SAĞLIK BİLİMLERİ ÜNİVERSİTESİ DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ

Our clinic is one of the leading clinics in Ankara, which was established on November 11, 2005, following current information and developments in the field of cardiology. In our clinic, there are 7 education staff with 6 experts and 10 assistant doctors who have significant experience in their fields. With 24-bed renewed cardiology service and 12-bed fully equipped coronary intensive care, many non-urgent patients are provided with full occupancy. There are 7 outpatient clinics (one special branch outpatient clinic), 2 coronary angiography and electrophysiology laboratories, 1 central echocardiography lab (3 advanced echocardiography devices), 2 exercise devices, tension and rhythm holter devices. In addition, accurate diagnosis can be reached quickly thanks to coronary tomography angiography, myocardial perfusion scintigraphy and cardiac MR imaging in our hospital.Coronary artery disease, heart attack, hypertension, heart failure, pulmonary hypertension (follow-up of patients with high lung pressure with chest diseases-cardiology-rheumatology council), heart valve diseases, congenital heart diseases, cardiac rhythm disorders, peripheral artery diseases (arm, leg , neck veins) treatments are successfully applied.The coronary angiography laboratory serves on a 24/7 basis for emergency response to a heart attack. In our angiography laboratories serving approximately 4000 patients annually, difficult coronary cardiovascular obstruction (CTO-chronic occluded vessels, bifurcation-fork vein), heart valve (mitral) balloon, TAVI (non-surgical aortic valve operation),intervention in congenital heart holes and vascular anomalies, pacemaker applications, electrophysiology and burning-freezing (ablation) method, rhythm disturbance operations (3-dimensional mapping systems), above-knee vein (peripheral artery) occlusions, and balloon vein (carotid) The stent is performed by doctors who are specialized in the area of closing the left auricle (appendage closure). Branching has been provided for different diseases of cardiology among our doctors, our private branch outpatient clinic is in service and the treatment of patients who require ongoing and close follow-up is successfully continued. With the academic team consisting of cardiology and cardiovascular surgery in our hospital, a council is held for all patients who have difficulty in the treatment decision and the best decision for the patient is made with the heart team.

CLINICAL BIOCHEMISTRY LABORATORY:

Our clinic consists of 2 main sections: Emergency Biochemistry and Routine Biochemistry Laboratory. A total of 26 technicians work in the Emergency Biochemistry Laboratory, 10 people in the daytime and 16 people in groups of 4 at night. In our Routine Laboratory, there are 23 technicians who work all day

Apart from this, there are supervised laboratories in the district polyclinics. In these laboratories, there are 3 technicians in Mevki Annex Building, 1 technician in Hasköy Polyclinic, 1 technician in Şentepe Polyclinic and 7 technicians in Akyurt State Hospital.

WORK AREA :

Clinical Biochemistry is a science that examines the organization and functions of biological systems in human organism at the molecular level. It forms the basis of medicine and provides the main aid to other departments by conducting biochemical analysis in blood, urine and body fluids that guide the diagnosis and treatment of diseases.

Management of Clinical Biochemistry Laboratory:

 It covers all the details required for doing all tests requested and performed by the clinics correctly and at the most appropriate time. It requires a detailed and meticulous workspace in all steps. The chief assistant, specialists and technicians working in the clinical biochemistry laboratories are obliged to carry out all the examinations and analyzes related to their units. They are responsible for the conservation of medical equipment, tools, materials and chemicals and all fixtures in their laboratories, as well as on-site and economical use of consumer materials.

Our clinic consists of 2 parts: Emergency Biochemistry and Routine Biochemistry Units. In the Emergency Biochemistry laboratory, 2 biochemistry auto analyzers, 2 cardiac tests auto analyzers, 2 hemogram devices, 2 coagulation devices, 2 urine analyzers, 3 blood gas devices, 2 Procalcitonin and Pro BNP measurement devices and 3 centrifuges There.

There are 3 hormone auto analyzers and 2 biochemistry auto analyzers in our Routine Biochemistry Laboratory, and these work depending on the preanalytical system. There are also 2 tube sorting devices, 3 hemogram devices, 1 coagulation device, 3 sedimentation devices, 3 HPLC analyzers for HbA1c measurement, 1 fully automatic urine analyzer, 1 deionized water device, 5 centrifuges.

 In the Mevki Annex Building, 2 hemogram devices, 1 fully automatic urine analyzer and 1 centrifuge; 1 urine device with strip reader and 1 centrifuge in Şentepe polyclinic; Hasköy polyclinic has 1 urine device with strip reader and 1 centrifuge.

There is 1 biochemistry auto analyzer, 1 hemogram device, 1 strip reader urine device, 1 blood gas device, 1 sedimentation device and 2 centrifuges in the Akyurt State Hospital Biochemistry Laboratory.

STATISTICAL ANALYSIS REPORT OF THE CLINIC

CENTRAL AND EMERGENCY BIOCHEMISTRY LABORATORY 2018 MONTHLY TEST, TUBE AND RED NUMBERS :

CLINICAL WORK FLOW PROCESS

Biochemistry Laboratory serves patients in accordance with the criteria specified in the regulation of the Ministry of Health. The Routine Laboratory is in service until all the samples received during the day are completed, and the Emergency Biochemistry laboratory is in service 24 hours a day.

Blood samples of polyclinic patients are accepted to the Central Biochemistry Laboratory between 08.00-16: 00. The Emergency Biochemistry Laboratory accepts samples for 24 hours (for emergency tests).

Requests for outpatient and service patients who apply to our hospital are made by the doctor of the patient through the automation system in computer environment. If an external inspection request is to be made, it is selected from the general chemistry definition in Biochemistry / External Analysis tab. Our external laboratory tests are conducted in a contracted private laboratory.

After the test request is made, appropriate sample tube is selected for the blood sample according to the tests, barcode labels are affixed to the selected tubes. While the patient is resting in the blood collection chair, the patient is authenticated and the desired tests are checked. If there is no inappropriate situation, blood collection is performed. The patients whose blood collection is completed are given information on when the results will come out and where they can get the results.

In Services, Intensive Care and Emergency Department, patients' samples (blood, urine, CSF etc.) are taken in their own units. After entering the test requests, the sample container is selected according to the tests, and the barcode label is affixed to the sample containers. In patients with vascular access, the other arm of the patient is used for blood collection. Blood collection is performed by nurses. Samples taken from the services are sent to the laboratory registration / blood collection unit with the staff without waiting.

Biochemistry samples taken from the Emergency and Intensive Care Units are sent to the Emergency Biochemistry Laboratory registration and acceptance department with a pneumatic system. Samples taken from Dışkapı blood collection unit are sent to the Routine Biochemistry sample reception unit with a pneumatic system. Here, the samples are collected and taken by the sample acceptance officer and the classification and sample acceptance is done through the tube sorting device.

Samples from Mevki, Hasköy, Şentepe polyclinics and Akyurt state hospital blood collection unit are sent to the Dışkapı Clinical Biochemistry Laboratory. All blood collected here is accepted by the sample acceptance officer. For biochemistry, hormone, blood count, coagulation, sedimentation, HbA1C analysis, samples are accepted and classified by the sample acceptor. Since hormone and routine blood are taken into a single tube, they are given directly to the Preanalytical system. Blood is centrifuged for coagulation. HbA1C, Hemogram and sedimentation blood are given directly to the devices. If there are unsuitable samples during all these processes, the sample rejection form is filled from the system.

24-hour urine samples from clinics and brought by polyclinic patients are studied.

Spot urine samples requested from the patients who are examined in the outpatient clinics are left by the patients to the urine reception desk next to the blood collection unit. The urine collected here by the staff is transferred to the Biochemistry laboratory by the staff, along with other examples. After the samples are accepted, the urine samples are placed in the urine tubes and the barcodes are pasted and studied.

In the Emergency Biochemistry and emergency blood gas studies, the samples received by the pneumatic system are accepted. The blood coming for emergency biochemistry is centrifuged first. The sample, whose serum is separated, is loaded into the emergency device and the result is sent to the system within 1 hour.

The tests that cannot be worked in the laboratory are transferred to the laboratory where the service is purchased for the external examination.

The resulting tests are checked, technical and expert approval is made. Approved results are transferred to the system. If there is any result at the intervals specified in the Panic Values List during approval, the analysis is repeated first. If the repeat results are in the range in the panic value list, the clinician who wants the test is notified of the panic value, and further information about the patient's clinic is obtained by contacting the clinician, and the result is confirmed if the test result is compatible with the patient's clinic. If it is not compatible with the patient's clinic, the analysis process is reviewed, the source of the error is searched, the sample is taken from the patient and the analysis is repeated.

After all tests are run, the barcode is read by the sample acceptance officers and the device responsible and the tubes are checked one by one and it is checked whether all tests are working or not. If there is a sample to be repeated, it is separated and delivered to the device responsible and those tests are rerun and approval procedures are carried out in the same way.

Samples are rejected because of the following situations :

* Incorrectly Identified Samples: Each sample must be identified with some information it   must carry on the label when it arrives at the laboratory. This information is minimum should inclode :

- Patient Name Surname

- Patient File Number

- Date The Sample Was Received

- Name of the Laboratory Where the Test Was Worked

* Wrong Sample Container: Each sample should be sent to the laboratory in the most suitable and defined container (tube, urine cup, etc.).

* Insufficient Sample Volume in Additive Tubes

* Hemolysis: It is known that many tests are negatively affected by hemolysis caused by the breakdown of erythrocytes in the blood. Therefore, blood samples that have undergone hemolysis should not be accepted into the laboratory. If this situation did not become evident until the laboratory came, it is checked after the centrifuge process after the acceptance registration and the new sender is requested by informing the unit that sent the sample by deducting the required record for the unsuitable samples.

Maintenance and calibration of the auto analyzers and devices in the laboratory are carried out by laboratory technicians with authorized company technical service. Maintenance and calibrations to be performed by the authorized company technical service are followed by laboratory experts. The monitoring, maintenance and control of the fixture devices are carried out with the personnel assigned by the hospital. User Periodic Maintenance and Calibrations are performed by Laboratory technicians according to the Device Usage and Maintenance Instructions or Device User Guides. Periodic maintenance and calibrations other than the user are followed by laboratory experts, company maintenance commitments, maintenance cards and laboratory devices according to the calibration maintenance plan.

Analytical performances of all tests performed during the day are measured at least once a day, at least two levels, with internal quality control samples. The intraday and intraday performance of the tests are evaluated on the device by Levey-Jennings graphics by responsible laboratory experts.

In case of device failure, technical service is notified if the problem cannot be solved by the user.

Kits and materials to be used in the laboratory are determined by the laboratory responsible and experts. Supply of laboratory materials, material demand amount is determined by the responsible in accordance with the previous year's statistical information and technical specifications are prepared.

For the tests included in the program on the calendar days determined by the external (external) quality control program that we are a member of, external quality control samples are studied together with the patient tests. The tests studied in our laboratory are included in the international external quality control program.

Our practices and studies that will serve as an example to clinically similar or other clinics:

* Our clinic continues to work with a multi-disciplinary approach, keeping innovations, quality and science at the forefront with international guides.

* Doctors come from different countries for biochemistry rotation.

* It is a clinic preferred by doctors who are ranked in the specialty examination in medicine.

* Thesis, project etc. All kinds of consultancy and support services are provided by our clinic for scientific studies.

* In addition to intensive routine services, scientific studies and research are carried out in our clinic.

Opportunities / advantages we have clinically

*  one of Turkey's most preferred hospital samples of patients from all over come to our laboratory.

* There is a harmonious teamwork among all the staff working in our clinic.

* Our laboratory is a laboratory with a large device park.

* All laboratory personnel work diligently and devotedly to provide reliable, quality and timely results.

What are the negative factors that prevent you from progressing in our clinic? What are the measures to be taken against these elements?

* The Information Processing System (Laboratory Information Management System / LBYS) is one of the components of the laboratory, and if it does not operate to the required standards, it may cause serious problems for both the laboratory and the hospital. This is one of the weak points that need to be addressed sensitively. It would be beneficial to warn companies that they do not change very often and that the existing company eliminates its shortcomings.

Clinical Training Programs:

Training, articles and seminar programs are held every week on Tuesday and Thursday between 09: 30-10: 30 in our clinic during the training period (September-June). These programs are attended by Education and Administrative Officers, Education officers, Chief Assistants, all Specialist and Assistant doctors. Every year, our clinical assistants participate in academic activities such as poster presentations at national and / or international congresses.