Evaldas Kontautas, Ema Rajackaitė, Živilė Jacikė, Ramunė Šepetienė
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Abstract
Background: Improving quality and laboratory testing turnaround time (TAT) is a constant challenge for a clinical laboratory. The formulas that describe the best way to manage these goals are outlined in International Organization for Standardization standards. According to standards, improvement must be timely and continuous. Lean methodology is a tool to meet this requirement. One of the fundamental elements of Lean is a systematic approach to process improvement by removing waste to create value for the end-user (eg, patient) of the service. This methodology can be adapted in resource-limited settings.
Objective: The aim of this study was to test the application of Lean methodology in urinalysis.
Methods: Lean has various collections of tools and concepts. We applied the most useful for the clinical laboratory: Gemba walk, Takt time, cycle time, and value-stream mapping. Finally, we created and approved workplace standards to improve the performance of urinalysis.
Results: We compared the TATs of urinalysis tests before optimization, immediately after, and long after (~5 months). We found that TATs had significantly shortened. The TATs of emergency (STAT) urine tests immediately after optimization improved: automated microscopy to 16% (P =.194), fully automated test-strip to 23% (P = .0172), and standardized urine sediment examination to 20% (P =.0048). The TATs of routine urine tests also improved immediately after optimization: automated microscopy to 18% (P <.0001), fully automated test-strip to 11% (P =.0025), and standardized urine sediment examination to 18% (P =.0011). After 5 months of Lean application within the urinalysis laboratory, TATs of routine urine tests remained improved; however, the improvement of STAT urine test TATs dropped to approximately 4%.
Conclusion: The application of the Lean methodology shows significant improvement in TATs of processes in our laboratory.
背景：提高质量和实验室检测周转时间（TAT）是临床实验室面临的一项长期挑战。国际标准化组织的标准概述了管理这些目标的最佳方法。根据标准，改进必须是及时和持续的。精益方法就是满足这一要求的工具。精益的基本要素之一是通过消除浪费，为服务的最终用户（如病人）创造价值，从而系统地改进流程。这种方法可适用于资源有限的环境：本研究旨在测试精益方法在尿液分析中的应用：精益有多种工具和概念。我们采用了对临床实验室最有用的工具：Gemba walk、Takt time、周期时间和价值流图。最后，我们创建并批准了工作场所标准，以提高尿液分析的绩效：结果：我们比较了优化前、优化后和优化后很长时间（约 5 个月）尿液分析测试的 TAT。我们发现 TAT 明显缩短。优化后立即进行的急诊（STAT）尿液检验的 TAT 有所改善：自动显微镜检验的 TAT 缩短了 16% (P=.194)，全自动试纸检验的 TAT 缩短了 23% (P=.0172)，标准化尿沉渣检验的 TAT 缩短了 20% (P=.0048)。尿液常规检查的 TAT 在优化后也立即得到了改善：自动显微镜检查的 TAT 缩短了 18%（P=.0048），标准化尿沉渣检查的 TAT 缩短了 20%（P=.0048）：精益方法的应用显著改善了我们实验室流程的 TAT。
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