SMLS presents proposal for dengue patient management

July 03, 2017 (LBO) – Sri Lanka Society for Medical Laboratory Science (SMLS) has put forward a proposal for the dengue outbreak that relies on efficient management of laboratory services. There are about 140 species of mosquitoes found in Sri Lanka. Out of them Aedes Aegypti and Aedes Albopictus mosquitoes transmit the dengue virus to humans.

Dengue has become an epidemic in Sri Lanka and it has become a major cause of hospitalization. But in some dengue cases hospitalization is not mandatory if the clinician can closely monitor the patient’s clinical status through laboratory evidence; only patients who are proven to have complications can then be admitted for close management. It will reduce the hospitalized duration and the number of beds occupied with dengue fever patients. SMLS said their proposal prepared with the collaboration of College of Medical Laboratory Science, provides a solution for efficient dengue patient management with the aid of timely produced medical laboratory evidence. President of SMLS, Ravi Kumudesh said this proposal, which is reproduced below, has been sent to the President and Health Minister for further action. Proposal for Dengue out break Management by efficient management of Laboratory Services Objective 1. To reduce the Turnaround Time of Laboratory Reports 2. To develop a quick and direct communication with laboratory and Clinician regarding laboratory evidences 3. To Strengthen the Outpatient laboratory service with dengue diagnosis facilities 4. To regularize and supervise the process of newly established Dengue diagnostic laboratories with overall Dengue laboratory management officer Methodology It is expected to achieve above objectives with following methodology. 1. Establish Outpatient department laboratories It is expected to locate required equipment at the OPD laboratories where is the patient’s first point of care in the hospital. Further this OPD laboratory should be strengthen with easy access and phlebotomy facilities. Especially fever patients should be directed to the lab without Time consuming long procedures or queues reducing turnaround time. It has been proven and practiced in National Hospital OPD laboratory as a pilot project. It provides Dengue lab report within 20 – 30 minutes and patient samples are collected at the laboratory itself.

Therefore  OPD laboratories should be established where OPD laboratories are not functioning.  Existing OPD laboratories should be strengthening with equipments especially with Haematology analyzers with autoloaders. o All the hospitals located in Dengue high risk areas to be equipped with “High through put seven part Hematology analyzers with sample Auto loading capability and immature platelets counting possibility (120 test / Hour). The suppliers of these instruments should be able to connect these instruments to HIMS /LIMS systems available at the laboratory with bar cords. o Rest of the hospitals to be equipped with medium through put hematology five part analyzers with Auto loaders. ( 60 test/hour)  OPD laboratories should be located near to the patient entry point of the hospital 2. Maintain 24h emergency continuous service for admitted Dengue patients Existing already equipped emergency laboratories can be oriented facilitating Dengue patients. It will reduce turnaround time of reports of admitted dengue patients facilitating efficient evidence based Dengue patient care. 3. Introduce LIMS / Telemedicine system Utilizing new information technology in hospital set up reporting system can be re organized more efficiently by sending reports to the clinician through telemedicine technology and LIMS.  Time Frame One Week  Equipment required Five computers, five Printers and five routers (Dengue wards -3 / OPD Lab -1 / OPD Clinic -1)  Pricing of software / networking  The pricing of software can be per computer/ per month which is Rs. 4000 (LKR)  The pricing includes patient’s mobile apps  The pricing also includes complete cloud infrastructure  The pricing DOES NOT include Doctor Tabs / computers and other mobiles required by users  Additional networking charges of 1500.00 (LKR) per month need to be paid to telecommunication providers  Approximate Cost of the machines/ hardware Computers Rs 500,000.00 Printers Rs 150,000.00 Cost of networking with 5 routers Rs 50,000.00 Total Hardware cost Rs 700,000.00 4. Appoint a coordinating Laboratory Management Officer It is expected to regularization and continuous improvement of Dengue laboratories with close supervision and management decisions with institutes. This management support is highly required in purchasing equipment, placing professionals and managing different problematic situations. Immediate initiation and implementation of these processes will solve most of controversies and problematic situations reducing additional health expenditures on short term solutions of dengue management and these processes will make maximum benefit to the patient.