• 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

Kochi Medical School Hospital (2) Dec.2007

I. Preface

Kochi Medical School Hospital was established in October, 1981. As a pioneer in the automation and systemization of laboratory testing field, they have been performing tests using LAS (Laboratory Automation System) and LIS (Laboratory Information System) the laboratory staff have built and constructed on their own since the very beginning. With their motto “You never know until you try. Be the first to try good ideas”, Kochi Medical School Hospital is actively trying new ideas and making improvements.

<Kochi Medical School Hospital>

Address: Kohasu, Okocho, Nankoku-shi, Kochi-ken, Japan 783-8505
URL: http://www.kochi-ms.ac.jp/~hsptl/index.shtml
No. of Dept.: 28
No. of Beds: 605
No. of Staff: 866

Kochi Medical School Hospital

II. General Information of Laboratory

Hospital Staff (as of Nov. 27, 2007)

Lab. Director 1
Instructor 1
Assistant 1
Medical Technologists 23(1 assigned to Pathology)
Contract Medical Technologist 10(1 assigned to Pathology)

Number of Tests in 2006

  Inpatient Outpatient Total
Urinalysis 131,505 205,744 337,249
Hematology 390,231 419,138 809,369
Serology 14,906 28,291 43,197
Clinical Chem. 688,982 918,208 1,607,190
Blood Trans. 14,986 4,388 19,374
Microbiology 22,468 7,047 29,515
Physiology 12,451 17,490 29,941
Pathology 4,198 7,877 12,075
Outsource 15,033 28,191 43,224
Total 2,931,134

Chief Technologist Ogura

Chief Technologist Ogura

Kochi Medical School Hospital Laboratory has been operating under our Laboratory Automation System, “Open LA21 Module System” and Laboratory Information System “CLINILAN LRP Suite” since 2006. We spoke with Chief Technologist Ogura.

III. From the Belt-line System to Open LA21 Module System

How the first LAS worldwide began

Original belt line (partial) still kept in lab

Original belt line (partial) still kept in lab

The story begins a year before the hospital opened. While commuting between Okayama and Kochi prefecture to attend meetings, the former laboratory director Professor Sasaki was trying to figure out how he could start up a laboratory with just five medical technologists. When testing operations were broken down, majority of man power was spent on transporting samples which led him to his idea of “transporting samples automatically”. Now, how could they be transported? I’ve heard that his idea came from seeing a conveyer transporting lime to a cement plant during his commute on the ferry that runs between Okayama and Kagawa prefecture. This is the untold story behind the birth of the “belt-line system”.
I was assigned to Kochi University (formerly Kochi Medical University) in April and we began constructing the self-made belt-line system for the opening of the hospital in October. Since we started from scratch, there was no model to follow. So we had to start from buying tools and structural members for the belt conveyors. After a continuous process of trial and error, the new system was developed.
On the other hand, we requested the manufacturers of analyzers who had agreed to the belt-line system, Sysmex, A&T and Hitachi, to modify the analyzers; a new function (current external sampler) was developed where sample nozzle aspirated once analyzers detected transported samples. And just within six months, the belt-line system was completed and began operating with the opening of the hospital. From the very beginning, we worked on computerization such as incorporating barcodes. We believe that our automation and systemization in the clinical testing field was the first worldwide which we take pride in. After that, we installed an industrial robot and continued to commit ourselves in automation and systemization.
It has been 25 years since the hospital opened and the belt-line system as well as us developers have gotten older. So we decided to purchase a new system instead of rebuilding a new one.

For details of the belt-line system, please see Laboratory Reports:The Legendary “Belt-Line System” (October 1999).

LAS

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LAS

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Current LAS – Open LA21 Module System –

The first financial lease for a national university

The cost for the belt-line system including installation, maintenance and updating was 20 million yen for the first three years and 2 million yen for maintenance annually. Because of the low cost, it was difficult to prepare a budget. There was no way a list price of over 1 billion yen for LAS and LIS would be approved. Fortunately, because we were incorporated around that time, we no longer needed to submit a request for budget allocations and so we chose financial lease. In order to get approval from the university, the laboratory spent six months preparing a financial statement to grasp the existing situation. Everything went smoothly as timing was good as there was someone who understood about leasing in hospital affairs in the hospital network.

Installation Advantages of the Open LA21 Module System

LAS:A&T/CLINILOG Ver.2 + Bayer/MXS

Reagent Cost Comparison
Chemical screening

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LIS:A&T/CLINILAN Ver.7.5

TAT Report
(Item: WBC)

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The first advantageous effect is the significant cut in reagent cost. In the graph showing (see left graph) the reagent cost for chemical screening before and after the installation of the system, you can see an average reduction of 1.5 million yen by the installation of JCA-BM2250LA Type. There was even a month where 3 million yen was cutback.
The second is consolidation of operation. The four sections, urinalysis, hematology, chemistry and immunology, were combined into two sections, “Automated analysis section” and “Urinalysis and special section”.
The third is consolidation of analyzers. Compared to before, we decreased the types of analyzers and created more space. Frankly we had a more consolidated picture, but similar to falling into metabolic syndrome, we were caught off guard and more units were connected.
The forth is the reduced TAT(Turnaround Time). As shown in the graph from last year’s data (see graph on the left), the amount of time from accession to entering result was reduced which has been kept up today.

The fifth is the expansion of operations by laborsaving. Student health checks and staff medical check-ups were enforced and tuberculosis testing (QuantiFERON) was implemented by prefectural engagement. For PSG testing (overnight polysomnography), we set up a night-time operation system operated by those in charge of physiological testing (male) and enabled two patients to be tested simultaneously twice a week.
These are the current advantageous effects but honestly speaking, we are not yet satisfied. We believe that there is still room for improvement in showing effects in labor and personnel as we have not yet been able to operate to our ideal. The reason comes from the overall undeveloped reagents, automated analyzers and transportation units which have room for improvements to be made. We look forward to higher functions and working together in the future.

IV. Renovating the Entire Laboratory

The significance in total renovation, not partial updating

Looking back at the updating method for analyzers and system, budget is cut to 50 to 70% even after renewal plans were made by each section. In a manner, we were forced to compromise, which led us to make up for it in the next renewal plan. But by the time budget was prepared, the timing was too late and this cycle seemed to have repeated itself. Partial investment is an uneconomical investment. Why? Advancement in technology is so rapid that what’s best today is not the same for tomorrow. So this time around, we decided that renewal should be made extensively as much as possible, and renovated patient reception to sample collecting, analyzing and result reporting.
This lump renovation was made possible by the implementation of financial lease.

Commitment in renewing the blood collection room

Comfort was the top priority for renewing the blood collection room since it is most subject to evaluation from the outside. So we decided why not have patients relax comfortably while they wait? The biggest point was reducing the testing space to create an interim-waiting room with a TV for entertainment and doubling the blood collecting space. Also, we changed the blood collecting area to individual booth type to protect the patients’ privacy, and installed chairs for blood collection (pink chairs in photo) based on the blood collecting guidelines. We did an overall renewal by implementing number and color display for calling patients and installing automated transportation system for test tubes.

Interim-waiting room Blood-collection booths are set up in the back
Interim-waiting room
Blood-collection booths are set up in the back

Blood collection booths and test tube transportation system
Blood collection booths and test tube transportation system

V. ISO Application of the New System

Roles fulfilled by LAS and LIS in acquiring ISO

Our laboratory acquired ISO9001 in October, 2006. The biggest advantage with the new system is that ISO file could be shared. We placed a document prepared with support software, for standardization of testing processes, for creating operation sheets so that it could be accessed from any computer.
In addition, since total data such as TAT are obtainable from LAS and LIS, its helpful when monthly quality management reports are prepared. We made our own program where we can pull out data immediately for reports. In the future, since we are considering acquiring ISO15189, the role of LIS is quite significant.

What is being done in the ISO Deming Cycle

Each month, we write up a monthly QMS (Quality Management System) report. ISO manager collects monthly reports from each section and hands them out to the professor, chief technologist, vice-chief technologist, and each supervisor. The reports are examined at the managers’ meeting at which coping strategies are set for problems to be solved. TAT information, inquiries, and number of trouble cases are available every month which plays a big role in continuous analyzing. On the newest QMS report, you can see that the number of problem cases has reduced considerably.
In the ISO review, personal evaluation is also included. Personal improvement is shown individually on a radar chart in a 5-point scale.

QMS Monthly Results TAT for main 7 items reported monthly
QMS Monthly Results
TAT for main 7 items reported monthly

Contents of QMS Monthly Results

1. Customer satisfaction
(1) Number of inquiries and their questions
(2) Claims and requests to each section and support provided
(3) Information from staff
2. Conformance to product requirement
(1) Test result report time (TAT) analysis
(2) Nonconformance control status
(3) Instrument problem occurrence status
(4) In-lab incident report status
(5) Other reports
3. Claims and trouble report summary
VI. For Better Medical Care

Continuous effort for improvement

Reception/ Waiting Room
Reception/ Waiting Room

Since we reviewed the testing operations, next we plan to reexamine accessioning operations the place where it is the busiest with patients. At reception, one staff controls and instructs patients where to go while comprehending the traffic situation at urine collection, blood collection and physiology. This highly specialized supernatural task cannot be replaced by a system or just anyone else as it relies a lot on experience. We started identifying types of tasks and the amount of time each required. However, congestion at reception cannot be solved by the laboratory itself. We feel that changes need to be made comprehensively in the outpatient medical system and patient administration and accounting system to find a solution.

Enhancing hospital operations

Friendly Sunflower Project Logo
Friendly Sunflower Project Logo

In addition to daily efforts for the betterment of the hospital, the “Sunflower Project” under the direct supervision of the director of the hospital is in operation. This project consists of two working groups.
“Service improvement group” consists of 30 members which includes the hospital director and representatives from each department. The group meets once a week and reviews comments and suggestions made by patients and staff, which are quickly handled and reported.
“In-hospital environment improvement group” consists of 10 members which includes the chief nurse, comedical and administrative staff, and staff in charge of facility maintenance. Hospital routine rounds are made once a month where repairs and clean ups are done.

VII. From the Department Director

杉浦部長
Professor Sugiura

In recent years, clinical testing departments must increase their cost-consciousness in testing operations due to economical constraints. This means that laborsaving and streamlining in testing operations are demanded while maintaining scientific basis. Also, in order to process vast amounts of clinical data ordered to the laboratory quickly and accurately, and provide clinical support by giving feedback to the examiner’s side, laboratory must be equipped with highly analytical technology and data analytical capability. The growth of automated technology in testing is absolutely imperative. Based on the situation laboratories are in, we restructured the laboratory by implementing a new generation total laboratory management system in 2006 with “a satisfactory laboratory for patients and clinical sections” in mind. Although it is a given that clinical laboratories should produce accurate testing data promptly, it is also necessary for the clinical support section to provide high quality information effectively to clinical sections in addition to fulfilling its duties as a testing operation center. And so, while maintaining high precision in testing, we wish to contribute to harmonious medical care with each of our laboratory staff working closely with the nursing department and diagnosis and treatment department one step further as a member of team medical care.

We thank Professor Sugiura, Chief Technologist Ogura and all the staff at Kochi Medical School Hospital for their cooperation and support.