Patricia Hernández

Análisis de productividad, calidad y costos en laboratorios del primer nivel: la biometría hemática

OBJECTIVE Assessment of productivity, quality and production costs and determination of the efficiency of top grade clinical laboratories in Mexico. METHODS Ten laboratories were selected from among the total number (52) existing in Mexico City, and the Donabedian model of structure, process and results were applied. Blood count was selected as a tracer. RESULTS The principal problems found were: inadequate distribution of trained human resources, poor glass material, inadequate analytic process and low productivity. These factors are reflected in the unit costs, which exceed reference laboratory costs by 200%. Only 50% of the laboratories analyzed generate reliable results. Only 20% of the laboratories studied operate efficiently. CONCLUSIONS To solve the problems identified requires integral strategies at different levels. A specific recomendation for the improvement of quality and productivity is an assessment of the cost/benefit of creating a central laboratory and using the remaining sites exclusively for the collection of samples.OBJETIVO: Conocer el grado de eficiencia con la que funcionan los laboratorios clinicos del primer nivel mediante una evaluacion que integre: la productividad, la calidad y los costos. METODOS: Se seleccionaron 10 laboratorios clinicos de un total de 52 existentes en la Ciudad de Mexico; se utilizo el modelo de Donabedian en sus componentes de estructura, proceso y resultado utilizando la biometria hematica como rastreador. RESULTADOS: Los principales problemas fueron: inadecuada distribucion del recurso humano calificado; malas condiciones del material de vidrio; inadecuado proceso analitico y baja productividad. Estos problemas se reflejaron en un incremento de un 200% en los costos unitarios respecto al costo ideal. Solamente son confiables los resultados de 50% de los laboratorios analizados. Veinte porciento de los laboratorios analizados son eficientes. CONCLUSIONES: La solucion a los problemas encontrados requiere de estrategias integrales que comprometen a diferentes ambitos, por lo que su solucion se plantea dificil. Se recomienda analizar el costo-beneficio de crear un laboratorio central y dejar a los demas laboratorios como sitios para la toma de muestras exclusivamente.

Escalas para evaluar la mortalidad de pacientes con trauma y síndrome de insuficiencia respiratoria progresiva del adulto

Objective. To compare different scores and scales used to evaluate mortality in patients with trauma and adult respiratory distress syndrome (ARDS). Material and methods. The clinical charts of 80 adult patients, 70 men and 10 women, who were admitted during the period from January 1st, 1990, to December 31st, 1993, to the Hospital Guillermo Barroso C., Cruz Roja Mexicana in Mexico City with trauma and ARDS, were revised. The following data were evaluated: sex, age, injury-producing mechanisms, associated morbid conditions (shock, multiple blood transfusions, long bone fracture, pulmonary contusion and sepsis), ARDS diagnostic criteria, systemic failure, multiple organ failure, injury severity score, Acute Physiology and Chronic Health Evaluation Scoring System, time elapsed to ARDS diagnosis, period of tracheal intubation and stay at the intensive care unit. Results. Of the 80 patients, 26 died (32.5%), 2 women and 24 men. Injury-producing mechanisms were: running over (31.3%), car accidents (27.5%), gunshot wounds (15%), stab wounds (13.7%) multiple contusions (7.5%) and falls (5%). A highly significant relationship was found between all scores and scales investigated and mortality. In pulmonary contusion and gastrointestinal failure correlation was doubtful; period of tracheal intubation and stay at the intensive care unit showed no correlation to mortality. Conclusions. Adult patients with trauma who develop ARDS showed high probability of death if additional clinical data of shock and consolidation in three or four quadrants of thorax X-rays are present, among other factors.