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

Laboratory Reports

Kitano Hospital Dec.2005

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

Streamlining Laboratory Operations and Developing Human Resources

I. Preface

Tazuke Kofukai Medical Research Institute Kitano Hospital was established in 1928 in partnership with Kyoto University Graduate School of Medicine as a general hospital with the capacity of conducting research and development for medical treatment. Located in the center of Kita ward in the city of Osaka, it plays a central role in community health care.

<Kitano Hospital>

Address: 2-4-20 Ohgimachi, Kita-ku, Osaka-shi, Osaka-fu, Japan 530-8480
TEL : 06-6312-1221
URL: http://www.kitano-hp.or.jp/
No. of Dept.: 26
No. of Beds: 741
No. of Staff: 1,014

Kitano Hospital

II. General Information of Laboratory

Hospital Staff (as of Dec. 13, 2005)

Physician (Director of Laboratory) 1
Medical Technologists (Sample testing/ Physio. testing/ Comp. Med. Exam) 32
Clerk 3

No. of Samples tested In-house (2004)

Bio-chem. 2,243,174 Serolo.(Immu.) 182,054 TDM 3,698
Urine-chem. 42,982 Serolo.(Infec.) 72,087 Microbiology 39,531
Hemato. 170,676 Virology 7,863 Tuberculosis 6,304
Coag. 52,135 Endocrino. 39,144    
Urinalysis 130,609 Tumor Marker 38,712    
TOTAL 3,028,969

Kitano Hospital has been operating with our Laboratory Information System CLINILAN since 1997 and Laboratory Automation System which was implemented in December, 2004. The following is an interview with Chief Technologist Tabata on why they implemented LIS and LAS and the advantages brought upon the laboratory.

III. LAS – Laboratory Automation System

LAS

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LAS

Catalyst of LAS implementation

When we relocated to the new hospital back in 2001, LAS mainstream was rack type transportation system and single line transportation type was rare. Although rack type transportation system is most capable of handling mass samples, we felt that it was not suited for us considering the size of our hospital. Soon after that, we learned about Open LA21 Module System (CLINILOG Ver.3) which operates like a single analyzer with a single line transportation capable of the kind of operation we were looking for and decided to implement the system.

(from left) Unloading and Sorting Module, Sample Loading Module, Centrifuge, De-capper, Aliquot Module (2 units)
(from left) Unloading and Sorting Module, Sample Loading Module, Centrifuge, De-capper, Aliquot Module (2 units)

Our Aim

Currently, there are 3 to 4 staffs for sample testing: 1 for bio-chemistry, 1 for serology (immunology), and 2 for transportation, manual handling, and reception. Decreased to almost a half from 6 before implementing the system. Sometimes implementation of LAS is reflected to cutback in staff, but not in our case. The basic number of staff at our laboratory, 32, has not changed; we have decreased the amount of responsibilities put on each staff and promoted an environment where staff are encouraged to learn new information and technology.

Flexible Staff Assignment

Before the implementation of LAS, each analyzer was operated individually by an assigned personnel performing specific tasks which were time consuming, especially with pre-processing and post-processing. Before we had problems with complicated tasks of placing samples in order before storing and misplacing samples when setting them in analyzer. Because analyzers are connected in a single line and operate as a single instrument, we were able to eliminate these troublesome tasks. Although the least amount of technicians are assigned for physiological testing, depending on the time of the day or increased number of test orders received, staff from sample testing can help out while they still perform their main jobs.

(left) 504X and (right)TBA-200FR connected to LAS
(left) 504X and (right)TBA-200FR connected to LAS

Reduction in Reporting Test Results Time

Soon after 8:30, out-patient STAT samples begin to arrive. Before we used to have to interrupt routine sample testing to load STAT samples but with Open LA21 system we no longer have to since urgent samples are automatically prioritized. Now the time it takes to receive results for routine and STAT samples are basically the same so there is no concept of urgency with in-patients in our hospital wards. By 10:00, most of the test results are reported.

Simplification of Additional Testing

Recently, the number of test items each patient is tested on has decreased from 20 items down to 10 items in bio-chemistry. Before implementing LAS, finished samples had to be manually placed in a number order, from which additional testing samples had to be found when necessary. But now because each sample has a storing position, relevant samples are found quickly and loaded onto LAS. This was one of the great features that LAS implementation has provided the laboratory.

In Search of an Effective Operation

Over 1,000 samples are loaded onto LAS everyday with results reported in 40 minutes from the time samples are received. An assigned staff watches the entire flow in the laboratory and controls the amount of samples loaded since loading them all at once would only cause congestion. We also assign a fully knowledgeable staff so that when problems occur they are dealt with immediately. When a problem occurs with an analyzer, the assigned staff is expected to make decisions quickly to either load only the samples that do not need to be tested on it or load all samples and retest samples that are detected as error. You may wonder why we need people to make decisions after installing an automation system. But this in fact maximizes the full capability of LAS.

View of Laboratory
View of Laboratory

中央採血室
Central Blood Collection Room

Automated Analyzer 504X

Complicated urinalysis was automated by implementing 504X exquisitely for urine testing since there is no change of throughput in sample dilution.

Our demands for LAS

After DPC takes effect in April 2006, the number of initial test items will decrease but instead the number of additional tests ordered after reviewing initial test results will increase. We are planning a new operation where laboratory technicians decide whether additional tests are necessary based on test results before data is sent to physicians. In order to operate this way, it is best for samples to be stored in a refrigerator after analysis and automatically sent back for rerun. It would also be ideal to have a function where serum volume is automatically checked.

IV. LIS – Laboratory Information System

LIS

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Installation and Update History of CLINILAN

1997 : Introduction of CLINILAN (OS2) after comparing with competitors’ LIS
2000 : In-patient ordering began, connected with LIS
2001 : Updated to CLINILAN NT at the time of relocation, connected with out-patient ordering
2004 : Updated to CLINILAN Ver.8

Implementation of CLINEEL (Zonal Verification Method)

We do not feel that it is necessary for technicians to check all test data but rather important that data entry be done with as little manpower as possible. For example, why not have half the data be entered automatically by Zonal Verification Method? Verification by technicians may be considered more reliable but there are times when samples are retested merely by chance or not retested because it went unnoticed. Implementation of CLINEEL enabled us to retrieve data that need to be checked. Also because entering hundreds and thousands of data all day is an strenuous task where one can overlook data, we add some variations to the staff’s daily responsibilities such as assigning staff to perform other tasks (e.g. physiological testing in the afternoon).

V. Working Together with Clinical Side

Gaining Understanding of Testing

Doctors and nurses are not too familiar with testing since they do not learn much about it in school. So we provide 3 day training for interns where they learn from each section. Even for experienced doctors, we explain laboratory operations so that they have an understanding of what we do before they assume their positions. We cannot offer the same for nurses since approximately 100 of them come and go every year but instead a laboratory technician would give a lecture at their orientation or participate in study groups on how to analyze data on demand. In many hospitals, testing is not included in their education curriculum so we make sure that everyone receives training on it when they go through our hospital education curriculum. We also make sure that our technicians visit doctors and nurses on a daily basis to understand and to better serve their needs.

Answering Questions

Other than questions that only the technician who performed the test could answer, all other questions are handled at the reception. Some of the questions we receive are: How do I put in an order for an uncommon test? How much time interval does this test need? Because this is a pivotal job within the laboratory, we make sure that two specially trained staff are present at all times who are normally also in charge of LAS operations.

Support for Clinical Side

In addition to fulfilling our testing duties, we involve ourselves in a committee for infections, NST, diabetes workshops and other hospital activities and meetings in support of the clinical side.

VI. Future Vision

In our laboratory, we monitor skill improvement of our staff using a chart with staff on the vertical axis and tasks on the horizontal axis. A mark is placed next to each task that staff can perform such as bio-chemistry, hematology, and echo. The final goal is to be able to perform all tasks or increase the number of performable skills. Staffs are evaluated on tasks they can perform. So the more they can do the easier it is for me to assign them. I also encourage them to set personal goals such as working towards giving a presentation at conferences. I believe creating an environment where no one is overwhelmed with daily tasks would improve the entire laboratory.

Chief Technologist Tabata
Chief Technologist Tabata

Special thanks to Chief Technologist Tabata and the staff at Kitano Hospital.