การเพิ่มประสิทธิภาพและประสิทธิผลของการรายงานผลทางห้องปฏิบัติการเคมีคลินิก ด้วยระบบตรวจสอบผลอัตโนมัติ (Autoverification) โรงพยาบาลอุตรดิตถ์

suwipar Deebukkham

Authors

suwipar Deebukkham Department of Medical Technology and Clinical Pathology, Uttaradit Hospital

Keywords:

Efficiency, Effectiveness, Manual Verification: MV, Auto Verification: AV, Routine to Research: R2R

Abstract

ABSTRACT
Background: Laboratory result reporting is a critical function for patient diagnosis and clinical management. However, relying on medical technologists to manually verify each result can cause delays and negatively impact both the efficiency (processing time and staff workload) and effectiveness (accuracy and patient safety) of result reporting. Implementation of an autoverification system is a promising approach to improve laboratory result reporting.
Objectives: 1) To compare the efficiency of result verification and reporting in clinical chemistry laboratory between manual verification (MV) and autoverification (AV) systems in terms of turnaround time and staff workload, 2) To assess the effectiveness of both systems regarding accuracy and error detection capability.
Methods: A before-and-after study was conducted in the Division of Medical Technology and Clinical Pathology at Uttaradit Hospital over 12 months (6 months before and 6 months after AV system implementation). Twenty-two tests from clinical chemistry and immunology were included, with a total of 152,347 test results collected retrospectively. Data were analyzed using descriptive statistics
(mean, standard deviation, frequency, percentage) and Levene’s Test for Equality of Variances with SPSS software.
Results: The AV system successfully reported 123,546 results (81.10%), while MV reported 28,801 results (18.90%). The AV system significantly reduced verification time (p < 0.05), saving approximately 1,245.02 hours per month (~50% reduction) and decreased staff workload by 70-85%. Additionally, AV improved error detection from specimen collection and preparation, and achieved 100% critical value detection with zero missed results.
Conclusion: The autoverification system demonstrated high efficiency and effectiveness by accelerating result reporting, reducing errors, enhancing patient safety, and decreasing staff workload. This model can be implemented in other laboratory departments and expanded to other healthcare network units.

References

Campbell CA, Horvath AR. Harmonization of critical result management in laboratory medicine. Clin Chem Lab Med. 2014;52(11):1515-20. doi:10.1515/cclm-2014-0474.

Clinical and Laboratory Standards Institute. Autoverification of clinical laboratory test results; approved guideline. AUTO10-A. Wayne (PA): Clinical and Laboratory Standards Institute; 2006.

Clinical and Laboratory Standards Institute. Defining, establishing, and verifying reference intervals in the clinical laboratory: approved guideline. 3rd ed. CLSI document EP28-A3c. Wayne (PA): Clinical and Laboratory Standards Institute; 2010.

Clinical and Laboratory Standards Institute. Use of delta checks in the medical laboratory. 2nd ed. CLSI guideline EP33. Wayne (PA): Clinical and Laboratory Standards Institute; 2023.

Duca DJ. Autoverification in clinical laboratory. Lab Med. 2002;33(12):969-74.

Guidi GC. Autoverification: a smart way for quality control. Clin Chem Lab Med. 2009;47(7):767-73.

Harris EK, Yasaka T. On the calculation of a reference change for comparing two consecutive measurements. Clin Chem. 1983;29(1):25-30. doi:10.1093/clinchem/29.1.25.

Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and procedures: a College of American Pathologists Q-Probes study in 623 institutions. Arch Pathol Lab Med. 2002;126(6):663-9. doi:10.5858/2002-126-0663-LCVPAP.

Kazezoglu C. Investigation of the effect of autoverification on hematology laboratory workflow. Int J Med Biochem [Internet]. 2021 [cited 2026 Jun 25];4(1):19-24. Available from: https://doi.org/10.14744/ijmb.2020.63835

Kost GJ. Critical limits for urgent clinician notification at US medical centers. JAMA. 1990;263(5):704-7.

Lundberg GD. When to panic over abnormal values. Med Lab Obs. 1972;4(1):47-54.

Nuanin S, Tientadakul P, Reesukumal K, Piyophirapong S, Kost GJ, Pratumvinit B. Autoverification improved process efficiency, reduced staff workload, and enhanced staff satisfaction using a critical path for result validation. Siriraj Med J. 2020;72(4):296-300.

Promnuch S, Vanavanan S, Kumproa N, Bumrungpol P, Srisawasdi P. Autoverification in clinical chemistry laboratory. J Med Tech Assoc Thai. 2019;47(2):7001-15.

Randell EW. Six Sigma approach to autoverification improvement in clinical laboratory. Clin Biochem. 2018;61:23-29. doi:10.1016/j.clinbiochem.2018.07.003.

The Medical Technology Council. มาตรฐานงานเทคนิคการแพทย์ พ.ศ. 2565 [Internet]. Nonthaburi: The Medical Technology Council; 2022 [cited 2026 Jun 25]

Wu J, Pan M, Ouyang H, Yang Z, Zhang Q, Cai Y. Establishing and evaluating autoverification rules with intelligent guidelines for arterial blood gas analysis in a clinical laboratory. SLAS Technol. 2018;23(6):631-40. doi:10.1177/2472630318775311.

Promnuch S, Vanavanan S, Kumproa N, Bumrungpol P, Srisawasdi P. Autoverification in clinical chemistry laboratory. J Med Tech Assoc Thai [Internet]. 2019 [cited 2026 Jun 25]. Available from: https://he01.tci-thaijo.org/index.php/jmt-amtt/article/view/264622/183592