By: Ying Shen, Dahong Zhai, Yang Li, Tingting Gui, Dengqin Zuo
Keywords: Heparin anticoagulation; Laboratory quality management; Neurorespiratory care; PDCA cycle; Pre-analytical error; Quality of the specimen; Workflow optimization
DOI : 10.36721/PJPS.2026.39.1.REG.15056.1
Abstract: Background: The quality of heparin-anticoagulated specimens is of paramount importance for the delivery of highly accurate diagnostic results in neurorespiratory settings. However, pre-analytical factors such as hemolysis, clotting, and labeling errors often threaten this quality. This paper explores if the use of a Plan-Do-Check-Act cycle management would improve the quality of the heparin anticoagulation specimen. Objectives: To evaluate the effectiveness of managing the PDCA cycle to improve the quality of heparin anticoagulation specimen samples in a neurorespiratory care unit through error reduction and work process optimization. Methods: This was a pre-post intervention study that took place in the 47-bed neuro-respiratory care unit of Shanghai Sixth People’s Hospital. A total of 2,000 samples were screened from June 2020 to June 2021. Overall, 108 samples (54 pre-PDCA implementation and 54 post-PDCA implementation) were selected for analysis of specimen quality, delivery time, and pre analytical errors. Employee training was carried out, as well as process improvement through regular audits. Data collection took place in terms of specimen quality, delivery times, staff compliance, and staff knowledge from January to March 2023, with intervention phases from April to June 2023. Results: Following the PDCA intervention, there was a great improvement in specimen quality, with the percentage of qualified specimens rising from 68.5% to 94.4% (p < 0.001). Hemolysis decreased from 18.5% to 3.7% (p < 0.001), clotting from 11.1% to 1.9% (p < 0.001), and incorrect labeling from 9.3% to 0%. Mean delivery time reduced from 53.4 ± 11.8 minutes to 34.6 ± 7.3. Conclusion: A substantial improvement in the quality of anticoagulation specimens of heparin was achieved through the effective management of the PDCA cycle. It is evident that the PDCA cycle method possesses beneficial applications in optimizing laboratory practices for ensuring patient safety in neurorespiratory care units.
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