運用精實管理提升醫療品質

Improvement of Medical Quality by Lean Management

檢驗系統資訊化及自動化是當今實驗室發展趨勢，運用精實管理勾勒出二個明確的執行方向：（一）導入自動化血庫分析儀BioRad IH-1000，具有操作簡便、所需的檢體量少、判讀結果客觀、產生的廢棄物少及標準化等優點，但在判讀時偶爾會出現異常訊息等不確定反應，ABO血型不合的異體造血幹細胞移植偶爾也會引起血球分型與血清分型不一致，皆需使用手工試管法覆檢，整合儀器與手工試管法資料進行判讀可提高報告的正確性，（二）推廣減除白血球之紅血球濃厚液（LR-RBC）的效益，建議用血單位以LR-RBC取代紅血球濃厚液，導致紅血球類血品產生的輸血反應率及需進行輸血反應探討的數量皆有下降趨勢，因此可減少醫療成本。

Informatization and automation of inspection systems are the development trend of laboratories at present. The use of lean management outlines two clear implementation directions: (1) The automated blood bank analyzer BioRad IH-1000 is imported. It has the advantages of simple operation, less sample volume, objective interpretation results, less waste generated and standardization. However, there are occasional uncertain responses such as abnormal messages during interpretation. Allogeneic hematopoietic stem cell transplantation with incompatible ABO blood type may occasionally cause cell typing and serum typing to be inconsistent. All need to use manual tube method to review. The integration of instruments and manual tube data for reading can improve the correctness of the report. (2) The benefits of Leukocyte-reduced RBC (LR-RBC) are promoted. It is suggested that the used blood unit should replace the Red Blood Cells with LR-RBC, which leads to a downward trend in the transfusion reaction rate of red blood cell blood products and the number of transfusion reactions that need to be investigated, thus reducing medical costs.