going beyond laboratory automation: do less accomplish more · 2017-04-02 · 1 going beyond...
TRANSCRIPT
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Going Beyond Laboratory Automation:
Do Less Accomplish More
Susan Dawson, MBA, MT(ASCP)Swedish Covenant Hospital
Chicago, IL
325 Beds
15,000 admissions / year
46,000 ER visits / year
Culturally diverse patient population
Employees speak 40 different languages
Swedish Covenant HospitalOpen Heart Birthing Unit
Community Outreach ProgramOncology
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69.4 FTEs (40:60 technical : non-technical)
18.4 FTEs for Chematology section
1,200,000 tests / year
Continuous flow process
Swedish Covenant Hospital Lab
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Do More With LessAccomplish
How can we do less?
Pre-Analytical
Analytical Post-analytical
EfficientlyLess StressHigh QualityStreamline processes
Total Process Management
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Pre-Analytical Processes
Patient ID
System
CPOE
Pneumatic tube
No Aliquoting
Sample Distribution
Analytical Processes
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Employee Demographics
• Techs range in age from 25-67. Most over 45.
• Longevity - worked at the lab for over 15 years
• Most attended college when they were still typing on typewriters
• First computers used were at work• Retention rate is good• Pay rate is 65% of top pay in the area
Work Statistics
Solucient™ benchmarking
7.4% ranking in labor expense85% in BT/FTE11.5% in total expense/100 BT
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Analytical Processes
Repeats
Dilutions
AlgorithmsIndicies
QC
CriticalsDelta
CRR
HepatitisTSH
Hemo, Icterus, Lipemia
Reagent change
Computer connectivity
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CI
CII
Coag
UAHemo Hemo
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Wireless Headset
Hands are free
“Lean” things
• Phone, LIS terminal, automation terminal
• Controls in rack in the order they are loaded on the instrument
• One touch per tube• Stat bench• Wireless headset
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The Big Screen
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Post- Analytical Processes
Autovalidation
Single largest contributor to relieving stress and improving consistency, quality and turn-around time.
If a tech would/should take an “action” on the result, then it should not be autovalidated.
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Quality Control
• Stops patient results from being reported for an assay that has failed QC
• Stop results from autovalidatingif QC has not been run in the past xx hours
Review Ranges
• Don’t stop every abnormal• Actionable result• Hemolysis comment –
automatically generated• Critical values
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Delta Checksand Instrument Flags
• Delta checks–Clinically useful–Not for every assay
• Instrument flags–Translate important information
(linear limit, clots)
Autovalidation: Rules and Effect
LaborQualityLIS
QCReview rangesDelta checks
Instrument flags
Reviewed by tech
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Patient demographic information
Test information
Actions
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Hematology
Differentials
Review criteria
N
Y
Slide review/ Manual
differential?
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Differentials
Review criteria
N
Y
Slide review/ Manual
differential?
Complex rules for differentials
Review criteria
N
Y
Slide review/ Manual
differential?
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17
0600 TAT for hematology
Impact On Hematology
FY02 FY03 Q3040
40
60
70
Q404 Q105 FY06 FY07 FY09
50
30
20
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Connected tomiddleware
Auto-validation
Onlinedifferentials
ER TAT for hematology
Connected tomiddleware
FY03 Q2040
10
15
20
Q304 Q404 FY05 FY07 FY09
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Auto-validation
Onlinedifferentials
Impact On ER Specimens
11 min
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0600 TAT for chemistryAutomation
Auto-validation
FY02 FY03 Q1040
40
80
120
FY04 FY05 FY06 FY07 FY09
Impact Of Automation& Auto-validation
51 min
ER TAT for chemistry
Auto-validation
Impact On ER
FY03 Q1040
30
40
50
FY04 FY05 FY06 FY07 FY09
20
10
28 min.
Big Screen
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Advantages of Autovalidation
• Objective, not subjective review of results
• Rule violations will be captured• Every rule is consistently applied and
not dependent on personal preference or tech capability.
Post analysis tasks
• Add on testing • Reflex orders• Post analysis sorting• Reports• Phone calls• Send outs
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One Touch
Maximize the use of all automated processes–Auto repeats–Auto dilutions–Hemolysis grading–Add-on testing–Reflex orders–Archiving and specimen retrieval
Advent of the Centra-tech!
Hematology Manual differentials
Central Desk Chemistry Workstation
Any of these techs can simultaneously manage the entire process from order to result verification for Hemo, Coag, Chemistry, and Immunoassay.
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Inpatient BT/adjusted discharge
Total billed tests /
Lab FTE
Total Expense /
100 Billed tests
Hours paid per 100 billed tests
Utilization
ProductivityProductivity
Cost Effectiveness
Operational Indicators
SCH – Lab Services: Clinical Operations(Chemistry, Hematology, Coagulation, Urinalysis, Microbiology, Paratechnical)
Solucient KPI Benchmarking
N/AN/AN/AN/AN/AInPt Billed Tests/Acute Dish.Utilization
49.5238.2132.4410.34%22.72Skill Mix: Technologists %Staffing
16,597.7414,928.6512,989.4482.76%17,732.65Total Billed Tests/Lab FTEWorkload
15.5313.6711.7721.43%11.73Hours Paid/100 Billed TestsProductivity
728.91683.72615.8314.29%569.43Total Expense/100 Billed TestsCost Ratio
365.00327.49270.106.90%216.91Labor Expense/100 Billed TestsCost Ratio
75th50th25th
SCH%
Ranking
SCH Clin. Lab.
PercentileFYE 3Q 2009
Operational indicators of cost effectiveness, productivity and staffing compare very favorably to the targeted 25th
percentile. Utilization statistics not available from Solucient at this time.
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Test volume vs FTE
87.587.1
87.5
89.6
88.5
87.3
85.886.1
0
200000
400000
600000
800000
1000000
1200000
1400000
2002 2003 2004 2005 2006 2007 2008 2009
Test
vol
ume
80
82
84
86
88
90
92
FTE
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Do Less Accomplish More
• Pre-analytics– Specimen quality– Delivery of specimens– Accuracy– Computer connectivity of information
• Analytics– Eliminating manual processes– Visuals– Maximizing computer capabilities
Do Less Accomplish More
• Post Analytics–Autovalidation–Add-on and reflex test orders–Computer documentation–Specimen sorting–Reports
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National Employee Satisfaction survey ranked the laboratory in the top 10% in employee engagement.
Job satisfaction - 80% of staff rated it good or excellent.
We Do Less and Accomplish More !
Contact Information
Susan [email protected]
Swedish Covenant HospitalChicago, IL