Laboratory Services in Hospital

8/14/2019 Laboratory Services in Hospital

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Dr. Ripal ShahMedical Director

Indian Red Cross Society,Ahmedabad


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Various Hospital Support

Services Support services

Auxiliary services

Dietary services

Engineering maintenance services

Hospital security


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HospitalA hospital is a place for the diagnosis & treatment of

human ills & restoration of health & well beings of

those temporarily deprived of these.

A large no. of professionally and technically skilledpeople apply their knowledge and skill with the helpof complicated equipment and appliance to producequality care for the patient.


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Hospital support services

Laboratory facility

CSSD

Diet department

Pharmacy

Laundry

Radiology

Nursing services


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Auxiliary services Registration & indoor case record (patient file,

medical record, statistics)

Stores (Pharmacy store, chemical store, linen store,surgical store, glassware store, narcotic store etc)

Transport services (trolley, stretchers, wheel chairs

etc.) Mortuary


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Dietary services Important for the nutrition of the patients

Different menu available for patients (salt free, sugarfree, fat free, gluten free, protein less, liquid diet,semi solid diet)

Different menu for patient attendants (five start

menu to suit the palate) Well trained dietician.

Must be hygienic


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Engineering and

maintenance services Calibration of equipment

Validation of equipment In house maintenance of equipment

Negotiation for purchase

General maintenance (building, plumbing, carpentry,

mason, air conditioning)

Vehicular maintenance

Boiler maintenance


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Water, Medical Gas &

Sanitary System Hospital needs lots of water supply but should rely

on public water supply.

Water supply line is concealed and repairing is acomplex job; requires expertise.

Two components

# Water supply network system# Sewage distribution system


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Water supply Sources of water supply

# Bore well

# tanker supply# Recycled water

While supplying water:

# Continuous reliable water supply

#Quality of water

# Cost & proper distribution


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Medical gas system

Gases administered to patients; comprises of O2,nitrous oxide, vacuum, compressed air.

Available in OT, ICU, special room, patient room

Clean reliable supply of gases on line

Easy purchase of gases in bulk quantities.

No nuisances of gas cylinders, breakage

Sterile areas protection, point to point conectn Rationalized ordering, storing & transport

Minimum damage to building


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Safe handling of gases Experienced & trained person handle gases

Observe all regulation & statutory instructions

Do not remove, deface labels of manufacturer

Ascertain gases before putting into services

Know properties/ hazards associated of gases

Establish & familiar with emergency situations Never lift a cylinder with cap or guard


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Layout of pharmacy


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Lay out of typical laundry


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Layout of central sterilization &

supply department


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Security & loss preventionprogram (1)

Types of frauds & thefts (embezzlement, pilferage,

kickback & collusion, equipment thefts, personalproperty theft, payroll fraud, cash theft, fraudulentpractices in purchasing, receiving and storing, Fraudin registers records & billing, computer theft)

Methods of internal controls

Establish procedural security


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Security & loss prevention

program (2) Security task of a bomb threat

Alarm system (fire, medical gas, blood bank,narcotic, cols room & walk-in cooler, voltagefluctuation, elevator, security, patients emergency,code blue alarm)

Code blue= cardiac arrest; Code red= fire alarm;Code black= bomb threat; Code white= securityemergency; Code green= all clear)


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Laboratory Services Blood bank (Transfusion Medicine)

Pathology

Microbiology

Biochemistry

Stat lab


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Blood Bank services Regulated services Service may be of own or out sourced

Goal: To supply safe blood and blood components toall needy patients in right time and in adequatequantity.

Policy of government:

# It is under Drugs & Cosmetics Act (1945)# Administrative control of NACO.


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Organizations &

management

Legal identity

Types of blood banks Responsibilities

Ethics in blood bank

Management system

Policies, processes & procedures


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Accommodation & premises

Space allocation

Environmental control

Biological, chemical & radiation safety

Internal communication system


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Accommodation

Registration & Medical examination

Blood collection (A/C)

Blood component preparation (A/C) Lab for blood group serology (A/C)

Lab for TTI testing (A/C)

Sterilization cum washing Refreshment cum rest room (A/C)

Store cum records


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Personnel

Personal Requirement

Qualification

Job Description/Responsibilities Responsibilities of Medical Director/In-charge/Medical

Officer, Technical Manager & Quality Manager

Training

Personal Health

Confidentiality of Information


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Equipment Equipment requirement

Selection & Validation of Information

Equipment detail record, Unique Identification

Program for calibration & maintenance ofequipments.

Equipment for storage of blood & component Computer system.


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External Services & Supplies Policies & procedures for suppliers selection

Inventory control

Evaluation of suppliers


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Blood Bank Operation Donor laboratory

Phlebotomy procedure Post donation care

Adverse donor reaction management

Blood donation camps/drives

Autologous transfusion procedure

Handling of samples & blood units


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Quarantine & storage &

Labeling

Refrigerators & freezers

Quarantine

Blood/component labelling

Instructions for transfusion

Special requirments


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Testing of Donated Blood Determination of ABO group

Determination of Rh(D) type

Determination of unexpected antibodies

Test for transfusion transmitted infection


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Compatibility Testing Request for blood & its component

Sample receiving, acceptance & preservation

Pre-transfusion testing

Issue of blood & its component


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Transfusion Reaction & evaluation

Error prevention

Immediate complication

Delayed complication

Detection, reporting & evaluation of transfusionreaction


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Quality control

ABO & antiD reagents

Reagent red blood cells

Red cell panel

Anti-human globulin reagent Bovine serum albumin

Enzyme reagents

Hepatitis B antigen, anti-HCV & anti-HIV 1 & 2 tests

Tests for syphilis Normal saline & buffered solution

Blood component


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Bio-Medical waste disposal & laboratory

safety in blood bank/blood centre

Protection of blood bank personnel against

laboratory infection

Safety in the laboratory

Disposal of blood & laboratory material


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Identification of Deviations

& Adverse Events

Policies & procedures when non-conformity is

detected

Procedures for release of non-conforming bloodcomponents

Preservating recurrence of non-conformity


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Performance Improvement

Addressing complaints

Corrective action

Root cause analysis

Documentation of corrective action

Preventive action


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Document control Procedure for document control & review of

documents

Document required

Maintenance of document in computer software


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Record Record identification

Quality & technical records

Record training period


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Internal Audit &

Management Review Policy for internal audit & management review

Procedure for internal audit

Procedure for management review

Documentation of internal audit & management review


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Other Lab services

A well equipped Lab services is essential as itsupports the function of the hospital

It could be high income generating source for thehospital.

An efficient Lab services reduces hosp stay

Good Lab services attracts doctors & patients


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Basic function of Lab services To assist doctor in arriving or confirming diagnosis in

treatment of patients

It generates prompt/ reliable reports & also keeparchived reports

To provide services any part of the day

Assist in teaching programs for doctors, nurses andlab technologists


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Workloads

Admitted patient undergoes average of 8-20 tests duringadmission

Pt. admitted in medical ward in average 10 days stay,about 20 tests (2/ day) are done/ pt. (excludingradiographic & other tests)

A 100 bedded hosp with 10 days ALS treat 37 patients(365%10)/ year. The hosp admits 37 x 100= 3700 pt./yr& generates about a max. of 37,00 x 20= 74,000 test/ yr


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Functional divisions Hosp lab is a conglomerate of many technologies

and methods & they are under five divisions:

# Hematology

# Microbiology

# Clinical chemistry

# Histopathology# Urine & stool analysis


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Functional planning It is involved in floor plan, areas, spaces, equipment,

organization & staffing

Increasing demand, over-crowding, lack ofmanpower may lead to poor result

Program development depends upon projected no.of tests and hosp beds

Organization: Centralized Lab is better with batchingof samples for economy


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Location (1)

Preferable in the ground floor of hosp

In smaller hosp, between out patient & wards

In large hosp, patient entry can be prevented bysample collection window

OPD sample collection:

# Suitable room at OPD

# Waiting room patients

# Vene-pucture room

# Specimen toilet (male/ female)


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Area/ Space Should be planned with future workload & expansion

Adequate working areas for all activities

Primary space is required for these for thoseprofessional activities including waiting.

Secondary space is utilized for all supportiveactivities e.g. admin, office, toilet, staff room

Circulatory space is for personnel/ materialmovement, store, auxiliary areas etc.


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Laboratory space unit (LSU)

Basic unit planning for Hosp lab is LSU

It is a module for space and all lab planning basedon LSU

Primary LSU: 10x20 =a module of 200 sq mt.

Rectangular module is better than square module

because of it gives deep bays (more economical &circular space)


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Internal designs & fittings

(1)

Height of working bench should be 75-90 cm.

Width of bench should be 60 cm; good forequipment & comfort of technicians

Optimum size of bench length is 2 mtr; continuouslength of 6 mtr gives flexibility.

Lab requires sink for staining slides etc. High level natural ighting is desirable

All benches should have good flourecent lighting andsufficient electrical points.


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Internal designs & fittings

(2 ) Lab surfaces should be washable, heat/ stain

chemical/ proof & easy for decontamination

Staff locker room & toilets

Utility services: Water, Gas, Compressed air

Colored piping system for easy recognition

Partitions for easy working & dust prevention

A/C: Formalin in Histopath. A/c is must here; ifpossible in all Lab


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Lab staffing (1) Under direction of a qualified doctor: MD/PhD

Authorized signatory/ full or part time

No. of MLTs depends on:

# No. of samples/ day

# Range of tests to be performed (Cl Chem/ Hemat/

Micro/ Histopath/ other specialized)#Emergency service

# Leave reserve


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Lab staffing (2)

MLT responsible for most technical work undertechnical supervisor (then doctor)

No. of personnel (30 tests/day/ tech.)

Large hosp study with 8 technicians: 2804 tests /tech/ month (requirement14 tech)

Very high utilization of tech shows low quality

Non productive activities (Doc/ Admin work) Scheduling: Multi-tasking & various shifts

Sufficient leave entitlements


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Tests performed annually/

MLTLaboratory units Tests

Hematology 13,400

urinalysis 390,120

Serology 11,520

Biochemistry 9,600

Bacteriology 7,680

Histology 3,840

parasitology 9,600


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Lab staffing (3)Avoid monotony ( it is long cycle, repeat task job

leads to early fatigue, psychological stain, poor time

keeping, low productivity & Quality)# In service CME, instrumentation, QC addscommitments to staff

Equipment: Reduces dependence of MLT; No. ofsamples/ day; No. & range to be performed


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EquipmentEquipment = instruments, reference materials, consumables,reagents, analytical systems.

Equipment availability with respect to work.

Equipment shall be shown (upon installation and in routineuse) to be capable of achieving the performancerequired.

Program for calibration and monitoring of functioning. Theequipment shall be calibrated from NPL, India or

calibration laboratory accredited by NABL or its MRApartner having accreditation for the specific scope.


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General list of equipment

Robot cell counter

Centrifuge

Microhenematocirtcentrifuge

Refrigerators

Blood bank refrigerators

Water still

Pressure sterilizer

Pipette washer

Flame photometer

Spectrophotometer

Hot air oven Incubator

Calorimeter

Analytical balance

Blood gas analyzer

Auto analyzer


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Automation Ensures speed, accuracy, less manpower

Autoanalyser can take large tests at rapid rate

Decision to buy: Cost per test/ equip cost/ no. oftests/ reagent cost/ semi- fully automated

Calibration & breakdown support

Interfacing with software

AMC/ CMC & uptake time


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Policies & procedures (1) Lab samples: collected by ward staff or lab staff

collects personally.

All request must be in writing Sample receiving: (blood, faces, urine, pus, body

fluids, swabs etc) sufficient racks, ID, instruction toPt, hand washing facility

FANC requires separate cubicle


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Policies & procedures (2) Request forms should have all important info

(demographic & clinical details, last tests)

Time of accepting samples; Priority of tests: routine& emergency samples

Sample container: as specified

Identification of samples: Most Important Reports double checked & signed

Records to be kept for monthly/ yrly review


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Record request forms,

test results and reports,

instrument printouts, procedures, worksheets,

complaints and action taken,

instrument maintenance and calibration records,

quality control records,

package inserts,

supplier records,

staff training and competency records .


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Miscellaneous Lab safety & TTI

Liaison with clinicians: difference between diagnosis

& report: discussion needed Technicians motivation: discuss various issues,

periodical meeting & try to solve problems

Cross training

Lab waste disposal

Laboratory Services in Hospital

Documents

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