Research On The Application Of Quality Control Circle In The Emergency Examination Of X Hospital In Shandong Province

BackgroundHospital medical quality management is of great value to the life and health of patients,and as a quality management tool that is suitable for the use of the grass-roots staffs,quality control circle(QCC)is widely used in the medical field.At present,some researches apply QCC to shorten the test turnaround time(TAT),but most of the existing researches are aimed at improving the TAT of various test items and pay more attention to intra-laboratory TAT,and pay less attention to the whole test process.The delay phenomenon of emergency test TAT of cardiac biomarkers occurs frequently in the actual work of X hospital of Shandong province,and clinical workers generally reflect the longer TAT.Cardiac biomarkers including troponin I(TnI),creatinine kinase isoenzyme(CK-MB),myoglobin(MYO)are important biomarkers in the diagnosis of acute myocardial infarction,and their turnaround time(TAT)is closely related to the life and safety of patients,thus it is urgent to improve the emergency examination efficiency and realize continuous improvement of emergency test quality.X Hospital of Shandong province,as a comprehensive tertiary public hospital,has drafted work schemes to promote the use of quality control circle(QCC)throughout the hospital in recent years.Therefore,the study adopts QCC in the hospital to decrease the emergency test turnaround time of cardiac biomarkers,and reduce the outlier rates of TAT in the study.PurposesThe study implement QCC activity in X hospital of Shandong province to analyze the status of cardiac biomarkers for emergency test,explore the cause of emergency test TAT delay,find and adopt corresponding countermeasures to shorten the emergency test TAT,and reduce the outlier rates of TAT,which will realize the continuous improvement of testing quality.Next review the QCC activities to find something that needs to improve.Finally,put forward some relevant improvement suggestions aiming at the problems existed in the process of the activities.MethodsIn this study,the emergency examination turnaround time of cardiac biomarkers refers to the time when the doctor issues an examination request to the completion of the emergency laboratory’s test report.The indicators include the emergency test TAT of cardiac biomarkers,outlier rates of TAT,and the intangible achievements of the circle members including the problem solving ability,communication and coordination ability,teamwork ability,quality control technique,responsibility,cohesion,enthusiasm and happiness.We carry QCC activity to reduce the outlier rates of TAT.First,the TAT data of emergency test for cardiac biomarkers on October 1,2018 to November 30,2018 is obtained from the hospital laboratory information system as the baseline data to represent the current situation before the implementation of the QCC,and the TAT data from October 1,2019 to November 30,2019 is obtained as the data after the implementation of the QCC.The TAT can be divided into three intervals,including "apply to the collection","acquisition to computer","computer to report",and we conduct descriptive statistics analysis,using TAT the tenth percentile,the median,the 90th percentile to show TAT status.Then,the causes of TAT delay are collected by brainstorming and semi-structured interview,and the fish bone diagram is made by means of causal analysis to determine the true causes of TAT delay,which are the main influencing factors.Secondly,to put forward the corresponding countermeasures to shorten TAT.Finally,analyze the effect of QCC using the contemporaneous contrast of the above three evaluation indicators before the QCC(October 1,2018 to November 30,2018)and after the QCC(October 1,2019 to November 30,2019).And for outlier rates of TAT,set P values in the χ2 test,if P<0.05,the difference is statistically significant.ResultsThe study finds that there are a total of 1579 cases before the implementation of the QCC(from October 1,2018 to November 31,2018),with 142 cases failing to meet the standard.And there are 103 cases in 1839 fail to meet the TAT standard after the implementation of the QCC(from October 1,2019 to November 31,2019).After the implementation of QCC,the median of total TAT("order to report")is shortened from 78.27min before improvement to 66.83min after improvement,and the 90th percentile of total TAT("order to report")is shortened from 117.54 minutes before improvement to 103.96 minutes after improvement.The outlier rates decrease from 8.99%before QCC to 5.60%after QCC.Intangible achievement scores are improved evidently in terms of problem solving ability,communication and coordination ability,teamwork ability,quality control technique,sense of responsibility,cohesion,enthusiasm,and happiness.It uses χ2 test to evaluate the outlier rates of total TAT before and after the implementation of QCC,finding that P<0.05,which means the difference is statistically significant and the QCC has a significant effect on the emergency test TAT.Conclusions and SuggestionsThe conclusions of the study are that the QCC carried out in the emergency laboratory of X hospital successfully shortens the test TAT of cardiac biomarkers,and reduces the outlier rates of TAT,which is conducive to promoting the continuous improvement of test quality and benefit to patients;life and health,and it also improves the comprehensive quality of the circle members.In the future,the hospital can extend the results of the QCC and monitor the long-term effect;the results of it will be further developed and utilized;increase the training effort to broad the quality management ideas of medical staffs;continuously promote the optimization and upgrading of laboratory information system;give certain material incentive to ones who are not the QCC members and have the outstanding contributions for the QCC.