急診檢體退件率改進方案

A Project of Improving the Rejection Rate of Specimens in the Emergency Room

檢體的運送和收集是一項很重要的急診工作。不同檢體的收集方式及規定容易造成許多檢體的退件。任何一件檢體的失誤都將影響病患疾病的診斷與治療；但是在忙碌緊張的急診工作中，要精確的完成檢體的收集和運送並非易事。從86年7月至9月，本院急診室共有5372件檢體送出，卻有1.18%檢體遭退件，分析其原因包括：容器不符、標籤和申請單不符、檢體未貼標籤、檢體滲出、檢體量不足、檢體錯誤等。因此我們著手進行此方案，依據持續品質促進理念Continuous Quality Improvement(CQI)來改善問題，針對此問題我們制定出檢體送出的標準流程、檢體收集之範本、檢體退件評核表及安排在職教育加強宣導。實施至84年4月檢體的退件率已降至0.5%以下。迄今，急診檢體被退件的情形已成為稀有或偶發事件。

Specimen collection and delivery are important works in emergency department (ED). However, different collections and specifications of specimens have brought out many rejects so far. Any missing of a specimen may affect the diagnosis and the treatment of a patient's disease. But it is not easy to collect specimens exactly while ED overcrowding. From July to September in 1997, a total of 5372 specimens were collected in our ED. 1.18% (64/5372) of specimens were rejected by different departments. Six leading causes of rejections were as follows: 1) specimen is unsuited to container, 2) sticker mismatch, 3) no sticker to mark container 4) container leakage or package contamination 5) shortage of specimen and 6) wrong specimen. A program to reduce rejection of specimens with the method of Continuous Quality Improvement (CQI) was developed in October 1997. By CQI method, rejection rate of specimens dropped under 0.5% in April, 1998. Until now, the rejection of specimens has been rare and accidental.