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CEUTEH‘16
Dr Shyam Prakash
• M.Sc, Ph.D
Assistant Professor, Department of Laboratory Medicine, All
India Institute of Med...
Cost Effective Technology of
Medical Health Care in Medical
Institutions
• Inappropriate advanced medical technology
• Patient involvement in decision-making
• Payment system distortions
• Over-u...
• Reduce avoidable, ineffective, and
duplicate use of services—
including technology that does not
improve patient care
• ...
• An online platform provides all benefit information, forms,
formularies, and prior approval information could be accesse...
• Wide range of information system
• EHR can be used at primary, secondary & tertiary care
• Data can access at any time :...
7
Phlebotomy: Historical Practice
8
9
• Phlebotomy is the most commonly performed procedure
worldwide
• Laboratory testing is a highly complex skill requiring e...
• Pre-analytical—Specimen collection, transport and processing,
storage, ethical clearance
• Analytical—Testing, Equipment...
The steps of the pre analytical phase
Preparation prior to
sampling
Sampling/handling
Storage/transport
Preparation prior ...
Collection of Sample
• Locate Patient
• Patient preparation
• Draw Sample
• Label
• Dispose of supplies
• Safety
The Pre-A...
When identifying the patient, have them provide their full
name, address, identification number and/or date of birth.
Hosp...
Test Collection
• Timing of Collection
– Therapeutic Drug Monitoring
• Peak and trough collection times
– Basal State Coll...
Phlebotomy Technique
• Cleaning of venipuncture site
– Thorough cleaning with alcohol
– Allow alcohol to dry completely to...
Phlebotomy Technique Errors
• Tourniquet Application
• Tourniquet tied too close to the venipuncture site can cause
hemato...

×
• Patient Identification
• It is important to identify a patient accurately so that blood
is collected from the correct pe...
Pre-analytical errors
• Errors at any stage of the collection, testing and reporting
process can potentially lead to misdi...
Association of errors
. and compromise
the diagnosis and
treatment of the
patient
• may influence
the quality of the
final...
Factor Affecting Lab Result
• Some patient variables that affect test results
a) Age h) Genetic variation
b) Gender i) Nut...
Error Prevention
• Phlebotomy Education
– Phlebotomists should have completed a standard academic
course in phlebotomy and...
Specimen Transport
Temperature
Light
Time
Blood Specimen Transport
• Transport of blood specimens in the proper manner after
collection ensures the quality of the s...
Transport Errors
• Temperature
– Specimens must be transported at the appropriate
temperature for the required test
• On i...
Insufficient Mixing With Heparin
• Insufficient mixing can cause
coagulation of the sample
• It is recommended to mix the
...
Although the
anticoagulants serve
many purposes, we
should keep in mind that
they are chemicals after
all and can interfer...
• All blood collection tubes need to be filled to the correct
volume.
• This will ensure the proper amount of blood for th...
 Inaccuracy in labeling of specimen
 Labeling lost during transport
 Transport media improperly prepared
 Specimen hea...
Potential pre-analytical errors
Preparation
prior
to sampling
1. Misidentification of Patients
2. Mislabeling of specimen
...
• Certain chemistry analytes will require the tube of blood
to be chilled after collection in order to maintain the
stabil...
 Keep precious biological samples safe and in a secure place
 Check and log freezers temperature daily.
 Locate samples...
Specimen Rejection
• Clotted
• Hemolyzed
• Underfilled,
overfilled
• Insufficient quantity
• Incorrect labeling
• Unlabele...
KIOSK
Advances
AdvancesBar Code Scanner
Collection site
Automation In Blood Collection
Management of Preanalytical phase
• Unnecessary Laboratory Testing
• Management of Test request
• Needle stick injury prev...
Clinical Question Biochemical Answer
Finally…
• The human role in sample collection makes
complete elimination of errors associated
with laboratory testing unr...
Quality system begins and ends
with the patient
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
Cost Effective Technology of Medical Health Care in Medical Institutions
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Cost Effective Technology of Medical Health Care in Medical Institutions

Dr SHYAM PRAKASH
DEPARTMENT OF LABORATORY MEDICINE
ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI

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Cost Effective Technology of Medical Health Care in Medical Institutions

  1. 1. CEUTEH‘16 Dr Shyam Prakash • M.Sc, Ph.D Assistant Professor, Department of Laboratory Medicine, All India Institute of Medical Sciences • Authored a book, Health and Dietary aspects of Mustard ,oil. Eds. 2001 • Has many national and international publication • JRF by Council of Scientific and Industrial Research (UGC- CSIR), India,1989 • SRF by CSIR, India,1992
  2. 2. Cost Effective Technology of Medical Health Care in Medical Institutions
  3. 3. • Inappropriate advanced medical technology • Patient involvement in decision-making • Payment system distortions • Over-use, high prices for health care services • Not aligned with national needs • Excessive administrative costs • Medical liability and defensive medicine What are the Major Drivers of Health Care Costs? Why Do We Need to Control Health Care Costs ?
  4. 4. • Reduce avoidable, ineffective, and duplicate use of services— including technology that does not improve patient care • Pilot test and adopt new models to encourage with desired outcomes. • Pay appropriately for health care services, and encourage adoption of innovative models of health care delivery. • Reduce administrative costs • Encourage patient responsibility for health to promote wellness, prevention, chronic care management, changes in unhealthy behaviors
  5. 5. • An online platform provides all benefit information, forms, formularies, and prior approval information could be accessed and completed online with as little disruption to medical practices as possible. • Hospital – many systems – Computer-based Provider Order Entry (CPOE) – Electronic Medication Administration Record (eMAR) – Clinical Data Repositories – Ancillary Systems (Lab-chemistry, Lab-micro, Blood Bank, Radiology, Pharmacy, Pathology, etc). • Clinic – Electronic Health Records (Electronic Medical Records) – Practice Management System • Patient : Personal Health Records Health Information Technology
  6. 6. • Wide range of information system • EHR can be used at primary, secondary & tertiary care • Data can access at any time : Daily charting, Medication administration, Nursing care plan, Physical examination, Diagnosis, Tests, Procedures, Treatments, History, Findings etc • Provide the important information for planning of health policy • Data sharing has the potential to improve quality of health care by reducing error & lowering cost. Electronic Health Records
  7. 7. 7 Phlebotomy: Historical Practice
  8. 8. 8
  9. 9. 9
  10. 10. • Phlebotomy is the most commonly performed procedure worldwide • Laboratory testing is a highly complex skill requiring expert knowledge, and critical judgment • Venipuncture is a frequent medical procedure. • Phlebotomy errors may cause harm to patients or result in needle prick injury to the phlebotomist • Must be proactive
  11. 11. • Pre-analytical—Specimen collection, transport and processing, storage, ethical clearance • Analytical—Testing, Equipments, SOP, QA, method of assessing quality of lab data • Post- Post analytical—Testing results transmission, interpretation, follow-up, Retesting, statistical evaluation of Lab data Stages of Laboratory Testing
  12. 12. The steps of the pre analytical phase Preparation prior to sampling Sampling/handling Storage/transport Preparation prior to analysis The steps of the pre analytical phase
  13. 13. Collection of Sample • Locate Patient • Patient preparation • Draw Sample • Label • Dispose of supplies • Safety The Pre-Analytical process
  14. 14. When identifying the patient, have them provide their full name, address, identification number and/or date of birth. Hospital No in patients should be wearing an identification band with the above information, which the phlebotomist should confirm before the venipuncture. Patient identification
  15. 15. Test Collection • Timing of Collection – Therapeutic Drug Monitoring • Peak and trough collection times – Basal State Collections • Fasting requirements—no food or liquid except water(9- 11h) • 2h postprandial, from the start of food . – Specimens affected by time of day, for example, cortisol, iron and TSH.
  16. 16. Phlebotomy Technique • Cleaning of venipuncture site – Thorough cleaning with alcohol – Allow alcohol to dry completely to avoid stinging sensation upon needle entry and hemolysis of sample – Samples such as blood cultures should be collected using iodine to cleanse site to ensure sterility of sample • Recollection rate for blood cultures ranges due to contamination is as high as 50% in hospitals with increased costs, patient overtreatment
  17. 17. Phlebotomy Technique Errors • Tourniquet Application • Tourniquet tied too close to the venipuncture site can cause hematoma • Veins may not become prominent if tourniquet is tied too high (more than 3 to 4 inches above venipuncture site) • Tourniquet left on longer than one minute can result in hemoconcentration, affecting some test results Tourniquet should be released as soon as needle is in the lumen of the vein and blood flow established
  18. 18.  ×
  19. 19. • Patient Identification • It is important to identify a patient accurately so that blood is collected from the correct person. • Drawing blood from the wrong person, or labeling the correct patient’s sample with a different patient’s label can certainly contribute to laboratory error. (Mislabeling ???) Effects of Pre-analytical Variables
  20. 20. Pre-analytical errors • Errors at any stage of the collection, testing and reporting process can potentially lead to misdiagnosis • Errors during the collection process are not predictable but can be prevented with a thorough application of quality control, continuing education and effective collection systems.
  21. 21. Association of errors . and compromise the diagnosis and treatment of the patient • may influence the quality of the final measured results ... • Errors made in the period prior to the analysis of the sample ... It is better NOT to report
  22. 22. Factor Affecting Lab Result • Some patient variables that affect test results a) Age h) Genetic variation b) Gender i) Nutrition status c) Diet j) Diagnostic and therapeutic d) Stress procedures, endoscopy e) Exercise k) Obesity f) Posture l) Tourniquet & fist pressure g) Haemolysis, lipemia & icterus
  23. 23. Error Prevention • Phlebotomy Education – Phlebotomists should have completed a standard academic course in phlebotomy and undergo thorough on-the-job training under the supervision of a senior phlebotomist • Continuing Education – Phlebotomists should participate in regular educational competency assessments (written and observational) • Phlebotomy Staffing – Adequate staffing to maintain collection standards • Technology – Use of barcode scanners for patient identification
  24. 24. Specimen Transport Temperature Light Time
  25. 25. Blood Specimen Transport • Transport of blood specimens in the proper manner after collection ensures the quality of the sample • Timing – Some specimens must be transported immediately after collection, for example Arterial Blood Gases. – Specimens for serum or plasma chemistry testing should be centrifuged and separated within two hours
  26. 26. Transport Errors • Temperature – Specimens must be transported at the appropriate temperature for the required test • On ice—ABGs, Ammonia • Warmed -- (370 C), Cryoglobulins • Avoid temperature extremes if transported via vehicle from other collection site • Transport Container – Some samples need to be protected from light, for example, Bilirubin, Vitamin A – Transport in leak-proof plastic bags in lockable rigid containers, avoid agitation.
  27. 27. Insufficient Mixing With Heparin • Insufficient mixing can cause coagulation of the sample • It is recommended to mix the blood sample thoroughly with heparin • Invert the syringe 10 times and roll it between your palms
  28. 28. Although the anticoagulants serve many purposes, we should keep in mind that they are chemicals after all and can interfere with various tests !!!
  29. 29. • All blood collection tubes need to be filled to the correct volume. • This will ensure the proper amount of blood for the amount of additive in the tube (blood to additive ratio). • For example, if a 5 mL draw heparin tube is only filled with 3 mL of blood, the heparin concentration is erroneously high and may potentially interfere with some chemistry analytes, tube for Coagulation Studies incomplete filling results in specimen dilution and erroneous Prothrombin and aPTT test results. Correct Specimen Volume
  30. 30.  Inaccuracy in labeling of specimen  Labeling lost during transport  Transport media improperly prepared  Specimen heated or cooled during transport  Delays or inconsistent transport time  Specimen lost during transport to laboratory Transportation Errors : Specimen to Laboratory
  31. 31. Potential pre-analytical errors Preparation prior to sampling 1. Misidentification of Patients 2. Mislabeling of specimen 3. Short draw /wrong anticoagulant/ blood ratio 4. Mixing problems/ clot 5. Wrong tube/ wrong anticoagulant 6. Hemolysis / lipemia 7. Hemoconcentration 8. Exposure to light/ extreme temperature 9. Improperly timed specimen/ delayed delivery to the lab 10. Processing errors: incomplete centrifugation, incorrect log-in, improper storage
  32. 32. • Certain chemistry analytes will require the tube of blood to be chilled after collection in order to maintain the stability of the analyte. • A slurry of ice is recommended for chilling the tubes of blood. • Examples : – Adrenocorticotropic hormone (ACTH) – Angiotensin converting enzyme (ACE) – Acetone – Ammonia – Catecholamines – Free fatty acids – Lactic acid – Pyruvate – Renin, PTH etc. Special Handling of Blood Specimens:
  33. 33.  Keep precious biological samples safe and in a secure place  Check and log freezers temperature daily.  Locate samples quickly and easily through computer base program to access sample reporting and retrieval easily.  Retrieval and shipping of biological samples while maintaining the cold environment.  Trained and certified personnel with compliance to IATA, DOT and ICAO regulations should ship the specimen. •The process of collecting, maintaining, and sharing biological samples is viewed as an essential tool in the modern landscape of the genetic, medical, and behavioral sciences and we should; Storage, Repository or Biobank
  34. 34. Specimen Rejection • Clotted • Hemolyzed • Underfilled, overfilled • Insufficient quantity • Incorrect labeling • Unlabeled specimen • Incorrect patient • Incorrect specimen • Contaminated • Lost sample • Too old to process • Broken and leaking
  35. 35. KIOSK Advances
  36. 36. AdvancesBar Code Scanner
  37. 37. Collection site
  38. 38. Automation In Blood Collection
  39. 39. Management of Preanalytical phase • Unnecessary Laboratory Testing • Management of Test request • Needle stick injury prevention • Influence of physical activity • Medical contrast media on in vitro diagnostic testing • Optimization of training • Utilization of laboratory resources • Concept of demand restriction and demand adequacy
  40. 40. Clinical Question Biochemical Answer
  41. 41. Finally… • The human role in sample collection makes complete elimination of errors associated with laboratory testing unrealistic • However, good practices and compliance with the new strategies for error prevention can lead to a substantial reduction in pre- analytical errors and cost in medical health care at medical Institutions.
  42. 42. Quality system begins and ends with the patient
  • AshokkumarSah1

    Nov. 16, 2017
  • FredMalepa

    Sep. 14, 2017

Dr SHYAM PRAKASH DEPARTMENT OF LABORATORY MEDICINE ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI

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