Development of a GeneXpert MTB/RIF Referral Testing System to Improve the Efficiency of Tuberculosis Diagnosis Using the LEAN Concept at Phayakkhaphum Phisai Hospital.
Keywords:
GeneXpert MTB/RIF, tuberculosis, LEAN, action research, referral testing system, laboratoryAbstract
This study aimed to develop a referral system for GeneXpert MTB/RIF testing by applying LEAN concepts alongside the three-stage laboratory testing process—pre-analytical, analytical, and post-analytical—to enhance the efficiency of the referral process and support the detection of new tuberculosis cases in line with estimated figures. This action research study was conducted using one Plan–Act–Observe–Reflect (PAOR) cycle during fiscal year 2024. The LEAN concept was integrated with three phases of the laboratory testing process: pre-analytical, analytical/referral, and post-analytical phases. The system was developed in three areas: specimen management, coordination and transportation of specimens, and result tracking and reporting through the HosXP system.
Results: In fiscal year 2024, 198 specimens were referred for GeneXpert testing. Twenty-four specimens (12.00%) were unsuitable, and all 24 specimens were recollected, including 9 specimens recollected immediately. All 198 test results were received (100%). The number of AFB-negative patients referred for GeneXpert testing increased from 145 in fiscal year 2023 to 198 in fiscal year 2024, representing a 36.55% increase. The number of newly identified tuberculosis cases increased from 104 to 122, while the proportion of cases identified compared with the estimated number of new tuberculosis cases increased from 85.95% to 87.14%.
References
World Health Organization.(2024). WHO operational handbook on tuberculosis. Module 3: diagnosis—rapid diagnostics for tuberculosis detection. 3rd ed. Geneva: World Health Organization; 2024. Available from: https://www.who.int/publications/i/item/9789240089501
World Health Organization.(2025). WHO consolidated guidelines on tuberculosis. Module 3: diagnosis. Geneva: World Health Organization; 2025. Available from: https://www.who.int/publications/i/item/9789240107984
ณัฐธกูล ไชยสงคราม, ระพีพงศ์ สุพรรณไชยมาตย์, เพชรวรรณ พึ่งรัศมี, ศตวรรษ แสนใหม่, อินท์ฉัตร สุขเกษม, ชุลีพร จิระพงษา.(2565). การประเมินระบบการส่งตรวจและรายงานผลการทดสอบความไวต่อยาในผู้ป่วยวัณโรคปอดรายใหม่และกลับเป็นซ้ำ: กรณีศึกษาโรงพยาบาลชุมชน จังหวัดนครราชสีมา ปีงบประมาณ 2562. รายงานการเฝ้าระวังทางระบาดวิทยาประจำสัปดาห์. 2565;53(39):591-601. doi:10.59096/wesr.v53i39.3439.
กลุ่มงานเทคนิคการแพทย์ โรงพยาบาลพยัคฆภูมิพิสัย. (2567). ข้อมูลจากการทบทวนผลการดำเนินงานกระบวนการส่งตรวจ GeneXpert MTB/RIF ของโรงพยาบาลพยัคฆภูมิพิสัย
Cherie N, Berta DM, Tamir M, Yiheyis Z, Angelo AA, Tarekegn AM, et al.(2024). Improving laboratory turnaround times in clinical settings: a systematic review of the impact of lean methodology application. PLoS One. 2024;19(10). doi:10.1371/journal.pone.0312033.
Gupta S, Kapil S, Sharma M.(2018). Improvement of laboratory turnaround time using lean methodology. Int J Health Care Qual Assur. 2018;31(4):295-308. doi:10.1108/IJHCQA-08-2016-0116.
Persoon TJ, Zaleski S, Frerichs J.(2006). Improving preanalytic processes using the principles of lean production (Toyota Production System). Am J Clin Pathol. 2006;125(1):16-25. doi:10.1309/865V7UMFPUKGCF8D.
White BA, Baron JM, Dighe AS, Camargo CA Jr, Brown DFM.(2015). Applying Lean methodologies reduces ED laboratory turnaround times. Am J Emerg Med. 2015;33(11):1572-1576. doi:10.1016/j.ajem.2015.06.013.
Reechaipichitkul W, Phetsuriyawong A, Chaimanee P, Ananta P.(2016). Diagnostic test of sputum GeneXpert MTB/RIF for smear negative pulmonary tuberculosis. Southeast Asian J Trop Med Public Health. 2016;47(3):457-466.
Horne DJ, Kohli M, Zifodya JS, Schiller I, Dendukuri N, Tollefson D, et al.(2019). Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2019;6(6). doi:10.1002/14651858.CD009593.pub4.
