الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The diagnostic departments play an increasingly important role in modern medical practice. The present study was undertaken to study the adequacy of resources of these departments, to study the pattern of utilization of services of these departments, and to assess the quality of these departments in some of the general hospitals in Alexandria. Four hospitals were selected for the study, namely, the Main University Hospital, Ras El Teen General Hospital, . Gamal Abdel Nasser Hospital, ~nd Al Moassat Hospital. The adequ~cy Qf resources of these departments was studied in Gamal Abdel Nasser and Ras El Teen Hospitals, both by personal observ~tion ~nd by questioning the direc tor of the department investigated. Data were collected about physical resources, human resources, equipment and supplies, policies and procedures, records and reports, as well as statistical information about the volume of work done by the department. . To study the p~ttern of utilization of the diagnos . tic departments, a total of 1744 patients were followed fifteen months period on the general medical and general surgical wards in the 4 hospitals (822 during 8 months in the University Hospital,184 during 2 months in Ras El Teen Hospital, 531 , during 3 months in Gamal Hospital, and 207 during 2 months in Al Moassat Hospital). A form was filled for the patient who stayed 2 days in the hosp i tal. The data were collected by visiting the patients and reviewing their charts daily or at most every second day throughout their entire course of hospitalization; from the treating phy~icians,nursing st&.ff, and laboratory or x-ray department personnel; and by reviewing the patients’ medical records after patient’s The collected data included data related to the patient, administrative data, medical data, data reMed to lab tests, and data related to repeated lab tests. Preadmission tests and tests done in the ward by the nursing staff were excluded. Only tests performed by the laboratory or the x-ray department personnel were tf1ken into account. Lab tests and radiological invest i g&.tions were grouped according to the following categor ~ ies: clinical chemistry, hematology, microbiology, histo plain radiology, contrast radiology, and mis evaluations; excluding ECG, EEG, ENG, EMG, echocardiography, cardiac catheterizat ion, tests needed with blood transfusion service, pulmonary functions laboratory, and gastroenterological laboratory. To assess the quality of performance of the clinical laboratory, two parameters were selected - urea and sugar - to evaluate the analyt ical methods used for their estimation in the laboratories of the study hosp In this study, evaluation of the methods used assessment of precision and accuracy. Four solutions with known concentrations were prepared, low and high glucose solutions (100 and 200 mg./ d1.), and 10\1’( and high urea solutions (30 and 60 mg./ Each standard solution was divided. into 4 parts, one for each laboratory (A, B, e, and D laboratories). So each laboratory was provided with 4 standard solutions to be analyzed along with patients’ samples 20 times onseparate occasions. The study revealed the following main results: Resources and Organization of the Diagnostic Departments: 1. Clinical laboratory: 1) In Gamal Hospital, the laboratory services were clinical chemistry, hematology, microbiology, and . #histopathology. In Ras El Teen Hospital, they were clinical chemistry, hematology, and some microbio logical tests. Other microbiological tests and histopathological tests were sent to consulting laboratories. 12) In Gamal Hospital, the laboratory services were provided by.one laboratory. In Ras El Teen Hospital, they were provided by 5 laboratories. J) There were no written administrat ive policies and prooedures regulating the laboratory services in any of the hospitals. ~) In Gamal and Ras El Teen Hosp i ta1s, the total labora t ory surface area, the working area, and the length oj laboratory benohes were not sufficient. 5) There were no speoial precautions for fire warning and safety in the 2 hosp itals except fire ext inguish era in Garnal Ho sp it al. b) In Gamal and Ras El Teen Hospitals, the pathologists were graduates of the Faculty of Medicine with post graduate qualificat ions and the technicians were graduates of the Health Technician Institute. 7) The number of pathologists was suffioient in Gamal Hospital and insufficient in Ras El Teen Hospital. The number of technicians was not sufficient in the 2 hospitals. In Gama.l Hospital, in addition to the appo inted pElthologists, there were 5 consultants from the Facul ty of Medicine. I) In Gama.l Hospital, equipment and supplies needed for performance of approximately all tests were availablE I) InRas El Teen Hospital, equipment and supplies were not available to perform many important and commonly requested tests. ) Most of the instruments used in Gamal Hospital were of modern styles. In Ras El Teen Hospital, the equipment in the main laboratory were old-fashion. 2) In the 2 hospitals, there ’were no intralaboratory quality control procedures. ) In Gamal Hospital, there was a proper system for reporting of the laboratory findings and recording of the laboratory work. Record system in Ras El Teen Hospital showed many points of deficiency. rI. Radiology department: 1) In Gamal Hospital, the department performed all types of examinations requested except the high 1y technical examinations. In Ras El Teen Hospital, a limited types of examinations were performed. ,) None of the 2 hospitals had written polic ies and procedures regulating the work in the x-ray department. I J) In Gamal HC?spital, the total surface area of the department was more or less sufficient, but in Ras El Teen Hospital, it was insufficient. 4) Some of the radiation safety precautions were pro vided in Ga.mal Hospital. In Ras El Teen Hospital, there was only a lead screen behind which the radiologist stands during the examination performance. 5) In the 2 hospitals, the radiologists were graduates of the Faculty of Medicine with postgraduate quali fications and the technicians were graduates of the Health Technician Institute. 6~ The number of radiologists was sufficient in Gamal Hospital and insufficient in Ras El Teen Hospital. The number of.technicians was insufficient in Gamal Hospital but sufficient in Ras El Teen Hospital. 7) In Gamal Hospital, in addition to the oppointed radiologists, there were 3 consultants from the Faculty of Medicine. 8) In the 2 hospitals, the number of x-ray units was . suffic ient . In Ras El Teen Hospital, the films were not available in sufficient amounts all over the year. 9) The record system was better fn Gamal Hospital than in Ras El Teen Hospital. Utilizat ion of the Diagnost ic Departments: .. Total utilization: 1) The mean number of lab tests ordered per pat ient was 6.5 in the University Hospital, 5.0 in Ras El ~een Hospital, 4.3 in Gamal Hospital, and 3.7 in Al Moassat Hospital. 2) The mean number of lab tests ordered per patient in the departments of general medicine was 9.1 in the University Hospital, 6.8 in Gamal Hospital, 6.0 in Ras El Teen Hospital, and 5.9 in Al Moassat Hospital. J) The mean number of lab tests ordered per pat ient in the departments of general surgery was 4.4 in Ras El Teen Hospital, 3.8 in the University Hospital, and 2.3 in both of Gamal and Al Moassat Hospitals. 4) The mean number of lab tests performed per patient was 4.3 in Gamal Hospital, 4.2 in the University Hobpital, 3.3 in Al Moassat Hospital, and 3.2 in Ras El Teen Hospital. 5) The mean number of lab tests performed per patient in the departments of general medic ine was 6.1 in Gamal Hospital, 6.0 in the University Hospital,5.2 in Al Moassat Hospital, and 3.6 in Ras El Teen Hospital. 6) The mean number of lab tests performed per patient in the departments of general surgery was 3.0 in Ras El Teen Hospital, 2.4 in the University Hospital, 2.3 in Gamal Hospital, and 2.1 in Al Moassat Hospital. 7) The performance r&.te of lab tests was 99.0 in Gamal Hospital, 89.2 in Al Moassat Hospital,65.3 in the University Hospital, and 64.3 in Ras El Teen Hospital. 8) The performance rate for the departments of general medicine was 99.1 in Ras El Teen Hospital. 8) The performance rate for the departments of general medicine was 99.1 in Gamal Hospital, 81.9 in Al Moassat Hospital, 66.4 in the University Hospital, and 60.7 in Ras El Teen Hospital. 9) The performance rate for the departments of general surgery was 99.0 in Gamal Hospital, 91.1 in Al Moassat Hospital, 67.1 in Ras El Teen Hospital, and 62.5 in the University Hospital. ~ Patterns of laboratory utilization: (1) : 1) The department of medicine accounted for about two thirds of the total number of tests ordered and ” performed in 3 of the study hospitals. 2) Initial lab tests ordered accounted for 14.8 of total tests ordered in the study hospitals. They constituted 12.2 of tests ordered in the medical departments and 80.2 of tests ordered in the surgical departments. 3) The highest proportion of follow-up tests ordered was encountered in the University Eospital. 4) The performance rate of initial tests was higher than that of follow-up tests. 5) In the medical departments, the lowest number of tests ordered for any patient was zero in Gamal Hospital, one test in Al Moassat Hospital, 2 in Ras El Teen Hospital, and 4 in the University Hospital. 6) In the surgical departments, the lowest number of tests ordered for any patient was zero in Ras El Teen, Gamal, and Al Moassat Hospitals, and one ~test in the University Hospital. 7) Patients discharged while all or some of the tests ordered for them were not performed, constituted the following percentage of total patients: 66.9 in the University Hospital, 54.9 in Ras El Teen Hospital, 21.3 or more of the total tests ordered in the 4 hospitals (clinical chemistry, hematology, and plain radiology). 2) Clinical chemistry tests constituted the following percentage of the total tests ordered: 54.5 in each of the University, Gamal, and Al Moassat Hospitals; and 48.6 in Ras El Teen Hospital. 3) Hematology tests amounted to the following percent age of the total tests ordered: 38.5 in Ras El Teen Hospital, 35.2 in Gamal Hospital, 35.1 in the University Hospital, and 30.8 in Al Moassat Hospital. 4) Plain radiological examinations amounted to the fo11owing percentage of the total tests ordered: 10.6 in Al Moassat Hospital, 9.7 in Ras El Teen Hospital, 6.2 in Gamal Hospital, and 5.5 in the University Hospital. 5) The least ordered category was histopathology in the University and Ras El Teen Hospitals, contrast radio logy in Gamal Hospital, and both of histopathology and contrast radiology in Al Moassat Hospital. 6) Test categories with highest performance rate were: microbiology, histopathology, plain radiology, and contrast radiology in Gamal Hospital (100.0 for each) ; histopathology in Al Moassat and in Ras El Teen Hospitals (100.0 in each) ; and microbiology m the University Hospital (79.8 ). 7) Test categories with lowest performance rate were: microbiology in Ras El Teen Hospital (25.0 ) ; plain radiology in the University Hospital (49~0 ) ; and . clinical chemistry in Al Moassat Hospital (86.4 ), and in Gamal Hospital (98.7 ). 8) The 20 most frequent lab tests ordered in each hospital amounted to the following percentage of the total tests ordered: 91.1 in Ras El Teen Hospital, 87.5 in the University Hospital, 87.4 in Al Moassat Hospital, and 87.0 in Gamal Hospital. 9) Of’ these 20 tests, 11 were common for the four hospitals: . complete urine analysis, complete blood count, blood urea, erythrocyte sedimentation rate, fasting blood sugar, pla:fLn x-ray chest and heart, blood cholesterol, coagulati~n time, bleeding time, stool analysis, and SGOT. 10) Lab tests with highest performance rate were: plain x-ray chest and heart, hemoglobin percentage, blood cholesterol, coagulation time, bleeding time, serum sodium, serum potassium, and blood sugar 2 hours after meal in Gamal Hospital (100.0 for each) ; plain x-ray chest and heart, blood cholesterol, and WEC in Al Moassat Hospital (100.0 for each) ; coagu lation time and bleeding time in Ras.El Teen Hospital (92.9 for each) ; as well as coagulation time in the University Hospital (87.5 ). . 11) Lab tests with lowest performance rate were: SGOT and red blood count in Ras El Teen Hospital (0.0 ), stool analysis in the University Hospital (27.7 ), serum creatinine in Al Moassat Hospital (50.0 ), and stool analysis ~n Gamal Hospital (95.9 ). 12) Other lab tests ordered excluding the 20 most frequent tests (119 tests) amounted to the following percent age of the total tests ordered: 13.0 in Gamal # Hospital, 12.6 in Al Moassat Hospital, 12.5 in the University Hospital, and 8.9 in Ras El Teen Hospital. in Al Moassat Hospital, and 2.3 in Garnal Hospital. (2) : 1) Three test categories constituted 95