• Iizuka Hospital
  • Kochi Medical School Hospital
  • The Fraternity Memorial Hospital
  • Gifu University Hospital
  • Kitano Hospital
  • Iwate Medical University Hospital
  • Yamaguchi University Hospital
  • Kurashiki Central Hospital
  • Goto Central Hospital
  • Kishiwada City Hospital
  • Aso Iizuka Hospital
  • Kochi Medical School

Laboratory Reports

Iizuka Hospital Dec.2007

※Name of facility and titles are from the time of visit.

Ensuring promptness and building trust as our goal

I. Preface

Carrying on the spirit of the founder, Mr. Takichi Aso, Iizuka hospital has developed as Sincere medical care and service.
As the hospital for the citizens in Chikuho region, Iizuka hospital has been evolving under the management principal “We Deliver the Best ? Sincere medical care and service” carrying on the spirit of the founder of the hospital, Mr. Takichi Aso, “Provide top treatment and medication by inviting good doctors for the people.” Approved as a clinical training hospital and community healthcare assisting hospital in 1989 and in 2005, respectively, Iizuka hospital has kept pace with the changes in the environment surrounding medical care, working to improve treatment results and the advancement and streamlining of medical practices.

<Iizuka Hospital >

Address :  3-83 Yoshio-machi, Iizuka-shi,
Fukuoka-ken, Japan 820-8505
URL : http://aih-net.com/
No. of Dept.: 34
No. of Beds: 1,116
No. of Staff: 1,730

Iizuka Hospital

II. Overview of the Central Laboratory

Hospital staff (as of December, 2007)

Physicians 2
Clinical laboratory technologists 45
Clinical laboratory technologists (Part-time) 1

Number of tests (April 2007 – March 2008)

Urinalysis 107,219 Serology (Immu.) 110,867
Hematology/ Coagulation 493,276 Pathology/ Cytology 17,672
Chemistry 3,632,315 Physiology 53,205
Endocrinology 699,943 Tumor Marker 88,527
Microbiology 18,304 Drugs 13,074
Total 5,234,402

Since 1997, the central laboratory at Iizuka hospital has been operating with Laboratory Automation System, CLINILOG, and Laboratory Information System, CLINILAN. In October 2006, both systems were renewed. Vice Chief Technologist Kuwaoka explained to us about the purpose and the effect of the renewal.

Vice Chief Technologist Kuwaoka

Vice Chief Technologist Kuwaoka

To view LAS and LIS before the renewal, please go to Laboratory Reports: Cost Competition against Branch-labs -Dramatic Cost Improvement by LAS- (March 2000).

III. Purpose of Renewing the System

Since the first time we implemented LAS in 1997, the number of tests kept increasing every year to a 1.7 fold in 2005, compared to when LAS was first introduced. This meant the number of samples exceeded the throughput which effected rapid reporting of test results. In addition, the instruments had aged undeniably after 8 years of use since its introduction. These were the two main reasons we decided to renew our LAS and LIS.

IV. Setting a Goal

We conducted a survey on requests from the clinical side and summarized the current conditions and problems in the central laboratory. As a result, we found that accuracy in test results and increased rapidness in test reporting were being demanded. With such demands in mind, we set out a midterm goal in 2006, “Ensuring promptness and building trust,” as we inspected not only the system but also the analyzers that were not connected to LAS and reevaluated the operation of the entire laboratory. We’ve continued to work towards this goal in 2007 for the betterment of laboratory operations.

LAS (CLINILOG)

V. Establishing Promptness

LAS (CLINILOG) configuration

LAS (CLINILOG) configuration

Zoom

System management module

System management module

Shortening the flow line

After considering the available space in the laboratory and convenience, LAS was designed in a way that the modules were aligned in a squared U-shape with the system management module, which checks and confirms results, placed in the center. With the sample loading module and unloading and sorting module installed next to each other, the flow line was shortened. This reduced human mistakes and the amount of stress from the operators proportionally.

LAS connecting module

Aliquotting Module 2 units

Aliquotting Module 2 units

We decided to implement two units of aliquotting modules after a number of simulation runs conducted with the cooperation from A&T. This doubled the throughput and enabled us to handle the increase in the number of samples. We strongly feel that the simulations performed beforehand played a critical part.
The three units of automated chemical analyzers we use are JCA-BM 2250LA Type (JEOL) which increased throughput for chemistry testing by 1.5 fold. By automating syphilis testing using this analyzer, we saved manpower and time. On top of that, it reduced reagent volume consumption which has led to cost reduction.
The analyzer for immunology testing which we used to operate offline was connected to LAS. Two units of chemiluminescence immunology analyzers ARCHITECT i2000 (ABBOTT) which were connected enabled us to handle the increased number of tests in hepatitis virus, tumor marker, and hormone testing.

JCA-BM 2250LA Type 3 units
JCA-BM 2250LA Type 3 units

ARCHITECT i2000 2 units
ARCHITECT i2000 2 units

Hematology testing operations

Before renewing the system, chemistry and hematology analyzers used to be connected to LAS. Having the same sample loading area was an advantage but there was also a problem where hematology testing would stop when chemistry analyzer failed. So we placed the sample loading areas next to each other and removed the hematology analyzer from LAS.
Currently, we use hematology analyzer ADVIA 2120 (Siemens) for hematology testing. This time, we newly implemented a slide maker stainer ADVIA Autoslide (Siemens) which allows 24-hour smear preparation. Because checking smear is crucial in the diagnosis of blood poisoning and others, we have gained effective operations with sure diagnosis.

Handling emergency medical care

Promptness is crucial since we have an emergency center. Although some items are outsourced, we stop sending out test items once the number of tests accumulate and conduct tests in-house, as a DPC trial hospital. Some of the new items implemented with this system renewal are MMP-3, intPTH, and cortisol. Also we now provide 24-hour BNP and viral antibody testing. All these contributed to the reduction of patient reconsultation and the long term administration of medicine.

TAT (Turnaround Time) investigation

We investigated the change in TAT before and after the system renewal. In the case of chemistry testing, TAT was 1hour and 22 minutes on average before the renewal but decreased to 44 minutes after renewal. For hematology testing, 55 minute average before renewal was also decreased to 33 minutes after renewal. The drastic decrease observed in both cases made apparent its contribution to a more rapid result reporting.

TAT for Biochemistry test

Zoom

TAT for CBC test

Zoom

*Before renewal: Aug. 1, 2006 *After renewal: Aug. 6, 2007

VI. Building Trust

Confirming sample arrival
We do not have a central blood collection room at our hospital. Samples that are collected at each department are brought to the central laboratory by a nurse or a sample carrier called a “messenger.” If there is a problem, laboratory staff are informed immediately so basically we have no more “missing samples.”

Sample reception
Sample reception

On duty system

As mentioned earlier, since we have an emergency medical care center, testing is performed 24 hours a day. During the on-duty time slot (16:30-8:30), we have two personnel plus one cardiac catheter test operator on call to operate our sample testing and blood bank testing.
When deciding on on-duty shift, we select from two separate groups: physiology group which can perform cardiac catheter test and another group. One staff is selected from each group to take turns being on-duty. During the on-duty time slot, if cardiac catheter testing is required on top of blood bank testing, the cardiac catheter test operator on call is called in to avoid back up in testing. Cardiac catheter test operator on call is selected from the physiology group and the on-call duty is about two to three times a month.

New LIS

With the new LIS multi-worksheet, test data of various online analyzers can be browsed on a single screen. It is important that various data such as diseases can be checked on a single screen in considering the adequacy of test results.
In addition, person authentication system was implemented as we considered establishing traceability was essential in building trust. This has prevented all alterations and guaranteed test results.

Reporting test results to the clinical side

Web Base Information System (CLINIWeb-2) was installed as a countermeasure for overflow of HIS and as a progress monitor for the clinical side. For example, when infectious disease test result is negative, the result is sent immediately, and when result is not negative, “retesting” is displayed to let testing status known. Good feedback is received from the clinical side which seems to be utilizing the system frequently.

Display of CLINIWeb-2 Test status list
Display of CLINIWeb-2 Test status list

Engagement after the system renewal

With the available capacity from the renewal of system, we set a post-renewal goal. One year has passed since the renewal during which time genetic screening has expanded from just infectious diseases to pathology and blood diseases. There is also in increase in participation to team medical care and training. In the future, we want to achieve our goals; acquire ISO15189, conduct clinical research, and cooperate with a in a collaborative research.

VII. From the Chief Technologist

The rapid reporting of test results can be seen clearly by comparing TAT from before and after the renewal of both LAS and LIS which was possible with the hospital wide understanding and cooperation. Although the number of samples are increasing by the year, testing operation tasks including on-duty tasks have decreased as well as problems with hardware and software, and trust has been built.
From now on, technologists themselves must think and act and improve their skills. Since the renewal, we implemented new test items requested by the clinical side and actively encourage participation in team medical care, but also expect each staff to perform their duties with their own objectives. From reinforcing hardware to software, our goal is to obtain certification in 2009, we aim to avoid it being simply a formality but instead wish to build a structure including physiology testing, that would turn the Deming Cycle by itself.

Chief Technologist Manago
Chief Technologist Manago

Special thanks to Chief Technologist Manago, Vice Chief Technologist Kuwaoka and the laboratory staff at Iizuka Hospital.