An Analysis of Work Flow in the Phlebotomy, Chemistry, Hematology

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<ul><li><p>Project Number: SAJVA </p><p>An Analysis of Work Flow in the Phlebotomy, Chemistry, Hematology, and Urinalysis Laboratories at the Edith </p><p>Nourse Rogers Memorial Veterans Hospital in Bedford, MA </p><p> An Interactive Qualifying Project </p><p>Submitted to the Faculty </p><p>of the </p><p>WORCESTER POYLTECHNIC INSTITUTE </p><p>In partial fulfillment of the requirement for the </p><p>Degree of Bachelor of Science </p><p>By </p><p>Darcy Del Dotto </p><p> Michelangela Yusif </p><p> Date: March 13, 2012 Professor Sharon Johnson, Advisor </p></li><li><p>I </p><p>Abstract </p><p>The goal of this project was to reduce lead times for sample processing caused by the </p><p>increased sample volume received by a laboratory with limited technician capacity. Cluttered </p><p>work space, distractions, and lack of a technology-based tracking system all affected the time </p><p>for sample processing at the Edith Nourse Rogers Memorial Hospital laboratory, Bedford. </p><p>Observing and measuring the pre-analytical work-flow enabled the team to use lean methods </p><p>to suggest changes, develop plans for evaluating results, and outline actions for sustainability. </p></li><li><p>II </p><p>Acknowledgements </p><p> We would like to acknowledge the following individuals for their involvement and contributions to the project: </p><p>Mari Ann Amador - Laboratory Supervisor </p><p>MaryKay Buttery - Medical Technologist </p><p>Lorelle Hurlburt - Medical Technologist </p><p>Sharon Johnson Faculty Advisor (WPI) </p><p>Abigail Krinsky Improvement Advisor (VA) </p><p>Donette McLean - Phlebotomist </p><p>Geraldine McPhillips - Medical Technologist </p><p>Ed Nolan - Medical Technologist </p><p>Doreen Robotnik Laboratory Manager </p><p>Rita Rocha - Medical Technologist </p><p>Jean Rogers - Medical Technologist </p><p>Glenda St Gelais - Phlebotomist </p><p>James Taylor - Phlebotomist </p><p>Melissa Williams Phlebotomist </p></li><li><p>III </p><p>Authorship </p><p>Darcy Del Dotto </p><p>Worked mainly on becoming an expert of the processes in the laboratory and reflected her </p><p>observations in the background section. Worked on mapping the processes of the four areas in </p><p>the laboratory, phlebotomy, chemistry, urine, and hematology. Also spent time at all four of </p><p>these areas learning about the employees profiles, including their roles, responsibilities, and </p><p>interactions. Uncovered many opportunities for improvement by focusing on sample flow. </p><p>Formatting and spelling check of the final proposal was also conducted. Edited and formatted </p><p>first draft of final report. </p><p> Michelangela Yusif </p><p>Worked mainly on the methodology and the VA-TAMMCS and DMAIC within the literature </p><p>review. Described the 5S system within the report. Observed process of samples within the </p><p>laboratory as well as collecting data such as incoming and outgoing phone calls, and steps </p><p>towards completing accession and producing results. In addition multiple questions directed </p><p>towards the employees were asked during observation. Recorded observations of the work </p><p>area within the laboratory. Uncovered many opportunities for improvement by focusing on </p><p>telephone log and work space. Formatting and spelling check of the final proposal was also </p><p>conducted. Edited and formatted first, second, and final drafts of final report. </p><p>We would also like to acknowledge work done by our partner: </p><p>Burak Birand </p><p>Worked mainly on the introduction and processes within the literature review. Observed </p><p>process of samples within the laboratory as well as collecting data such as incoming and </p><p>outgoing phone calls, and steps towards completing accession and producing results. In </p><p>addition multiple questions directed towards the employees were asked during observation. </p><p>Formatting and spelling check of the final proposal was also conducted. </p></li><li><p>IV </p><p> Table of Contents </p><p>Abstract ............................................................................................................................................. I </p><p>Acknowledgements........................................................................................................................... II </p><p>Authorship....................................................................................................................................... III </p><p>Table of Contents ............................................................................................................................. IV </p><p>Table of Figures................................................................................................................................ VI </p><p>Table of Tables ................................................................................................................................ VII </p><p>Chapter 1: Introduction ......................................................................................................................1 </p><p>Chapter 2: Background .......................................................................................................................3 </p><p>Accession Process ...........................................................................................................................3 </p><p>Chemistry .......................................................................................................................................8 </p><p>Urine..............................................................................................................................................8 </p><p>Hematology ................................................................................................................................. 13 </p><p>Staffing and Employee Roles ......................................................................................................... 17 </p><p>Phlebotomists .......................................................................................................................... 17 </p><p>Medical Technologists .............................................................................................................. 18 </p><p>Employee Interactions .............................................................................................................. 19 </p><p>Telephone log .............................................................................................................................. 30 </p><p>Chapter 3: Literature Review ............................................................................................................ 21 </p><p>Processes ..................................................................................................................................... 21 </p><p>VA-TAMMCS and DMAIC .............................................................................................................. 24 </p><p>Case Studies28 ............................................................................................................................. 28 </p><p>Case Study 1 ............................................................................................................................. 28 </p><p>Case Study 2 ............................................................................................................................. 32 </p><p>Chapter 4: Methodology .................................................................................................................. 41 </p><p>Objectives .................................................................................................................................... 41 </p><p>Vision .......................................................................................................................................... 42 </p><p>Analysis ....................................................................................................................................... 43 </p><p>Team ........................................................................................................................................... 44 </p><p>Aim .............................................................................................................................................. 44 </p></li><li><p>V </p><p>Mapping ................................................................................................................................... 45 </p><p>Measure ................................................................................................................................... 45 </p><p>Change ..................................................................................................................................... 46 </p><p>Sustain and Spread ................................................................................................................... 47 </p><p>Chapter 4: Results ........................................................................................................................ 48 </p><p>Telephone Log .............................................................................................................................. 48 </p><p>Aim and Map ............................................................................................................................ 48 </p><p>Measure ................................................................................................................................... 49 </p><p>Change ..................................................................................................................................... 50 </p><p>Work Space .................................................................................................................................. 55 </p><p>Aim .......................................................................................................................................... 55 </p><p>Map ......................................................................................................................................... 55 </p><p>Change ..................................................................................................................................... 57 </p><p>Sustain ..................................................................................................................................... 63 </p><p>Sample Flow .................................................................................................................................... 64 </p><p>Map ............................................................................................................................................. 64 </p><p>Measure ...................................................................................................................................... 64 </p><p>Change ........................................................................................................................................ 70 </p><p>Sustain ......................................................................................................................................... 72 </p><p>Chapter 6: Conclusions and Recommendations ................................................................................. 73 </p><p>References ....................................................................................................................................... 75 </p></li><li><p>VI </p><p>Table of Figures </p><p>Figure 1: Breakdown of work flow .......................................................................................... 2 </p><p>Figure 2: Flow of the three types of samples through the laboratory (emphasis is how the </p><p>CBOC samples are followed) ........................................................................................ 4 </p><p>Figure 3: CBOC accession process ............................................................................................ 6 </p><p>Figure 4: The number of samples accessioned per half hour on July 5, 2011, an average day at </p><p>the laboratory at the Bedford Veteran's Association ................................................... 7 </p><p>Figure 5: The chemistry flow chart from the time of centrifuging to the samples final </p><p>destination, whether it is staying at the lab or being shipped to another location ....... 9 </p><p>Figure 6:Current urinalysis flow chart ................................................................................... 11 </p><p>Figure 7: Flow chart for urinalysis process with the addition of the IQ 200 machine .............. 12 </p><p>Figure 8:Flow chart of the four processes conducted in the hematology laboratory .............. 14 </p><p>Figure 9: Example of a pre-analytical flowchart for a laboratory ........................................... 23 </p><p>Figure 10: Bar graph of the outgoing phone calls overlapping sample accession time of August </p><p>22 .............................................................................................................................. 53 </p><p>Figure 11: Bar graph of the incoming phone calls overlapping sample accession time of August </p><p>22, 2011 ..................................................................................................................... 54 </p><p>Figure 12: Pictures of the designated hallways in the laboratory ........................................... 58 </p><p>Figure 13: Chemistry laboaratory as it is now ........................................................................ 59 </p><p>Figure 14: Future outlook of the chemistry laboratory after implementation of suggestions . 60 </p></li><li><p>VII </p><p>Table of Tables </p><p>Table 1: Percent of total processing time each sample takes through each process ............... 30 </p><p>Table 2: Problems within the Veteran's Hospital in Bedford .................................................. 43 </p><p>Table 3: Data collected on incoming and outgoing phone calls .............................................. 51 </p><p>Table 4: Data collected on incoming and outgoing phone calls including time spent to regain </p><p>previous attention level by employee ........................................................................ 52 </p><p>Table 5: Out-patient process observation worksheet ................................................................ 66 </p><p>Table 6: STAT sample process observation worksheet........................................................... 66 </p><p>Table 7: CBC process observation worksheet ........................................................................ 67 </p><p>Table 8: Coagulation process observation worksheet ............................................................ 67 </p><p>Table 9: Out-patient chemistry process observation worksheet ............................................ 68 </p><p>Table 10: CBC stat process observation worksheet ................................................................ 68 </p><p>Table 11: Coagulation process observation worksheet .......................................................... 69 </p></li><li><p>1 </p><p>Chapter 1: Introduction </p><p>The Veterans Health Administration (VHA) is part of the United States Department of </p><p>Veterans Affairs (VA), directed by the Under Secretary of Veterans Affairs for Health, which </p><p>implements the medical assistance program of the VA through the administration and </p><p>operation of numerous VA outpatient clinics, hospitals, and medical centers 12. The Edith </p><p>Nourse Rogers Memorial Veterans Hospital is located in Bedford, Massachusetts and is part of </p><p>the VA New England Healthcare System 2. Many patients are treated every day in Bedford, and </p><p>the hospital is committed to provide high quality, innovative, comprehensive an...</p></li></ul>

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