Haemolysis interferes with many test results through release of red blood cell (RBC) intracellular contents or via spe- cific analytical interferences. In grossly haemolysed sample, potassium level can be raised considerably dependent on the degree of haemolysis and may exceed the critical limit value. In this case report, the potassium level from a grossly haemolysed sample taken after haemodialysis remains within normal range, and this has led to unnecessary repeated blood samplings hence delay the diagnosis. With the persistently high haemolytic index (HI) of 400mg/ dL and normal potassium levels in sequences of samples taken post haemodialysis should raise a high suspicion of in vivo haemodialysis related-haemolysis. An effective communication between laboratory and clinician, and a proper, well-designed protocol or guideline on the management of sample haemolysis in clinical laboratory therefore is very essential to ensure all clinically important but rare case of in vivo haemolysis can be identified early and the potential unwanted serious outcomes can be prevented accordingly.
Introduction: Laboratory turnaround time (LTAT) is considered a reliable indicator of the quality and efficiency of a laboratory’s service. LTAT achievement, particularly of urgent tests, remains unsatisfactory and challenging in many clinical laboratories especially in tertiary health care centres with high workload and restricted resources. The unresolved issue of unsatisfactory urgent renal profile (RP) LTAT below the standard performance goal prompted our interest to improve laboratory’s handling of urgent test request. We thus implemented the Lean principle in the management of urgent test requests using urgent RP as the test model. Methods: The implementation of laboratory Lean involved 4 steps process; (1) Development of burning platform for change (2) Identification of waste (3) Plan- ning and implementation of control measures (4) Measuring, monitoring, and sustaining the improvement. Urgent RP LTAT and the percentage of the request met the time requirement determined based on the data extracted from laboratory information system (LIS) before and after the implementation of Lean was compared to assess the effec- tiveness. Results: Urgent RP LTAT after the implementation of Lean was reduced i.e 35 min (before) vs 31 min (after), with the percentage of LTAT met the time requirement was significantly increased above the set target i.e 82.8% (before) to 93.5% (after) with P-value = 0.001. Conclusion: Implementation of innovation using Lean management has significantly improved urgent RP LTAT achievement, thus optimised urgent test management in our Chemical Pathology laboratory. Lean is a strongly recommended strategy to improve urgent test LTAT especially in laboratories with restricted resources.