Once upon a time the hospital laboratory, was a small, dark, cul-de-sac reeking of chemicals, and located in the bowels of the hospital next to the morgue.
The scenario is changing fast its image and emerging as a high-tech, respected member of the hospital team.
Medical technologists and technicians no longer huddle over racks of test tubes; instead, they work in brightly-lit, air-conditioned labs.
Monitoring and maintaining sophisticated laboratory analyzers capable of running hundreds of patient samples each day.
IMPORTANCE OF LAB
Laboratory services are essential to health care delivery.
The hospital lab offers the convenience of local service, and familiarity with both the outpatient and his physician.
Hospital labs depend on their outpatient testing to make up money lost during times of low in-house census
They address both preventive and curative activities, i.e. patient diagnosis, and the selection of drugs for treatment.
They are also an indispensable tool in the surveillance and control of diseases.
Improved disease recognition will improve the accuracy of statistical reporting, and thus effective national health planning.
PRINCIPLE OF PLANNING The planning of hospital Lab services depends on following factors:- LAB SERVICES
Successful laboratory services is one that comes from careful planning and designing to meet current and foreseeable needs of personnel, equipment and spaces).
Secondly the type and extent of services to be provided depending on:-
1. OPD services: Central Laboratories
2. Ward Services
3. Emergency Services
i) Round the clock services
ii) Restricted Emergency Services
4. Type of investigation to be provided
KEY ELEMENTS OF PLANNING OF LABORATORY PLANNING INFRASTRUCTURE/ WORK PLACE EQUIPMENTS & FACILITIES MANPOWER
PLANNING OF INFRASTRUCTURE 1. Depends on type of services to be provided. 2. Work load and bed strength of the hospital .
Traditional ‘closed’ laboratory: The traditional hospital laboratory has discrete sections in hematology, chemistry, microbiology and blood bank generally separated into rooms or sections.
Open laboratory: The discrete services are placed in one large room with portable walls that can be adjusted as needed.
Core laboratory : Haematology and Chemistry (Chematology).
Regional laboratory: Low volume or expensive laboratory services consolidated in to one hospital
Reference laboratory: Traditional full service laboratory that handles all types of testing.
Point of care : Tests at patients bed side.
Stat laboratory: Rapid response lab often located near an emergency department provides critical lab test e.g. haematocrit, blood gases.
Limited service: Limited menu of routine and/or specialty services.
PLANNING OF INFRASTRUCTURE INFRASTUCTURE SIZE LOCATION ADMN. AREA ENVIRONMENTAL CONSIDERATION AUXILLARY AREA FUNCTIONAL AREA
SIZE OF THE LAB.
Size depends on the function
Generally 1 sq ft/ 20 samples annually.
Minimum requirement for each unit are 10 ft x 20 ft
Lab should preferably in ground floor.
Easy access to indoor, emergency and OPD.
Different sub units may be located at
- OPD Unit
- Emergency Unit
- Small unit attached to ICU and wards
- Main Central Unit
FACILITY DESIGN PROCESS STAGES ACTIVITIES SITUATION ANALYSIS Needs assessment staffing needs/requirements Technologic changes, current and anticipated . Identify team players (architect, laboratory staff. Medical staff interior designer etc.) STRATEGIC PLANNING Activities to be performed ,flow of people and materials storage. Equipment to be used, utilities. Laboratory sectional needs. STRUCTURAL DESIGN Structural design, identify construction materials. Architectural design. Cost System options (plumbing, electricity/heating/ventilations/air conditioning). INTERIOR DESIGN Interior design. Colors, fabric, texture, finish
SUGGESTED DIMENTIONS FOR INTERIOR Laboratory counter width 2 feet 6 inches Laboratory counter to wall clearance 4 feet Laboratory counter to counter clearance 7 feet Desk height 30 inches Keyboard drawer height 25-27 inches Human body standing 4 square feet Human body sitting 6 square feet Desk space 3 square feet
CENTRAL COLLECTION UNIT
It is centrally located in OPD.
Space required depends on type of collection, work load and drainage minimum
capacity of 150-200 patient collection.
The various components includes:
a) Special service and guidance
b) Registration Counter with token system
c) Finger prick collection area
d) I.V Blood Collection Area
e) Collection of urine, stool area
MORGUE - This area specially for collection of body specimens for histopathology like body tissues and vicera .
CENTRAL LAB. UNIT A. ADMINISTRATIVE AREA
Office of Pathologist
Patient Waiting Area
B. AUXILLARY AREA
Glass Washing Room
Cleaning of instrument
C. ANCILLARY AREA
Treatment and disposal of specimens
Chemical and reagent store
D FUNCTIONAL AREA
FUNCTIONAL AREA It comprises of various service areas . FUNCTIONAL AREA HAEMATOLOGY VIROLOGY & IMMUNOLOGY BIO CHEMISTRY HISTOPATHOLOGY STOOL & URINE CYTOLOGY MICROBIOLOGY BLOOD BANK
Floor should be strong, acid and stain resistant, grease proof.
Walls washable light colour, water proof, no crevices.
As far as possible, natural light.
Adequate ventilation and exhaust system.
Spot light, no extension cord.
Sufficient Electric Points
Special investigation area to be air conditioned
Working benches Sitting type - 30 inches ht
Revolving stool Standing type - 36 inches ht
3 ½ ft space between two benches
Water sinks, hot and cold water supply, compressed gas burner
ACTIVITY PLANNING LAB MANAGEMENT SYSTEM PATIENT OPD SAMPLE COLLECTION REGISTRATION IN DOOR EMERGENCY RESULT REPORTING IMPRESSION TESTING QUALITY CONTROL SAMPLE ANALYSIS
FUNCTIONS OF LAB
Laboratories are the pillars on which quality of medical diagnosis is based.
8. Training and education of medical students and staff.
Planning and organising work in clinical chemistry laboratories. Carrying out complex analyses on specimens of body fluids and tissues. Auditing the use and diagnosis performance of tests. Developing new and existing tests, mostly automated and computer assisted. Submitting funding bids and conducting research with clinicians. Liaising with clinical and technical staff. Some patient contact. ACTIVITIES CARRIED OUT
EQUIPMENTS Types of equipments depends on type of investigations . Common equipments are:-
Auto analyzer, Semi auto analyzer, Blood gas analyzer.
Hot Air Oven
Wax meeting bath
CRITERIA FOR COSTLY EQUIPMENTS PROCUREMENT (i) Type and size of the Hospital. (ii) Daily attendance of patients (III) No of tests needs to be performed per day (iv)After sales service, warranty. (v)Availability of reagents (vi)open system availability of spares. (vii) Familiarity with storage specifications of reagents and expiration dates.
STAFFING Staffing depends on units functioning and workload . MEDICAL SUPERINTENDENT HOD (PATHOLOGY) I/C BIO CHEMIST LAB. TECHNICIAN LAB. ASSISTANT LAB. ATTENDANT SAFAIWALA I/C HAEMATOLOGY I/C HISTOPATHOGY I/C MICROBIOLOGY I/C CYTOLOGY I/C URINE & STOOL No. of Lab technicians required 100 bedded-7, 300 bedded-26, 700 bedded - 52
Provision of Services
Procurement, Storage of Reagents, Chemicals
Quality Control, Calibration
Technical Evaluation and Supervision
Maintenance of Records and Registration
QUALITY CONTROL IN LAB. SERVICES
- It is a surveillance method, where the skills of the performer, performance of
Equipment and material used are synthesized to gather to produce diagnostic report to assist the physician in diagnosis.
-The output of the process must conform to pre-established norm/ standard.
It emphasizes on the skill of the performer, technical procedure and process performed to achieve the desired result.
It is a statistical system for measuring the reproducibility of degree of precision in lab procedure and its constant improvement.
Objective of the quality control is to develop a quality assurance system having continuing quality improvement.
QUALITY CONTROL Quality Control is the on going effort to maintain the integrity of a process to maintain the reliability of achieving the expected outcome. PROCESS INPUT OUTPUT IDENTIFY THE PROCESS SET THE PROTOCOL PREPARE SOP SET QUALITY LEVEL PUT THE SYSTEM INTO ACTION MEASURE THE OUTPUT AND COMPARE TO PRE- DETERMINED LEVEL
STAGES OF QUALITY CONTROL PRE ANALYTIC ANALYTIC POST ANALYTIC Preparation of Patient Specimen Collection Transportation of Sample Sample Accession Sample Preparation Test in run Final Testing Report Generation Report Dispatch Report Interpretation DOCTOR & PATIENT SATISFACTION QUALITY ASSURANCE SYSTEM
TYPES OF QUALITY CONTROL QUALITY CONTROL INTERNAL QUALITY CONTROL EXTERNAL QUALITY CONTROL
Assessment at lab level/internal group
Basis for day to day improvement
Provide immediate improvement
Involves many outside institution
Assessment done by outside lab
Helps in inter org. compatibility
COMPONENTS OF INTERNAL AND EXT. QUALITY CONTROL COMPONENTS INTERNAL EXTERNAL
c) Material - Good Quality Reagents d) Collection of Specimen - Acquisition, handling, preparation e) Accurate Test Report f) Monitoring and Evaluation
b) Types of Programmes
QUALITY ASSURANCE Introduction of planned or systemic actions to provide enough confidence that a product or service will satisfy the given requirements for quality as pre- determined. IDENTIFY THE SERVICE/ PRODUCT SET INDICATORS ESTABLISH STANDARD OBSERVE THE PROCESS MEASURE OUTPUT COMPARE WITH STANDARD QUALITY ACHIEVED QUALITY NOT ACHIVED ENHANCE STANDARD REVIEW THE PROCESS & AREAS OF IMPROVEMENT