Clinical laboratory services are a critical yet much neglected component of health systems in resource poor countries. They are crucial for public health, disease control and surveillance, and guide patient diagnosis and care, but their key role is often not recognized by governments or donors. Laboratory tests should be used to improve the outcome for individual patients or to provide public health information. However, if the quality of laboratory tests is poor, resources will be wasted on repeat tests or inappropriate management and the laboratory service will be inefficient. The primary goal of Laboratory Medicine is to provide information that is useful to assist medical decision-making, allowing optimal health care. This can only be obtained by generating reliable analytical results on patient samples. Meaningful measurements are indeed essential for the diagnosis, monitoring, treatment, and risk assessment of patients. Inadequate laboratory performance may have extensive consequences for practical medicine, healthcare system, and, in conclusion, for the patient. Poor quality results may actually lead to incorrect interpretation by the clinician, impairing the patient’s situation. Accreditation authorities have identified twelve quality system essentials that need to be in place for a laboratory to perform clinical tests adequately and in a quality assured manner. Along with each laboratory performing tests that are in its scope, it is essential that duplication and excess capacity is addressed by forging and operating a network of laboratories leading to consolidation and integration of clinical testing. A network would have collection centers at places convenient to the patients, supported by frequent transfer of samples in appropriate conditions to the laboratory. In the laboratory there is a need for increased automation and relevant training of personnel and the setting up of centralized accessioning, pneumontic chutes for transport of samples to the work bench and for bidirectional interphased equipment to transfer results to desk top of laboratory physicians and after validation of results for the results to be electronically transferred by SMS and/or PDF files via email and/or becoming available online for clients, supplemented by delivery of hard copies of the results. The challenge in the next decade for laboratory medicine is to accomplish these major changes in organization to meet fiscal restraint and shortage of adequately trained laboratory personnel. Collaborative networks, constructive use of point of care devices, and the development of rapport between laboratories and their clients leading to cost effective utilization of limited resources, are some of the strategies that will maximize patient benefit

1. Laboratory reorganization in view of fiscal & human resource constrains Dr. Ashok Rattan, Chief Executive, Fortis Clinical research Ltd., Adviser, Religare SRL Diagnostics labs in Fortis / Escorts Hospitals, Delhi & NCR

2. Optimal Laboratory System

4. Quality in Laboratory Services

12. We never make any mistakes in our Laboratory , Mr. Sharma My name is Sunil Verma Recognize that we ALL make mistakes

14. Deaths in USA due to medical error are Equivalent to ONE Jumbo jet crashing every day of the year

15. Old Paradigm Errors because of bad apple Name, Blame and Shame

18. Blunt and Sharp end model

19. Swiss cheese model of error prevention

20. Optimal Laboratory System

21. 9+2 Establish NETWORK Set up Rapid response labs Supported by Reference Lab

22. Pre analytical Sample Collection & Transportation

23. SRL Clinical Reference Laboratory: The lab that never sleeps Infrastructure & Trained Manpower

24. Analytical Automation

25. IT enabled bidirectional interphase Post Analytical

26. Processes & Accreditation

28. Which tests are available Which can be ordered as STAT How to complete lab request form Pt preparation & precollection assessment Collection instruction Transport, temperature, storage Feedback on specimen quality Tracking mechanism Roles & Responsibilities

29. Performing the tests as per SOP Use ICQ Participate in EQA Verify validity of test results Interpreting the findings Reconcile significant disparity

30. Preliminary reports Final report Report TAT Corrected reports Specimen management Report & material archiving

33. constantly review quality of results

38. frequently review output

39. review workload & optomise (wo)manpower

40. Provide Regular Feedback & Monitor Corrective Action

41. Effect on Workload in NCR Total Accessioning TOTAL 49,915 65,724 89,536 973 771 729 423 279 219 - - - ROT 6294 6303 4485 3333 3264 3267 3459 2871 2843 DLF 5945 3938 3658 3471 3474 3321 3028 2951 2656 SUN 3719 3160 3269 2696 2843 2601 2926 1271 2287 FHJR 6902 5012 4883 4129 4232 3471 3887 3299 2736 PV 7148 6084 5350 4804 5083 4911 5569 5222 4949 FHVK 11783 11351 10405 8552 8589 9001 9667 8278 7875 FHN 46772 44281 44859 42634 44388 38933 42108 30818 26569 GGN Sep Aus Jul Jun May Apr Mar Feb Jan Labs

42. A decade back Diagnosis known & tests available Clinicians experience In test selection & interpretation No difference

43. Situation now Diagnosis known & tests available Clinicians’ experience In test selection & interpretation No expert advice provided unless asked

46. Answer questions on lab Related issues Necessary to get Visibility in patient care Provide interpretative services For complex tests Necessary to gain indispensability in patient care

48. Even if we are on the right track we risk being run over, if we just sit there ACT