clinical pathology quality dashboard june 2009. clinical pathology quality dashboard inpatient...

Clinical PathologyQuality Dashboard

June 2009

Clinical Pathology Quality Dashboard

Inpatient Phlebotomy First AM Blood Draws University Hospital

0%

20%

40%

60%

80%

100%

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

2008 2009

8am

9am

10am

Drawn by

Mott Hospital

0%

20%

40%

60%

80%

100%


2008 2009

8am

9am

10am

Drawn by


Inpatient Phlebotomy First AM Blood Test Results:

PT/PTT, CBCP, and Comprehensive Panel

University Hospital

0%

20%

40%

60%

80%

100%


2008 2009

0

100

200

300

400

Av

g D

ail

y V

olu

me

8am

9am

10am

Results by

Mott Hospital

0%

20%

40%

60%

80%

100%


2008 2009

0

2

4

6

8

10

12

Av

g D

ail

y V

olu

me

8am

9am

10am

Results by

Inpatient Phlebotomy DrawsFiscal Year 2009


21,182

23,348

19,773

26,062

19,75920,459

19,598 19,795

21,992 21,71420,986

0

5,000

10,000

15,000

20,000

25,000

30,000

July Aug Sep Oct Nov Dec Jan Feb Mar Apr May

2008 2009


Turnaround Times

Emergency Department Cardiac MarkerVolume and Turnaround Time

0

200

400

600

800

1000

1200

1400


2008 2009

Mo

nth

ly V

olu

me

> 2 hours

1-2 hours

<1 hour

TAT

Point of Care service began

CSF Gram StainVolume and Turnaround Time

0

20

40

60

80

100

120

140

160

June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May

2008 2009

Mo

nth

ly V

olu

me

> 1 hour

30 min-1 hour

<30 minutes

TAT


Molecular Diagnostics Laboratory

Specimens Received and Turnaround TimeJanuary 2002 - December 2008

0

200

400

600

800

1000

1200

1400

January2002

July 2002 January2003






July 2008

Month/Year

# of

Spe

cim

ens

rece

ived

0

1

2

3

4

5

6

7

8

9

10

TAT

(day

s)

# Specimens TAT Linear (# Specimens) Linear (TAT)


Chemistry In-Lab Turnaround Times

Sample Turn-Around Time

0

5

10

15

20

25

30

35

Aug 07 - May 09

Per

cent

age

Routines >60 >45 IN >45 OUT

UMHS Blood Product Utilization


Crossmatch/Transfusion Ratio

1.3

1.4

1.5

1.6

1.7

1.8

1.9

J une J uly Aug Sep Oct Nov Dec J an Feb Mar Apr May

2008 2009

Threshold

Wasted RBC

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%


2008 2009

Threshold

Wasted Platelets

0%

2%

4%

6%

8%


2008 2009

Threshold

Wasted Plasma

0%

1%

2%

3%

4%

5%

6%


2008 2009

Threshold

Wasted Cryoprecipitate

0%

5%

10%

15%

20%

25%

30%


2008 2009

Threshold

Blood Product Utilization

0

1000

2000

3000

4000

5000

6000

7000

8000

June July Aug Sep Oct Nov Dec Jan Feb Mar Apr May

2008 2009

0

1000

2000

3000

4000

5000

6000

7000

8000

Pa

tie

nt

Po

pu

lati

on

Random Platelets

Allo RBC Units

Plasma Units

Cryo Units

Partial Units

SD Platelets

AdjustedDischargesUnits Used


CAP Proficiency Testing

3rd Quarter FY 2009

Clinical Pathology24 = Number of Challenges

100% = Satisfactory Results

Anatomic Pathology0 = Number of Challenges

N/A = Satisfactory Results

Department Total24 = Number of Challenges

100% = Satisfactory Results

Clinical Pathology Scores

0

100

200

300

400

500

600

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr

Nu

mb

er

of

Ch

all

en

ge

s

50

60

70

80

90

100

Pe

rce

nt

Sa

tis

fac

tory

FY2008 FY2009


CP Financial MeasuresClinical Path Tests per FTE and Total Tests By Month

1,000

1,200

1,400

1,600

1,800

2,000

Test

per

FT

E

275,000

300,000

325,000

350,000

375,000

400,000

425,000

To

tal

Tests

Tests per FTE Total Tests

Clinical Path Expense per Test*

$4

$5

$6

$7

$8

$9

$10

*excludes Blood Bank and Phlebotomy

Monthly Amount Paid to Southeastern Michigan American Red Cross

1,000,000

1,050,000

1,100,000

1,150,000

1,200,000

1,250,000

1,300,000

1,350,000

Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun

FY 2009

Do

llars


New Clinical Assays Added in Current Year

Protein S activity

Anti-Xa Arixtra (fondiparinux) assay

Hexagonal phospholipid neutralization (HEXAG) assay

Heparin – induced thrombocytopenia/thrombosis assay (improved IgG assay)

Automated Urinalysis platform (IRIS)

Rapid detection of Candida albicans and C. glabrata from blood cultures

BRAF V600 Mutation Detection

Clear Cell Sarcoma EWSR1/ATF1, t(12;22) Transcript Detection

UroVysion FISH for Bladder Cancer

KRAS Mutation Detection

NPM1 Mutation Detection

Warfarin Sensitivity Analysis

• Improvement of Critical Value Callback process- Brenda Schroeder, lead

• Improvement of Communication with Patient Care Units - Beverly Smith and Brenda Schroeder, leads

• Customer Service Initiative - Beverly Smith, lead

• Lab Formulary Committee- Office of Clinical Affairs, FGP, Pathology

• Lean Process Improvement Projects – many!

• Job-specific safety signs

• Creation of Blood Product Utilization Lean Team - Tim Laing, MD, (OCA), lead

• Improvement of Blood Draw Wait Times- Cancer Center- Taubman 2- Taubman 3


Clinical Laboratory Operations Initiatives

• On-demand unit-specific antibiograms – 2/09

• Expedited (rules-based) release of ANCs (absolute neutrophil counts) – 2/09

• Integrated hematopathology reports – 2/09

• Troponin point-of-care (ED) – 3/09

• 24/7 Microbiology Lab staffing

• Mycobacteriology culture – continuous monitoring

• Multiple new clinical assays (see list)


Clinical Laboratory Service Enhancements

Kudos


• Thank you to all personnel for our very successful biannual unannounced CAP Inspection of our laboratories on May 20 – 21, 2009.

• Thank you to the following group for their outstanding work with Ann Arbor Public School students who visited the Department of Pathology last month.

• Chemistry: Sheridan Mattson, Merry Muilenburg, Melissa Liebaert, Tony Sinay, Therese Horning, and Kevin Forbin.

• Microbiology: Michele Centi, Karen Machcinski and Robert Whitney

• Cytology: Brian Smola• Histology: Chris White and Danielle Fritzsche• Administration: Beverly Smith• Many positive comments were received from these AAPS

students. • Examples:• “I learned how to look for cancer cells – every day I was

with four different people and ALL of them were helpful – I really learned a lot”.

• “I not only gained a lot of knowledge in the clinical labs – I became more confident. Sheridan…really encouraged me. Sheridan was very helpful.”

• “I learned a lot. I learned about influenza and I got to see bacteria on the microscope. There were a lot of helpful people that were happy to help me and spend time explaining everything.”

• “Got to see a wide variety of procedures…got a good glimpse of what these jobs entail and a good sense of the different jobs available.”

clinical pathology quality dashboard june 2009. clinical pathology quality dashboard inpatient...

Documents

clinical affairs

department of pathology

blood draws slide

lab turnaround times

comprehensive panel

blood test results

number of challenges

care ed