Out Patient Department Laboratory

Introduction

Outpatient Department laboratory provides its services to the different patient categories.
Patients who get clinic facilities from outpatient department come to the OPD laboratory for
their laboratory facilities regularly. Other category is the patients who come to OPD for their
emergency health care needs fulfill their laboratory facilities from OPD laboratory and people
who come for health screening facilities such as NCD, Thalassaemia and medical certifications
fulfill their laboratory facilities from OPD laboratory.

OPD laboratory is established to provide the laboratory facilities to the patients who come to
the OPD. Accordingly it is expected to manage the OPD patient at the OPD set up completely.
Existing OPD laboratory set up provides their facilities in different ways. Some of them are
deviated from that goal and services have been established in different levels. Most of OPD
laboratories provides basic laboratory tests facilities and other biochemical and haematology
investigations which are not done at OPD laboratory are referred to the department of
pathology. It is varied from institution to institution.

This referral system and unavailability of complete service have created negative impact on
OPD patients who come for the services at OPD laboratory in different ways. Unavailability
of specimen collection or phlebotomy at OPD laboratory has created increased pre analytical
errors which directly affect the quality of report and unavailability of requested tests facilities
at OPD lab has created increasing turnaround time, report missing incidents and patient
inconvenience Therefore it is recommended to establish OPD laboratory with complete
laboratory service including phlebotomy and reporting set up by managing patient at OPD.

Some OPD laboratories are set up to provide complete laboratory service which includes
phlebotomy, specimen collection, processing, reporting and referral laboratory service and its
report delivery. OPD laboratory of National Hospital is one example which provides a
dedicated complete service to the OPD patient by managing them at OPD laboratory
completely setting. Patients who get facilities from these laboratories get benefit of
convenience. It can be applicable to all OPD laboratories which is suggested for all Teaching,
Base and Provincial General Hospitals in order to ensure a complete patient care in OPD
laboratory. It is expected to achieve following objectives.

Objectives:
 1. To reduce Turn around Tine of Laboratory Report
2. To reduce Report dispatch problems which affects patient convenience
3. To provide complete service to the OPD patients from OPD laboratory set up

OPD Laboratory Set up

OPD laboratory set up is suggested to establish at all Teaching Hospitals, Provincial General
Hospitals and Base Hospitals. Laboratory should be in separate premises with easy access to
the OPD patients. It should be strengthen with all Biochemical, haematological and
microbiological investigation facilities which are requested at OPD including screening people,
clinic patients and emergency care patients. Equipment should be provided with high
throughput, fully automated and maximum utility of manpower. Specification should be
provided accordingly. Man power should be allocated considering work load and nature of the
laboratory investigation. Space should be allocated with WHO standard for laboratories. It
should be run with separate inventory and management set up independently. Department of
Pathology can be referred at any time according to the requirement. Special tests can be sent to
MRI and other special units.

Test availability:

It is expected to establish all laboratory investigations which are requested from clinic patients
and emergency care patients at OPD and recommended to refer other laboratory only for rare
and highly specialized tests. Further the laboratory investigations facilities for preventive and
screening purposes should be available at OPD laboratory on long term or short term basis
according to the requirement.

Human Resource:

Separate human resource should be allocated to continue an undisturbed workflow at OPD

laboratory. It is recommended to coordinate with other departments and units of the institution
for the consultancy purposes. Staff allocation should be carried out according to the
institutional requirement and number of laboratory investigations and its nature. Infra structural
facilities should be arranged ensuring maximum utility of human resource. Specimen
collection, processing, analysis, reporting and quality assurance should be carried out within
the OPD laboratory and patient management for all laboratory investigations including tests
available at OPD lab, other laboratory of the Hospital setting or outside the hospital should be
carried out at the OPD laboratory without sending patient out of the OPD laboratory.
 Space:

Space should be separated for OPD laboratory with systematic laboratory arrangement
according to WHO recommendations. Patient waiting area, communication desk, appointment
counter, report counter, specimen collection area, specimen preparation area, analysis are
should be specified. Sanitary facilities of patients and staff should be established.

Equipment:

Separate equipment should be established with minimum turnaround time and high efficiency.
Automated technology for frequently requested laboratory investigations is recommended.
High throughput fully automated haematology and Biochemistry analyzers with auto loader
are recommended for OPD laboratory set up. Analyzers must have data storage, manipulation
and facilities for Information management.

Emergency Laboratory Infra structure

MLT Rest rooms

Specimen acceptance and Washing area and
storage area
Dining area
Biochemistry
Haematology

Em
erg Stores
enc
y Sub ordinary staff
Rest rooms and
sho Dining area
wer

Sup. MLT Room Reporting area Quality

Patient
waiting area Manager
 Description Remarks
1 Specimen acceptance and Refrigerator, Centrifuge, chair, hot air oven,
storage area sink
2 Biochemistry Analyzers, Refrigerator, Table, Chairs, sink,
computer, printer
3 Haematology FBC and Coagulation Analyzers, Microscope,
Staining rack and reagents, Refrigerator,
Table, Chairs, sink, computer, printer
4 Emergency shower optional
5 Supervisor room Table, Chair, Computer and printer
6 Reporting area Table, chair, Computer and printer, Document
storage cupboard
7 Patient Waiting Area Seating facility, water dispenser with cups
8 Stores Refrigerator, Storing cupboard
9 Rest rooms Beds, Chairs, table, Wash room,
10 Dining area Table, chair, sink, refrigerator, boiling kettle
11 Washing area Sink and racks
 Test availability:

Test TH PGH DGH BH A BH B DH

Haematology FBC √ √ √ √
Reticulocyte count √ √
PT/INR √ √ √ √
ESR √ √ √ √
Biochemistry Plasma Glucose √ √ √ √
Lipid profile √ √ √ √
HbA1C √ √ √
Liver profile √ √ √
Renal Profile √ √
S. Calcium √ √
S. Lithium √ √
S. Amylase √ √
Troponin I √ √ √ √
TSH/T3/T4 √ √
UFR √ √ √ √ √ √
UMA √ √ √
UPCR √ √
Bense Jhone Protein √ √
U. Bile √ √ √ √ √
U. Ketone bodies √ √ √ √

Working Hours:

Working hours should be arranged considering clinic and OPD opening hours. It is usually
7.00am to 4.00pm or 8.00pm. It is recommended to open OPD laboratory with parallel to OPD
working hours based on institutional requirements.

Request form:

Separate Request form should be designed for OPD laboratory and referral laboratories which
can be easily identified as OPD request form (Standard format will be provided)
Turnaround time:

It is expected to minimize turnaround time and following turnaround time is recommended. It

can be deviated according to the analytical technique and technology of analyzer. Therefore
turnaround time can be defined institutional basis. Following are the recommended turnaround
time for laboratories with high throughput auto analyzers with auto loader.

FBC and coagulation tests: Half an hour to One hour

Biochemistry: One day (Urgent requests within two hours)

Reporting system:

It is recommended to introduce LIMS and issuing reports to the relevant clinic. If LIMS is not
available or not convenient hard copy of a report should be issued. Report format should be
designed (Report Format will be provided)

Store management:

Separate inventory and reagent management should be maintained.

Waste management:

It is recommended to follow common waste management system of hospital laboratories which

is recommended by WHO and MoH.