運用精實思維改善分生實驗室流程

Lean Thinking to Improve the Workflow in a Molecular Diagnosis Laboratory in Hospital

近年來分子診斷技術蓬勃發展，分析儀器上也不斷的翻新，各實驗室分生的檢驗項目、及檢體數量大幅的增加。然而相較於發展較早的生化檢驗，分生檢驗仍以大量的手工操作為主，步驟繁複冗長，此外，分生實驗輸出的資料大多需額外進行計算、分析及製作書面報告，甚至需等醫師核簽報告，以上都是造成分生實驗室人力負荷過大、流程管理不易及時效過長的原因。精實思維(Leanthinking)主要是以改善作業流程為手段，以減少浪費、提升效率及品質。我們將分生實驗分為前、中、後，導入精實思維的概念，除了購入自動化機台取代手工操作外，我們亦致力於實驗流程整合，並與科內電腦品管醫檢師合作進行檢體簽收、實驗數據計算及報告直接上傳等軟體開發，大幅降低人員操作的負擔。使用高通量、便利的自動化機台，固然可以簡化分生的作業流程，然而實驗室需耗費大量的經費，因此若適當的使用現有的機台、輔以電腦軟體、改善作業流程，便可以在不斷增加的檢體中，達到降低人力負荷及減少品管異常的目的。

Due to rapid development of new technology and equipments in molecular diagnostics, the items and specimen had been dramatically increased in clinical molecular laboratory in recent years. However, compare to conventional biochemistry tests, molecular diagnostic tests are still more complicated and rely on manual operation. Moreover, most of the raw data need to be calculated and processed to become the final report. Some genetic tests even need the further interpretation and approval from medical director. All of these are the source of work load and prolongedturnaroundtime and it raises the challenge of management in molecular laboratory.Lean thinking is a concept of continuous improvement of current processes. The central goal of Lean is to reduce all kinds of waste and enhance work efficiency and quality. We introduce the Lean thinking to pre-, in-, and post-analytic steps in our molecular lab. First of all,automatic machines were implemented for replacing manual nucleic acid extraction and gel electrophoresis.Some examination processes were integrated to avoid repeated work. We also cooperated with IT people to simplify the process of specimens receiving, data calculation and final report uploading by using customized software to reduce the clerk error and increase the efficiency. In conclusion, high throughput and convenient automatic machine are easy to purchase to replacethe complicated manual work in molecular lab. However, not all labs afforded. The appropriate way to reduce work load and quality disconformities is to analyze the workflow and try to find the key point of wasting time and then improve the process by work integration or simplify the process by information system.