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Creating Customer Delight – A Case Study in Diagnostic Clinics: Part 4 of 5

Creating Customer Delight – A Case Study in Diagnostic Clinics: Part 4 of 5

This now five-part case study focuses on improving customer satisfaction at two of a company’s diagnostic clinics – Centers A and B. In Part One, the company worked at Center A to reduce patient turnaround time, a defining component of patient satisfaction. In Part Two, the chain’s improvement story focuses on increasing patient delight at Center B. In Part Three, the story returned to improving the processes of the lab in Center A. In Part Four, turnaround time in a new centralized laboratory is improved. Check back next Monday for Part Five.

A chain of medical diagnostic clinics was developed from the ground up. After two years of hectic expansion marked by acquisitions and setting up greenfield clinics across a number of cities, it became clear that due to the different inherited processes across those acquisitions, the chain needed to focus more on improving and standardizing the quality of service offered, and improving its customer satisfaction rankings.


After successfully improving the processes in laboratory of Center A, the chain of medical dianostic clinics wanted to move forward with improving the turnaround time (TAT) in the newly established centralized laboratory servicing the 62 individual lab centers.

A cross-functional team was set up to undertake the project.

Define the Problem

The group brainstormed a list of 52 problems related to the laboratory (see Appendix 1). Discussions revealed that most of the problems listed were causes of problems rather than problems in and of themselves. There were only four “real” problems:

  1. Delay (i.e., TAT)
  2. Quality
  3. Safety
  4. Service

These were prioritized to select the “vital” problem using a weighted average table. Scores indicated that delay (i.e., TAT) was the vital problem. The next step was to measure the problem.

Turnaround problems can be resolved using just-in-time (JIT) techniques. Here, this involved deciding at the outset the start and end points of the process for which the TAT was to be reduced.

Complete TAT starts with the customer arriving at the Diagnostic Center and ends with the report being given to them. The overall desire of senior management was that customers visiting the Center in the morning should receive their reports the same day and customers visiting in the afternoon should receive their reports the next morning.

The 30,000-foot-level process steps were listed and are shown in Table 1. Also shown are the various start and end points of the project that could be followed.

Table 1: Process from Patient Arrival to Getting Test Report

Table 1: Process from Patient Arrival to Getting Test Report

To select which part of the chain should be addressed, data was required for where the maximum time was being spent. A format was prepared to collect data for each part of the chain by tracking 100 samples as shown in Table 2.

Table 2: Excerpt of TAT Data Collection from Customer Registration to Report Handover
Responsible Division Dept. Item Customer 1 Customer 2
Date January 7, 2012 January 7,  2012
Customer ID 112608 112614
Customer name X Y
Diagnostic center Front desk admin Registration time 07:42 08:15
Diagnostic center Lab Sample collection time 08:03 08:37
Lab Sample ready for dispatch 08:45 08:45
Back-end admin Logistics Sample pickup time 09:00 09:00
Back-end admin Logistics Sample delivered time Varies Varies
Central lab Report upload time 17:39 15:17
Diagnostic center Front desk admin Report printing time 17:47 15:42
Diagnostic center Lab Report dispatch to counter 17:55 15:55
  TAT (hours:minutes) 10:13 07:40

The concept of sigma was introduced to the team to measure variability in addition to the average. The average and sigma for the current state TAT was calculated as follows.

Average = 15.9 hours
Average + 3σ = 56 hours

The logistics time was found to be 2.5 hours to 3 hours within the 15.9 hours average. The team set an objective of reducing the average TAT by 50 percent – from 15.9 hours to 8 hours.

A control chart was developed to track the TAT. The initial chart is shown in the figure below.

Control Chart of Register to Report TAT

Control Chart of Register to Report TAT

Mapping the Current State

Another metric was also introduced – the percentage of reports completed/returned to patients in a 24-hour period of time. Existing data showed that this was at 76 percent.

The next step was mapping the current state process, by looking at:

  • Volume to be processed
  • Arrival pattern
  • Time to process the smallest unit at each stage of the process
  • Deployment pattern of people, equipment

From there, the future state process map would be developed while applying the following techniques to reduce work in process (i.e., waiting time) and, therefore, TAT:

  • Reducing non-value adding stages
  • Balancing the line (i.e., ensure capacity available can process arrivals at the required speed)

The volumes to be processed were based upon the Center’s past data and growth projections. The target volume to be processed was 50,000 tests per day. Since different tests require different equipment and times, it was necessary to ascertain the ratios of the tests required to be able to make all of them flow (Table 3) based on 25 working days per month.

Table 3: Volume Estimates for Central Lab
Volume Per Day
Patients 300
Samples 650-700
Tests 1,200
Department Per Day
Blood 76%
Urine 19%
Others 5%

Arrival Patterns

Arrival patterns were studied by the hour for four days – for all samples, with blood and urine samples separately (the most common tests and the majority of tests ordered; see details in Appendix 2) – and are shown in Table 4. All patterns are based on 12-hour increments in time.

Table 4: Summary of Arrival Patterns of Samples
Per Hour All Samples Blood Urine
Average 65 55 9
Peak 136 80-100 33
Average Per Day 500-600 100-200

Testing Capacity

Next, it was time to look at testing capacity. A list of all equipment was prepared according to section (e.g., biochemistry, hematology, etc.). Against each test the information shown below was assessed:

  • Machine(s)
  • Batch (including batch size) or individual
  • Time
  • Units
  • Speed
  • Barcode logging of samples
  • Reports automatically generated
  • Printout of reports

Equipment Capacity

The results of an equipment capacity analysis helped explain the processes, the capacity, degree of automation/manual work involved and the batch/flow nature of the work.

  • Average time per test: A comprehensive list of tests was prepared and the average time per test was recorded. (See Appendix 3.)
  • Manpower deployment: When the arrival pattern of the load to be processed required deploying personnel to best match the incoming load patterns, manpower deployment was critical and also mapped.
  • Improving the TAT: Performed section by section.

Improved TAT Process

The following process was used to develop the improved TAT process:

  • Map key stages of process
  • Determine stations
  • Smallest unit though line at each station
  • Decide batch size
  • Time/unit at each station
  • Ensure flow capability at each station: capacity to process load-in time required
  • Instruct team
  • Run one batch without waiting
  • Record lead time/waiting time/non-value added times
  • Kill problems to smooth workflow
  • Try longer and longer runs at higher and higher loads

A green channel run, where the process is carried out without waiting between any stages of the process, was performed. TAT was obtained. Then, the team repeated the process for batch after batch to obtain the best possible TAT.

To determine a machine/section-wise load, the team needed to determine the number of tests expected per day in each section. This required estimations as follows:

  • Number of patients per day
  • Samples per patient
  • Tests per sample per machine or per station
  • Reports per patient

Biochemistry Example

Armed with this data, the green channel run was first piloted and then standardized in each section. For this article’s purposes, consider the example of biochemistry (a category of tests) with the maximum number of tests.

The process and the load – patients, samples per patients, tests per sample and the time per stage – are summarized in Table 5.

  • Samples per patient = 2
  • Tests per sample = 3
  • Tests per patient = 6
  • Time per test = 27 seconds
Table 5: Biochemistry Process and Stage Times
Process Map Biochemistry Op Unit Time (Seconds) Seconds/Sample
Accession (prepping a tray of samples to send to lab for processing – paperwork and arrangement) Smallest unit sample (1 sample test tube) 16 samples 900 <56.25
Centrifuge 16 samples 16 samples 900 56.25
Biochemistry Testing Test 16 tests/sample 432 27 (equivalent to 400 tests/hour)
Report Patient Up to 16 samples/patient 900 <56.25
Approval Patient Up to 16 samples/patient 900 <56.25

The centrifuge was the bottleneck and was the pace setter for the biochemistry process. It holds only 16 samples at a time and this was, therefore, selected as the minimum batch size. Loading it with minimum interruption provided the maximum output and last TAT.

The process was run, timed and studied in several trial runs with improvements built in and tested in each run. The results of two trials are detailed here.

First Trial

  • Start: Load into centrifuge
  • Finish: Report approved
  • Samples: 17
  • Tests: 37

The results are summarized in Table 6.

Table 6: Trial of Biochemistry Flow Run
Step Actual Time (Minutes) Ideal Time (Minutes)
Centrifuge in 12:13 12:13
Centrifuge out 12:23 12:23
Into machine 12:23 12:23
Processing (37 tests at 9 secs/test) 12:29
Report check start 12:30
Report approve start 12:31
Report check finished 12:36
Report approve finished 13:32 12:37
TAT 79 24
Expected 30

Against the ideal time of 24 minutes and expected time of 30 minutes, the actual time achieved was 79 minutes.

Avoidable reasons for the long actual time were:

  • Manual barcoding took 12 minutes. (Look for details on addressing this issue in the final part of this article next week.)
  • Waiting to be loaded into the analyzer that was avoidable in full flow took 10 minutes.

The achievable cycle time was 57 minutes.

Second Trial

  • Start: From sample repeat trial
  • Finish: Biochemistry report approved
  • Start time: 8:40 am
  • End time: Peak sample repeat trial time over by 12:30 p.m.

The results are summarized in Table 7.

Table 7: Second Trial of Biochemistry Flow Run
Step Number Center Number In Time Samples To Biochemistry Number of Samples
1 1,2 08:40 42 08:55 42
2 09:05 30 09:10 30
3 3,4 10:15 190 10:20 16
10:35 66
10:47 53
10:58 51
11:01 12
11:06 1
11:08 1
4 5 10:32 65 11:01 55
11:06 10
5 6 11:10 57 12:00 57
6 7,8 11:32 42 11:42 42
7 7,8 12:25 22 12:33 22

The run was completed by 1:30 p.m. With the peak time load processed early, the rest of the tests running in the afternoon were easy to manage.

Several improvements were implemented that had significant results.

  • Pre-trial process in accession: The first 42 samples were loaded into trays of 16 samples per tray. When one tray was loaded, the second tray was started. The process was to pass on the trays to biochemistry when all samples were loaded.
  • A small but significant change in work practice was made with one loaded tray being promptly passed on so that the centrifuge could start as the next tray was loaded. The bottleneck was able to begin running as soon as possible and then it was kept running.
  • There was a break between 9:10 a.m. and 10:15 a.m. due to a slipup from the Center related to transferring the samples. This break was removed and the centrifuge machine was able to keep running.

Third Trial

  • Number of samples = 16
  • Number of tests = 97

The results are shown in Table 8.

Table 8: Third Trial of Biochemistry Flow Run
Trial Run for 16 Tubes Start Time Time Lost (Minutes) Comments
Sample ready for centrifuge 10:33 4 · 15 red caps and 1 yellow cap (identifiers for types of sample tubes), which is taller and cannot balance in the centrifuge

· Yellow cap changed for red cap

Centrifuge start 10:37
Centrifuge end 10:47 6 · Worklist not available and had to be retrieved from the accession

· Reference was required to determine tests that cannot be completed by the machine

· 1 tube needed electrolyte (potassium)

Loaded in the machine 10:53
Barcode reading and ready for test 10:58
Test started in machine 11:03
First tube ready 11:06
Test completed (for all 16 tubes) 11:40
Report review start 11:40 24
Status changed to completed 11:50 Decimal values were added to whole number results (e.g., 14.00 instead of 14)
Approval completed by doctor 12:00 20
Total time taken 1:27

When it came to the time lost in various tasks in the process, there were a couple of areas of concern that were quickly addressed.

  • A yellow cap, which was a different height than the others and thus did not balance in the centrifuge, was changed to a red cap so that it could go with the other tests at the same time.
  • The delays due to report review and completion were addressed by explaining to the doctors how they needed to fit into the overall process flow.

Addressing of these types of problems continued over several cycles. Two other examples were:

  • Tubes of different sizes in one batch or partial batches were sent to the centrifuge. To keep tests moving, balancing dummy tubes were kept at the centrifuge to fill the extra slots as needed.
  • The trays from accession to centrifuge could carry 20 tubes, which meant that 16 were loaded while 4 (then 8 and 12) had to wait for the next batch. New trays holding 16 tubes per tray rather than 20 were bought and then to maintain the even flow of tubes.

The above trials and improvements were spread over three days. A summary of the results follows.

  • Day 1: No work in process (WIP). Work was finished at 5:30 p.m., unlike before the project when some samples had to be processed overnight (maximum TAT = 4 hours).
  • Day 2: No WIP at 5:30 p.m.

The head of the laboratory shared a great compliment: “I used to chase biochemistry; now I have to chase other departments!”

The Ultimate Test – Saturday

Saturday mornings always presented peak load challenges as this tended to be the day of the week with the greatest number of patients. The first Saturday using the new process flow system produced the results shown in Table 9.

Table 9: Saturday Biochemistry Processing in Flow
Batch Starting at Minute
Batch 1 30
Batch 2 45
Batch 3 60
Batch 4 75
Batch 5 90
Batch 6 105
Batch 7 120
Batch 8 135
Batch 9 150
Batch 10 165

The efficiency of processing was more than 90 percent.

  • Tubes = 160
  • Reports = 154
  • Start: 9:40 a.m.
  • Finish: 12:30 p.m.
  • Time to completion: 182 minutes
  • Ideal time: 165 minutes

By 1:00 p.m. the peak load had been processed and the worst was over.

Conclusion

The key objective – having 100 percent of the samples received in the morning getting their reports by the end of the same day – was achieved. Approximately 70 percent of the afternoon samples (fewer in number than what was received mornings) were completed by 7 p.m. The reports for those samples were ready to be given to patients by late evening.

Additionally, the revised process made the work easier, easily absorbing peak loads while dramatically reducing the overtime of staff and releasing capacity during the afternoons for additional samples to be processed.

The control chart was found to not be required and was, therefore, discontinued.


 

Appendix 1: List of Brainstormed Problems
Problem Number Problems  Result 1 Result 2
1 Timing of report Delay
2 Not working as per system Delay
3 Passing the buck Delay
4 Errors in reports Quality
5 Confusion for customer Service Delay
6 Communication to customers Delay Service
7 Early billing Delay
8 Wrong test Quality
9 Standard operating procedures Quality Delay
10 Delay in samples and, therefore, report Delay
11 Wrong committed time of report delivery Delay
12 Delay in critical samples Delay
13 Tracking of long test reports Delay
14 Wrong delivery commitment to outstation customers Delay
15 Committed delivery to outstation customer not known Delay
16 GHK Quality
17 Safety Safety
18 Stock outs Delay
19 Manpower Delay
20 Reagent temperature monitoring Quality
21 IP reports delay Delay
22 No logbook for GHK
23 Micropipettes left on floor Quality
24 Delay in sample transportation Delay
25 Punctuality – leave inform sanction Delay
26 Low awareness of problem Quality
27 Error In reports Quality
28 Maintenance of equipment/utilities Quality Delay
29 Medical immunization/emergency of lab personnel Safety
30 Sample handling gloves, personal protective equipment Safety
31 Internal quality control not maintained regularly Quality
32 Participation in external quality programs Quality
33 Education in techniques Quality
34 Lab coats not worn by phlebotomist Quality Safety
35 Handling/preservation and storage of reagents Quality Cost
36 IT-related issues Delay
37 Annual maintenance of machines Quality Delay
38 Incoming quality inspection Quality
39 Evaluation of performance of kit before use Quality
40 FIFO Quality Cost
41 Stock management Delay Cost
42 Logbook of complaints from customers not available Quality Delay
43 Staff lockers
44 Washing area for tubes inadequate Quality
45 Medical waste disposal
46 Door hitting people while opening
47 Pests Quality
48 Lab chairs Facility
49 Pantry Facility
50 Laundry arrangement for lab coats, etc. Quality
51 Separate cabin for clinical pathology Quality
52 Team work Delay Quality

 

Appendix 2.1: Arrival Pattern of Samples for Testing
Blood + Urine
February 10 February 11 February 12 February 13
7:00 a.m. 10 3 15 26
8:00 a.m. 8 5 40 24
9:00 a.m. 74 38 33 53
10:00 a.m. 68 117 90 75
11:00 a.m. 85 64 58 75
12:00 p.m. 136 111 50 110
1:00 p.m. 130 60 20 100
2:00 p.m. 48 95 55 51
3:00 p.m. 20 67 10 49
4:00 p.m. 24 16 2 44
5:00 p.m. 28 17 2 19
6:00 p.m. 33 20 5 39
7:00 p.m. 25 21 0 13
8:00 p.m. 8 5 1 23
9:00 p.m. 6 7 0 10
10:00 p.m. 15 5 0 12
11:00 p.m. 2 0 0 13
12:00 a.m. 3 0 3 2
1:00 a.m. 0 0 0 3
2:00 a.m. 0 0 2 0
3:00 a.m. 0 0 0 0
4:00 a.m. 0 0 0 0
5:00 a.m. 4 8 0 0
6:00 a.m. 1 15 0 19
Total 728 674 386 760
Average 30 28 16 32

 

Appendix 2.2: Arrival Pattern of Samples for Testing
Blood Samples
February 10 February 11 February 12 February 13
7:00 a.m. 8 2 11 20
8:00 a.m. 6 4 30 18
9:00 a.m. 56 29 25 40
10:00 a.m. 52 89 68 57
11:00 a.m. 65 49 44 57
12:00 p.m. 103 84 38 84
1:00 p.m. 99 46 15 76
2:00 p.m. 36 72 42 39
3:00 p.m. 15 51 8 37
4:00 p.m. 18 12 2 33
5:00 p.m. 21 13 2 14
6:00 p.m. 25 15 4 30
7:00 p.m. 19 16 0 10
8:00 p.m. 6 4 1 17
9:00 p.m. 5 5 0 8
10:00 p.m. 11 4 0 9
11:00 p.m. 2 0 0 10
12:00 a.m. 2 0 2 2
1:00 a.m. 0 0 0 2
2:00 a.m. 0 0 2 0
3:00 a.m. 0 0 0 0
4:00 a.m. 0 0 0 0
5:00 a.m. 3 6 0 0
6:00 a.m. 1 11 0 14
Total 553 512 293 578
Ave 23 21 12 24

 

Appendix 2.3: Arrival Pattern of Samples for Testing
Urine Samples
February 10 February 11 February 12 February 13
7:00 a.m. 2 1 4 6
8:00 a.m. 2 1 10 6
9:00 a.m. 18 9 8 13
10:00 a.m. 16 28 22 18
11:00 a.m. 20 15 14 18
12:00 p.m. 33 27 12 26
1:00 p.m. 31 14 5 24
2:00 p.m. 12 23 13 12
3:00 p.m. 5 16 2 12
4:00 p.m. 6 4 0 11
5:00 p.m. 7 4 0 5
6:00 p.m. 8 5 1 9
7:00 p.m. 6 5 0 3
8:00 p.m. 2 1 0 6
9:00 p.m. 1 2 0 2
10:00 p.m. 4 1 0 3
11:00 p.m. 0 0 0 3
12:00 a.m. 1 0 1 0
1:00 a.m. 0 0 0 1
2:00 a.m. 0 0 0 0
3:00 a.m. 0 0 0 0
4:00 a.m. 0 0 0 0
5:00 a.m. 1 2 0 0
6:00 a.m. 0 4 0 5
Total 175 162 93 182

 

Appendix 3: Time Required for Each Test
Test Number Lab Working Centrifuge Test Machine
I: Hematology
1 Hemoglobin x 5 Sysmax and Abx
2 Pcv X 5 Sysmax and Abx
3 Rbc X 5 Sysmax and Abx
4 WBC count x 5 Sysmax and Abx
5 Platelet count x 5 Sysmax and Abx
6 Differential count X 20 Sysmax
7 Malarial parasite x 15 Manual
8 Microfilarial X 15 Manual
9 P. smear study X 30 Manual
10 Reticulocyte count X 30 Manual
11 Blood group X 15 Manual
12 Prothrombin time (PT) 20 30 Stago
13 PTT 20 30 Stago
14 La1 and La2 20 30 Stago
15 Fibrinogen 20 30 Stago
16 Esr X 30 Vesmatic and manual
II: Biochemistry
1 Glucose 10 10 CS 300 and CS 400
2 Urea 10 5 CS 300 and CS 400
3 Creatinine 10 5 CS 300 and CS 400
4 Uric acid 10 10 CS 300 and CS 400
5 Total cholesterol 10 10 CS 300 and CS 400
6 HDL cholesterol 10 15 CS 300 and CS 400
7 Triglycerides 10 10 CS 300 and CS 400
8 Bilirubin total 10 10 CS 300 and CS 400
9 Bilirubin direct 10 10 CS 300 and CS 400
10 SGOT 10 10 CS 300 and CS 400
11 SGPT 10 10 CS 300 and CS 400
12 Alkaline phosphatase 10 10 CS 300 and CS 400
13 Gamma Gt 10 10 CS 300 and CS 400
14 Total protein 10 10 CS 300 and CS 400
15 Albumin 10 5 CS 300 and CS 400
16 CPK total 10 10 CS 300 and CS 400
17 CPK MB 10 10 CS 300 and CS 400
18 LDH 10 10 CS 300 and CS 400
19 Micro albumin 10 10 CS 300 and CS 400
20 GTT 10 10 CS 300 and CS 400
21 Calcium 10 10 CS 300 and CS 400
22 Phosphorus 10 10 CS 300 and CS 400
23 Iron 10 15 CS 300 and CS 400
24 Tibc 10 15 CS 300 and CS 400
25 Magnesium 10 10 CS 300 and CS 400
26 Amylase 10 10 CS 300 and CS 400
27 Lipase 10 10 CS 300 and CS 400
28 Ra factor 10 10 CS 300 and CS 400
29 Aso 10 10 CS 300 and CS 400
30 Crp 10 10 CS 300 and CS 400
31 Urine protein 10 10 CS 300 and CS 400
32 Urine creatinine 10 10 CS 300 and CS 400
33 Ferritin 10 15 Centaur
34 Electrolytes 10 10 IRIS
35 Trop I 10 10 Manual
36 pH X 10 Symmons
37 pO2 X 10 Symmons
38 pCO2 X 10 Symmons
III: Clinical Pathology
1 Urine complete 10 15 Strip reader
2 Urine ketone X 15 Strip reader and manual
3 Urine glucose X 10 Strip reader and manual
4 Bile salt X 20 Manual
5 Bile pigment 10 20 Manual
6 Stool complete X 25 Manual
7 Stool occult blood X 20 Manual
8 Stool reducing substances X 15 Manual
9 Semen analysis X 30 Manual
10 Pregnancy test X 20 Manual
11 CFS cell count and type 10 30 Manual
IV: Microbiology
1 Routine culture and sensitivity X 48 hours Manual
2 Gram stain X 30 Manual
3 Smear for AFB X 60 Manual
4 Blood culture X 5 days Manual
5 Smear for fungus X 30 Manual
6 Fungal culture X 10 days Manual
7 Hanging drop X 30 Manual
8 AFB culture X 7 weeks Manual
9 Stool culture X 5 days Manual
V: Immunserology
1 T3 10 20 Centaur
2 T4 10 20 Centaur
3 TSH 10 20 Centaur
4 Free T3 10 20 Centaur
5 Free T4 10 20 Centaur
6 FSH 10 20 Centaur
7 LH 10 20 Centaur
8 Prolactin 10 20 Centaur
9 Insulin 10 20 Centaur
10 Beta hcg 10 20 Centaur
11 IGE 10 20 Centaur
12 E2 10 70 Centaur
13 AFP 10 20 Centaur
14 CEA 10 20 Centaur
15 PSA 10 20 Centaur
16 Anti-thyroid antibodies 10 20 Centaur
17 Vitamin B12 10 20 Centaur
18 Vitamin D 10 20 Centaur
19 Testosterone 10 20 Centaur
20 CA–125 10 45 Centaur
21 CA–19.9 10 50 Centaur
22 CA–15.3 10 60 Centaur
23 Cortisol 10 20 Centaur
24 Progesterone 10 20 Centaur
25 Folic acid 10 20 Centaur
26 C–Peptide 10 20 Centaur
27 Phenytoin 10 20 Centaur
28 Valproic acid 10 20 Centaur
29 PTH 10 20 Centaur
30 Phenobarbitone 10 20 Centaur
31 Homocystine 10 20 Centaur
VI: Serology 
1 HIV 10 3 hours Elisa Reader
2 HbsAg 10 3 hours Elisa Reader
3 HCV 10 3 hours Elisa Reader
4 ANA 10 3 hours Elisa Reader
5 Anti-ds DNA 10 3 hours Elisa Reader
6 Anti-cardiolipin – IgG 10 3 hours Elisa Reader
7 Anti-cardiolipin – IgM 10 3 hours Elisa Reader
8 Anti-phospholipid – IgG 10 3 hours Elisa Reader
9 Anti-phospholipid – IgM 10 3 hours Elisa Reader
10 Anti-TB IgA 10 3 hours Elisa Reader
11 Anti-TB IgG 10 3 hours Elisa Reader
12 Anti-TB IgM 10 3 hours Elisa Reader
13 Torch profile–IgG
14 Toxoplasma antibody 10 60 minutes Mini Vidas
15 Rubella antibody 10 60 minutes Mini Vidas
16 Cytomegalovirus antibody 10 60 minutes Mini Vidas
17 HSV I–IgG 10 3 hours Elisa Reader
18 HSV II–IgG 10 3 hours Elisa Reader
19 Torch profile–IgM
20 Toxoplasma antibody 10 60 minutes Mini Vidas
21 Rubella antibody 10 60 minutes Mini Vidas
22 Cytomegalovirus antibody 10 60 minutes Mini Vidas
23 HSV I–IgM 10 3 hours Elisa Reader
24 HSV Il–IgM 10 3 hours Elisa Reader
25 Dengue–IgG 10 30 minutes Manual
26 Dengue–IgM 10 30 minutes Manual
27 Leptospira–IgG 10 30 minutes Manual
28 Leptospira–IgM 10 30 minutes Manual
29 Anti HEV–IgM 10 3 hours Elisa Reader
30 Anti-Hbe 10 90 minutes Mini Vidas
31 Anti-HAV 10 90 minutes Mini Vidas
32 Anti-Hbc–IgM 10 120 minutes Mini Vidas
33 Anti-HBC–Total 10 120 minutes Mini Vidas
34 Western blot 10 4 hours Manual
35 Brucella melitensis 10 30 minutes Manual
36 Brucella abortus 10 30 minutes Manual
37 Mono spot (infectious mono nucleosis) 10 30 minutes Manual
38 Widal 10 30 minutes Manual
39 Widal tube 10 12 hours Manual
40 D–Dimer 10 30 minutes Manual
41 HIV–Tridot 10 30 minutes Manual
42 HbsAg spot 10 30 minutes Manual
43 Anti-HCV spot 10 30 minutes Manual
44 Leptospira–IgG 10 2 hours Elisa Reader
45 leptospira–IgM 10 2 hours Elisa Reader
46 Leptospira (MAT) 10 30 minutes Manual
47 Dengue–IgG 10 2 hours Elisa Reader
48 Dengue–IgM 10 2 hours Elisa Reader

 

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