發展人因創意混合器提升血液檢體品質

Development of an Innovative Ergonomic Rotor to Improve the Quality of the Blood Specimens

本院每年急診血液檢體約25萬支，血液檢體因為凝固導致退件，占退件原因之60％，為改善血液檢體凝固的發生率，本研究旨在：（1）研發節能攜帶式小型血液試管混合器，協助檢體之採集；（2）評估此混合器之實用成效。首先進行採檢流程觀察，確定血液凝固的原因；進而開發血液試管混合裝置。透過測試與訪談，了解需求與回饋。將此器具放置在急診室執行抽血。2017－2018年期間，每月隨機選取約235支檢體共2,860支檢體，放入混合器後送檢。經實際測試，放入混合器後送檢之檢體均無發生凝固，改善程度可達99.97％。為簡化流程，檢體經過此混合器一併進行條碼掃描，掃描良率亦可達100％。在採血後使用血液試管混合器即可開始混合血液與抗凝劑，使血液在檢驗前不會因為凝固，而無法進行後續的檢驗，因此可以減少重新抽血的次數、時間消耗與減輕護理的工作負荷，提升醫療檢驗品質。

In the Emergency Department (ED) of the National Taiwan University Hospital (NTUH), 250,000 blood specimens are estimated to be collected each year. Clotted specimen was the main reason of test processing errors that accounted for 60% of sample rejection. An essential step to obtain high quality blood specimen is to adequately rotate the blood tubes to mix the blood and the anticoagulant. To reduce the incidence of clotted blood specimen, current study aims to: (1) develop a novel portable blood tube assistive rotor installed on a mobile nursing cart to assist specimen processing; (2) evaluate the clinical effectiveness of the assistive rotor device and a novel barcoding system to facilitate specimens processing in the ED. A waterfall model was then used to develop the assistive rotor device to facilitate blood mixing. Field tests and in-person interviews were performed to elicit feedback from end-users and optimize the design of the rotor device. The assistive rotor device was placed on a mobile nursing cart and used by trained nursing staff to mix blood specimen collected in the NTUH ED. Each specimen was immediately mixed using the rotor and sent to the hospital central lab processed by a newly developed barcoding system. During 2017-2018, a total of 2,860 specimens were randomly selected, approximately 235 specimens per month as the study group, which were put into assistive rotor device and sent for examination. Through actual tests, there's no clotting errors in the specimens put into the portable blood tube assistive rotor, and the improvement reached 99.97% in the study. Furthermore, the new barcode scanning system resulted in 100% accuracy of patient sample identification. The blood tube assistive rotor device significantly reduced clotted blood specimen errors and lowered blood specimen rejection rates. As specimen rejection leads to increased staff burden and extended patient ED length of stay, the assistive rotor device significantly promotes laboratory quality and medical service quality.