Development of a Laboratory Test Referral and Result Reporting Model for Assessing the Risk of Severe Thalassemia in Fetuses Using the LEAN Concept.

Abstract

      This action research aimed to develop a laboratory test referral and result reporting model for assessing the risk of severe thalassemia in fetuses using the LEAN concept. The study was conducted during fiscal year 2024 using the PAOR cycle (Plan, Action, Observation, and Reflection). The model focused on improving the pre-analytical and post-analytical processes. In the pre-analytical phase, the laboratory evaluated MCV, MCH, and DCIP results according to predefined criteria and initiated Hb Typing referral without waiting for repeated physician consideration. In the post-analytical phase, the reporting process was improved by replacing the downloading and attaching of external laboratory result files in HosXP with an online link for direct access to results.

      After implementation, the time from screening to Hb Typing referral decreased from approximately 13 days in fiscal year 2023 to 5 days in fiscal year 2024, while the time from screening to receiving Hb Typing results decreased from approximately 14–15 days to 6–7 days. The number of pregnant women receiving Hb Typing increased from 39 to 50 cases, while PCR testing increased from 8 to 10 cases. Staff satisfaction increased from 82% to 96%, and satisfaction among pregnant women meeting the Hb Typing criteria increased from 78% to 88%. No cases of severe thalassemia risk in the fetus were identified in either year.