
 <Kochi Medical School Hospital>
Address: Kohasu, Okocho, Nankoku-shi, Kochi-ken, Japan 783-8505
URL: http://www.kochi-ms.ac.jp/~hsptl/index.shtml
No. of Dept.: 28
No. of Beds: 605
No. of Staff: 866
II. General Information of Laboratory
Hospital Staff (as of Nov. 27, 2007)
| Lab. Director |
1 |
| Instructor |
1 |
| Assistant |
1 |
| Medical Technologists |
23
(1 assigned to Pathology) |
| Contract Medical Technologists |
10
(1 assigned to Pathology) |
|
|
Number of Tests in 2006
|
Inpatient |
Outpatient |
Total |
| Urinalysis |
131,505 |
205,744 |
337,249 |
| Hematology |
390,231 |
419,138 |
809,369 |
| Serology |
14,906 |
28,291 |
43,197 |
| Clinical Chem. |
688,982 |
918,208 |
1,607,190 |
| Blood Trans. |
14,986 |
4,388 |
19,374 |
| Microbiology |
22,468 |
7,047 |
29,515 |
| Physiology |
12,451 |
17,490 |
29,941 |
| Pathology |
4,198 |
7,877 |
12,075 |
| Outsource |
15,033 |
28,191 |
43,224 |
|
Total |
2,931,134 |
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| Chief Technologist Ogura |
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Kochi Medical School Hospital Laboratory has been operating under our Laboratory
Automation System, "Open LA21 Module System" and Laboratory Information
System "CLINILAN LRP Suite" since 2006. We spoke with Chief Technologist
Ogura.
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III. From the Belt-line System to Open LA21 Module System
 |
| Original belt line (partial) still kept in lab |
 How the first LAS worldwide began
The story begins a year before the hospital opened. While commuting between
Okayama and Kochi prefecture to attend meetings, the former laboratory
director Professor Sasaki was trying to figure out how he could start up
a laboratory with just five medical technologists. When testing operations
were broken down, majority of man power was spent on transporting samples
which led him to his idea of "transporting samples automatically".
Now, how could they be transported? I've heard that his idea came from
seeing a conveyer transporting lime to a cement plant during his commute
on the ferry that runs between Okayama and Kagawa prefecture. This is the
untold story behind the birth of the "belt-line system".
I was assigned to Kochi University (formerly Kochi Medical University) in April and we began constructing the self-made belt-line system for the opening of the hospital in October. Since we started from scratch, there was no model to follow. So we had to start from buying tools and structural members for the belt conveyors. After a continuous process of trial and error, the new system was developed.
On the other hand, we requested the manufacturers of analyzers who had agreed to the belt-line system, Sysmex, A&T and Hitachi, to modify the analyzers; a new function (current external sampler) was developed where sample nozzle aspirated once analyzers detected transported samples. And just within six months, the belt-line system was completed and began operating with the opening of the hospital. From the very beginning, we worked on computerization such as incorporating barcodes. We believe that our automation and systemization in the clinical testing field was the first worldwide which we take pride in. After that, we installed an industrial robot and continued to commit ourselves in automation and systemization.
It has been 25 years since the hospital opened and the belt-line system as well as us developers have gotten older. So we decided to purchase a new system instead of rebuilding a new one.
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|
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| Current LAS - Open LA21 Module System - |
The first financial lease for a national university
The cost for the belt-line system including installation, maintenance and
updating was 20 million yen for the first three years and 2 million yen
for maintenance annually. Because of the low cost, it was difficult to
prepare a budget. There was no way a list price of over 1 billion yen for
LAS and LIS would be approved. Fortunately, because we were incorporated
around that time, we no longer needed to submit a request for budget allocations
and so we chose financial lease. In order to get approval from the university,
the laboratory spent six months preparing a financial statement to grasp
the existing situation. Everything went smoothly as timing was good as
there was someone who understood about leasing in hospital affairs in the
hospital network.
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Reagent Cost Comparison
Chemical screening |
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TAT Report
(Item: WBC) |
Installation Advantages of the Open LA21 Module System
The first advantageous effect is the significant cut in reagent cost. In the graph showing (see left graph) the reagent cost for chemical screening before and after the installation of the system, you can see an average reduction of 1.5 million yen by the installation of JCA-BM2250LA Type. There was even a month where 3 million yen was cutback.
The second is consolidation of operation. The four sections, urinalysis,
hematology, chemistry and immunology, were combined into two sections,
"Automated analysis section" and "Urinalysis and special
section".
The third is consolidation of analyzers. Compared to before, we decreased the types of analyzers and created more space. Frankly we had a more consolidated picture, but similar to falling into metabolic syndrome, we were caught off guard and more units were connected.
The forth is the reduced TAT(Turnaround Time). As shown in the graph from
last year's data (see graph on the left), the amount of time from accession
to entering result was reduced which has been kept up today. (For other
data, click here.)
The fifth is the expansion of operations by laborsaving. Student health checks and staff medical check-ups were enforced and tuberculosis testing (QuantiFERON) was implemented by prefectural engagement. For PSG testing (overnight polysomnography), we set up a night-time operation system operated by those in charge of physiological testing (male) and enabled two patients to be tested simultaneously twice a week.
These are the current advantageous effects but honestly speaking, we are not yet satisfied. We believe that there is still room for improvement in showing effects in labor and personnel as we have not yet been able to operate to our ideal. The reason comes from the overall undeveloped reagents, automated analyzers and transportation units which have room for improvements to be made. We look forward to higher functions and working together in the future.
IV. Renovating the Entire Laboratory
The significance in total renovation, not partial updating
Looking back at the updating method for analyzers and system, budget is
cut to 50 to 70% even after renewal plans were made by each section. In
a manner, we were forced to compromise, which led us to make up for it
in the next renewal plan. But by the time budget was prepared, the timing
was too late and this cycle seemed to have repeated itself. Partial investment
is an uneconomical investment. Why? Advancement in technology is so rapid
that what's best today is not the same for tomorrow. So this time around,
we decided that renewal should be made extensively as much as possible,
and renovated patient reception to sample collecting, analyzing and result
reporting.
This lump renovation was made possible by the implementation of financial lease.
Commitment in renewing the blood collection room
Comfort was the top priority for renewing the blood collection room since
it is most subject to evaluation from the outside. So we decided why not
have patients relax comfortably while they wait? The biggest point was
reducing the testing space to create an interim-waiting room with a TV
for entertainment and doubling the blood collecting space. Also, we changed
the blood collecting area to individual booth type to protect the patients'
privacy, and installed chairs for blood collection (pink chairs in photo)
based on the blood collecting guidelines. We did an overall renewal by
implementing number and color display for calling patients and installing
automated transportation system for test tubes.
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Interim-waiting room
Blood-collection booths are
set up in the back |
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Blood collection booths and
test tube transportation system
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V. ISO Application of the New System
Roles fulfilled by LAS and LIS in acquiring ISO
Our laboratory acquired ISO9001 in October, 2006. The biggest advantage with the new system is that ISO file could be shared. We placed a document prepared with support software, for standardization of testing processes, for creating operation sheets so that it could be accessed from any computer.
In addition, since total data such as TAT are obtainable from LAS and LIS,
its helpful when monthly quality management reports are prepared. We made
our own program where we can pull out data immediately for reports. In
the future, since we are considering acquiring ISO15189, the role of LIS
is quite significant.
What is being done in the ISO Deming Cycle
Each month, we write up a monthly QMS (Quality Management System) report.
ISO manager collects monthly reports from each section and hands them out
to the professor, chief technologist, vice-chief technologist, and each
supervisor. The reports are examined at the managers' meeting at which
coping strategies are set for problems to be solved. TAT information, inquiries,
and number of trouble cases are available every month which plays a big
role in continuous analyzing. On the newest QMS report, you can see that
the number of problem cases has reduced considerably.
In the ISO review, personal evaluation is also included. Personal improvement is shown individually on a radar chart in a 5-point scale.
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QMS Monthly Results
TAT for main 7 items reported monthly |
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| Contents of QMS Monthly Results |
| 1.Customer satisfaction |
| (1) Number of inquiries and their questions |
(2) Claims and requests to
each section and support provided |
| (3) Information from staff |
| 2.Conformance to product requirement |
| (1) Test result report time (TAT) analysis |
| (2) Nonconformance control status |
| (3) Instrument problem occurrence status |
| (4) In-lab incident report status |
| (5) Other reports |
| 3. Claims and trouble report summary |
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VI. For Better Medical Care
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| Reception/ Waiting Room |
Continuous effort for improvement
Since we reviewed the testing operations, next we plan to reexamine accessioning operations the place where it is the busiest with patients. At reception, one staff controls and instructs patients where to go while comprehending the traffic situation at urine collection, blood collection and physiology. This highly specialized supernatural task cannot be replaced by a system or just anyone else as it relies a lot on experience. We started identifying types of tasks and the amount of time each required. However, congestion at reception cannot be solved by the laboratory itself. We feel that changes need to be made comprehensively in the outpatient medical system and patient administration and accounting system to find a solution.
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| Friendly Sunflower Project Logo |
Enhancing hospital operations
In addition to daily efforts for the betterment of the hospital, the "Sunflower
Project" under the direct supervision of the director of the hospital
is in operation. This project consists of two working groups.
"Service improvement group" consists of 30 members which includes the hospital director and representatives from each department. The group meets once a week and reviews comments and suggestions made by patients and staff, which are quickly handled and reported.
"In-hospital environment improvement group" consists of 10 members which includes the chief nurse, comedical and administrative staff, and staff in charge of facility maintenance. Hospital routine rounds are made once a month where repairs and clean ups are done.
VII. From the Department Director
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| Professor Sugiura |
In recent years, clinical testing departments must increase their cost-consciousness
in testing operations due to economical constraints. This means that laborsaving
and streamlining in testing operations are demanded while maintaining scientific
basis. Also, in order to process vast amounts of clinical data ordered
to the laboratory quickly and accurately, and provide clinical support
by giving feedback to the examiner's side, laboratory must be equipped
with highly analytical technology and data analytical capability. The growth
of automated technology in testing is absolutely imperative. Based on the
situation laboratories are in, we restructured the laboratory by implementing
a new generation total laboratory management system in 2006 with "a
satisfactory laboratory for patients and clinical sections" in mind.
Although it is a given that clinical laboratories should produce accurate
testing data promptly, it is also necessary for the clinical support section
to provide high quality information effectively to clinical sections in
addition to fulfilling its duties as a testing operation center. And so,
while maintaining high precision in testing, we wish to contribute to harmonious
medical care with each of our laboratory staff working closely with the
nursing department and diagnosis and treatment department one step further
as a member of team medical care.
We thank Professor Sugiura, Chief Technologist Ogura and all the staff at Kochi Medical School Hospital for their cooperation and support.
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