nichola marcus, automated laboratory manager -ah · nichola marcus, automated laboratory manager-ah...

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Connecting Our Lab Vision to Lab Success: Our Upgrade Journey and Improvements

Achieved

Huntsville HospitalHuntsville, AL

Nichola Marcus, Automated Laboratory Manager

-ah

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About Huntsville Alabama

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Huntsville Hospital Health SystemStandardization benefits the patient, physician and lab

Huntsville HospitalHuntsville Hospital for Women &

Children Madison Hospital Decatur General Hospital

Parkway Medical Center Athens-Limestone Hospital Helen Keller Hospital Red Bay Hospital

Lawrence Medical Center

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About Huntsville HospitalOur Automated Lab

Automated Lab Consists of:• Hematology• Coagulation• Urinalysis• Flow Cytometry• Chemistry• Immunoassay• Electrophoresis• Immunology• Pre Analytical & Post Analytical Processes and

Automation

• 60 to 70% of lab testing from outreach program

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About Huntsville HospitalOur Automated Lab

• AutoLab Sample/Test volumes• Monday – Friday average 7400 specimens/day

• Weekends average 3400 specimens/day

• Max – 9080 (3/9/15)

• Hematology Sample/Test volumes • Monday – Friday average 1500 specimens/day

• Weekends average 740 specimens/day

• Max – 1898 (3/9/15)

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Connecting Our Lab Vision to Lab SuccessThe Vision: Grow an Outreach Business

LAB HEADLINE NEWS

1996

Huntsville Hospital Laboratory Huntsville, Alabama

HUNTSVILLE HOSPITAL PURCHASES HUMANA

HOSPITAL

ADMINISTRATION TELLS LAB: OPEN

AN OUTREACH PROGRAM

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Action Plan to Achieve Success

Key Issues

• 3 labs are now under one management team

• HH Main Lab, HH East (formerly Humana Hospital) Lab, and ER Lab

• Duplications in testing

• Multiple vendors

• Attract and retain clients

• Manage growth in specimen volumes

• Minimize testing in HH East and ER Labs

• Choose one vendor for each area of testing

• Optimize processes to produce consistent, timely, reliable results

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LAB HEADLINE NEWS

2000


THE WALLS COME DOWN – THE CHEMISTRY AND HEMATOLOGY DEPARTMENTS ARE NOW KNOWN AS

‘AUTOMATED LABORATORY’. Shocked lab employees exclaim “What’s next…cross training?”

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Connecting Our Lab Vision to Lab SuccessCore Lab Concept and Cross Training

Key Issues• Staff resistance

• Extensive training needed

• Managing increasing specimen volumes

Action Plan to Achieve Success• Unified scheduling

• Choose analytical platforms from vendors at the forefront of automation

• Identify and streamline labor intensive processes – let Techs do what Techs need to do

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Connecting Our Lab Vision to Lab SuccessStreamlining processes

Processes Identified to free up Tech time•Bone Marrow and Flow Cytometry processing

•Processing and loading specimens

•Archiving specimens

•Preparing, labeling and staining manual slides

•Reviewing ‘negative’ results

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Connecting Our Lab Vision to Lab SuccessManaging Growth

LAB HEADLINE NEWS

2003


HUNTSVILLE HOSPITAL LAB INSTALLS PRE-

ANALYTICAL AUTOMATION

HEMATOLOGY LAB UPGRADES TO THE

XE-ALPHA AND IMPLEMENTS

AUTOVALIDATION

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Connecting Our Lab Vision to Lab SuccessStreamlining processes

Gains•Flow Tech can focus on acquisition and analysis

•Bone marrow processing is more consistent

•90% of all lab specimens follow a single pre-analytical process

•Chemistry specimens are automatically loaded onto the analyzers

•EDTA pre-analytical management

•Techs focus only on specimens that need special attention – shake out the ‘positives’ from the ‘negatives’

•Slide preparation is automagic

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Connecting Our Lab Vision to Lab Success

LAB HEADLINE NEWS

2004


HOSPITAL ADMINISTRATION ANNOUNCES TO ALL DEPARTMENTS: SHAVE $500,000 OFF OF

YOUR ANNUAL BUDGETS, IMMEDIATELY.

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By this time we already had:– Pre-analytical automation processing 90% of

our specimens

– Streamlined processes in each department with excellent TATs

– A Tram and pneumatic tube system between the HH East Hospital and the HH Main Hospital

– So we felt confident that we could…

Connecting Our Lab Vision to Lab SuccessManaging Growth and Change

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LAB HEADLINE NEWS

2004


HH EAST AND EMERGENCY DEPARTMENT LABS CLOSE – ALL TESTING TO BE PERFORMED IN

ONE LAB!!!!!

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Connecting Our Lab Vision to Lab SuccessThree Labs become One

Action Plan to Achieve Success

Key Issues

• All STAT, ER, InHouse, and Outreach specimens are run on the same analytical platforms

• Excellent TATs must be maintained

• Staff Resistance “We will just get STATed to death”

• Optimize pre-analytical automation so the Central Processors can focus on the STATs

• Automate, automate, automate

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LAB HEADLINE NEWS

2006


HEMATOLOGY UPGRADES FROM THE XE-ALPHA TO THE XE-HST. LAB STAFF

CELEBRATES BUT WONDERS… WHAT IS THAT ODD BLUE BOX.

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Gains– Less manual manipulation of specimens

– Handles increased volumes

– CellaVision is a cool toy

Processes to Improve– It takes 3 techs to get a.m. diffs out by 11:00

– CellaVision is very slick but the interface to SunQuest is not very good

– The coagulation department is still very manual

Connecting Our Lab Vision to Lab SuccessStill Growing

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LAB HEADLINE NEWS

2007


TECHS DECLARE “COAG CANNOT BE AUTOMATED, YOU

CAN’T TREAT COAG SPECIMENS LIKE

CHEMISTRY SPECIMENS”

BARRY AND NICHOLA HAVE STARTED

SPEAKING A NEW LANGUAGE. INSIDERS SAY ‘WAM’ IS A GOOD

WORD, AND ‘WAMMIT’ IS A BAD WORD.

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Coag specimens are now processed on the pre-analytical automation

- an aliquot goes to the chemistry analyzers for a specimens integrity check and the primary tubes automatically load onto the coag analyzer

WAM!– Enhanced Critical Value flagging

– Prioritization of STATs

– Multiparameter rules

– Transforms CellaVision from a toy to production tool


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Continued Evolution of the Hematology Line

– Second stainer added to the XE-2100 HST Line– XE-2100s replaced by XE-5000s– Reflex XE-5000 added– Second CellaVision

Problematic Process– Specimen handling is greatly improved but

there is a lot of paperwork and slide manipulation


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LAB HEADLINE NEWS

2012


HEMATOLOGY GOES PAPERLESS. TECHS ASK “IF WE PLANT TREES, CAN WE KEEP

OUR PRINTOUTS?”

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Instant Messaging System Eliminates Paper


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LAB HEADLINE NEWS

2013


HH ADMINISTRATION: “THE LAB IS GETTING MORE SPACE…ACROSS THE

STREET”

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Great!– 1 ½ floors in a multipurpose building connected by a

walkway– Enhanced tube system– All lab departments back together

Reality Strikes– Who is going to do all of the planning?– What do we move and what do we implement in the

new lab?– How do we deal with construction delays and

instrument installations?– How do we train everyone on multiple new analytical

systems– How can we stay fully operational during the move?

Connecting Our Lab Vision to Lab SuccessNew Lab

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Sysmex, the star of our Lab Move– Pre-planning XN line configuration for future

bidirectional connection

– WAM rules changes

– Virtual and on-site training

– Flawless installation and validation

– Excellent support on move day

– Customized Advanced Parameter education


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“If I could get my arms around the XN, I would hug it”

“I wish all benches could be as easy as the XN bench”


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RU-20

-25 X Concentrate

-Very infrequent reagent changing

-Frees up storage space

-May lead to scrawny arms

CellPack DCL

-50 pounds per box

-Changed at least one a day

-Monthly shipments could be built into small forts

-Great muscle building opportunity

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Additional XN Wins– Same footprint as previous XE-5000 system– Far less specimen hostage situations– Easy maintenance– Easy reagent loading– IPU is easy to interact with– Less manual reviews

• 18% ‘Positive’– 10% Diff and Morphology– 8% Morphology Only (Autovalidates CBC)

• XN operator only sees 11% of all specimens in WAM (Diff ‘positives’ plus delta failures)


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Improving Service Level to Meet/Exceed Organizational GoalsPredictable STAT turnaround times improve service to physicians and patients

0 5 10 15 20 25 30 35 40 45

ED CBC TATAverage = 11 minFebruary 2015

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

FEBRUARY REFLAB CBC TATAverage = 24 min

0 5 10 15 20 25 30 35 40 45

FEBRUARY INHOUSE CBC TATAverage = 16 min

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0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150

ROUTINE REFLAB CBC TATAverage = 38 min

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

ROUTINE INHOUSE CBC TATAverage = 25 min

Improving Service Level to Meet/Exceed Organizational GoalsPredictable Routine turnaround times improve service to physicians and patients

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Supplemental Slides

Monday - Friday Review Rates10%

8%

82%

Diff & Morph

Morphology Only

Negative

Weekend Review Rates14%

13%

73%

Diff & Morph

Morphology Only

Negative

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Specimen Mix 02/17/2015NonSTAT (76%) STAT (24%)

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Why Laboratory Automation?Efficiently manage growth and optimize lab processes

nichola marcus, automated laboratory manager -ah · nichola marcus, automated laboratory manager-ah...

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