An alternative proposal for managing morphological examination of urinary sediment and increasing its appropriateness

Abstract

Background. The morphological examination of urinary sediment (MEUS) is traditionally associated with urinalysis (UA), with workload implications and the need for automation of its execution.

Methods. Considering MEUS as a test requiring specialized knowhow and skill for its execution, since 2005 in our laboratory it is performed for inpatients only upon specific request. Eleven years after, we have analyzed the long-term impact of this approach on the provided service. We evaluated results in the 2009-2016 period, in which our hospital did not undergo any change both in the number of beds and in the clinical case-mix.

Results. From 2009 to 2013 an average of 2264 MEUS and 10,204 UA per year were ordered, respectively, with an average ratio of 22.2%. Since 2014, a change on computerized order entry involving MEUS caused a further decrease of its requests (in average, 923 per year), which was not associated to a decrease in UA (in average, 9810 per year) (in average, MEUS/UA 9.4%). MEUS requests came mainly from Paediatrics (47.8%), Nephrology (20.9%) and Rheumatology (18.3%) wards. By filling a satisfaction survey, clinical wards evaluated the provided service as satisfactory, while highlighting some critical issues, mainly referred to preanalytical phase.

Conclusions. The alternative proposal for managing MEUS presented in this paper markedly reduces the number of requests and increases their appropriateness. This is achieved without any negative impact on patient care.

Keywords: Clinical governance, Patient safety, Urinalysis

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INTRODUZIONE

L’esame morfologico del sedimento urinario (EMS) rappresenta tuttora uno strumento insostituibile per la diagnosi delle malattie del rene e delle vie urinarie [1]. Si tratta di un esame di semplice ma non banale esecuzione, effettuabile in ogni laboratorio. Infatti, l’unico strumento richiesto è un microscopio a contrasto di fase con almeno due livelli di ingrandimento, uno basso (ad es., 20x), per una valutazione generale della cellularità del sedimento, e uno più elevato (ad es., 40x), per la valutazione morfologica e semi-quantitativa dei singoli elementi.

 

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Errors in the medical report of urine cellular fraction

Abstract

Urine examination guides doctors in formulating diagnosis and therapies or in excluding diseases, not only of the urinary tract.
The research for urine cells has been and still is performed manually with manual optical microscopes.
Recently, in the reading of cells found in the urine, various technologies such as automated microscopy and cytofluorometry are used.
This change involved different preparation of the urine sample, microscope field diversity, sample volume diversity, different units of measurement, diversity of standard values.
This change has not been accompanied by the change of terminology in urine examination reporting, resulting in conceptual errors, communication and interpretation by the clinicians.
The job examines the errors and proposes the necessary changes.

 

Keywords. Error, Urine examination, Microscopy, Cytofluorometry.

Sorry, this entry is only available in Italian. For the sake of viewer convenience, the content is shown below in the alternative language. You may click the link to switch the active language.

PREMESSA

Con il termine sedimento si intende il deposito lasciato in fondo a un recipiente da sostanze o cellule in sospensione.

Il medico ha, da molti decenni, conoscenza che i valori normali di cellule presenti nel “sedimento delle urine” sono:

  • inferiore o uguale a 1 emazia/campo microscopia manuale (superficie 0.237 mm2) a ingrandimenti totali 400x su campione di 10 ml di urine centrifugate, il cui sedimento è ri-sospeso a 0.5 ml
  • inferiore o uguale a 2 leucociti/campo microscopia manuale (superficie 0.237 mm2); ingrandimenti totali 400x su campione di 10 ml di urine centrifugate, il cui sedimento è ri-sospeso a 0.5 ml [1]

 

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