September

kayakjokeMechanics

Feb 22, 2014 (3 years and 7 months ago)

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Clinical Pathology

Quality Dashboard

September 2013

Clinical Pathology Patient Care Quality


Blood Bank

The total number of errors dropped slightly in August. The
number of
hemolyzed

specimens
also decreased in the month of August. Particularly concerning are
MRN/name changes, which will be further investigated.

Pathology is pursuing a two pronged approach to “specimen quality” in the ED.

1.
There is and has been ongoing discussions via Nursing Liaisons (Barb Wetula, RN,
and Sheryl Woloskie) to addressing training for non
-
Pathology collected
specimens. This focus has been on all of UMHS, with an emphasis on the ED.

2.
Marty
Lawlor
(Pathology) is investigating possible deployment
of
additional
Pathology personal in the ED POCT lab. These individuals would take over
pre
-
analytic processes.

Clinical Pathology Patient Care Quality


Chemistry

Goal: Inpatient/Outpatient STATs=60 minutes; Internal project to
reach 45 minutes. Routines=120
minutes.



Clinical Pathology Patient Care
Quality

Hematology




A multi
-
disciplinary team is reviewing the pre
-
examination,
examination, and post
-
examination stages of CBC specimens
from the Heme
-
Oncology clinics. This patient population
requires expeditious results since physicians require same day
test results to determine whether the patient will receive an
infusion following their clinic appointment.




Clinical
Pathology Patient Care
Quality


Hematology




An increasing trend in the number of requests for Erythrocyte
Sedimentation Rates (ESR) has been observed in the past
year. Investigation into why this might be occurring will be
facilitated by the Hematology laboratory. As noted in the
Mlabs

Spectrum article (Volume 21, Number 2) regarding C
-
Reactive Protein (CRP), the ESR is an indirect measure of
inflammation in comparison to direct measurement of an
acute phase protein such as CRP. It is speculated that the
ESR is still being ordered in instances where a CRP would be
more appropriate.

Clinical Pathology Patient Care Quality


Microbiology

TAT Goal ≤ 1 hour


During the transition to the Soft LIS (Go
-
live; June 2, 2013) an
increase in TAT was observed. This was attributed to downtime for
the upgrade along with staff learning how to navigate effectively in the
new system. July data indicates that operations have stabilized and
TAT is back to normal levels.


Clinical Pathology
Efficiency

*Cost/adjusted discharge is the average cost per inpatient & outpatient
discharge (Forty outpatient visits~ 1 hospital discharge). Pathology
costs exclude: AP, Autopsy, blood products, specimen procurement,
and Pathology Informatics. The Pathology percentage is the cost of an
adjusted discharge that is contributed to by Pathology expenses.

Clinical Pathology Financials

There was an increase in overtime hours worked during the run up
to Soft go live (June 2, 2013). We can see the number of overtime
hours has a downward trend carrying into the month of August.

Clinical Pathology
Safety

Safety

Walk Audits


Date
Laboratory Section
Safety Observations
Other Observations
7/17/2013
Molecular Diagnostics
1. Paper being stored on the floor
7/17/2013
Molecular Diagnostics
2. No date on waste bnuckets
7/17/2013
Molecular Diagnostics
3. Staff member not wearing PPE (lab coat)
7/17/2013
Histocomaptbility
1. Unlabeled buckets - date
7/17/2013
Histocomaptbility
2. Storage on the floor
7/17/2013
Histocomaptbility
3. Biohazard bucket too full
7/17/2013
Immunology
1. Waste buckets too full
7/17/2013
Immunology
2. Storage on the floor
9/10/2013
MCTP
1. Unlabeled waste containers
9/10/2013
MCTP
2. Research equipment in the lab
9/10/2013
Human Genetics
1. Storage on the floor
Home style refrigerators in use may not
be maintaining reagents in the
appropriate range; frost free freezers
warm to above appropriate
temperatures for reagent storage;
Refrigerator D has alcohol and acid
storage that is corrosive
Random audits of clinical laboratories occur to ensure a constant
state of readiness relative to safety is established. Particular areas
are focused on for each audit. Follow
-
up with the Safety and
Compliance officer is required if the safety issue cannot be remedied
on
-
site.

Date

Lab

Lab Section

Test/ Procedure/
Instrument

Documentation of
Communication (email,
pkg insert, etc)

Procedure Changes
Communicated to
Technologist

4/2/13

Chem

Automation Line

CREAT

Y

Y

4/2/13

Chem

Specials

CYCLO

Y

Y

4/9/13

Micro

Specimen Processing

CDIFF

Y

Y

4/9/13

Micro

Bloods

BLD

N

N

7/2/13

Trans Med

Blood dispensing

TS

Y

Y

7/2/13

Trans Med

Blood dispensing

Verax

Y

Y

8/15/13

Histocompatibility



HLAS

N

Y

8/15/13

Histocompatibility



HLCTD

N

Y

8/16/13

MCTP



CTC

N

Y

8/16/13

MCTP



PCA3

N

Y

8/27/13

Molecular Diagnostics



BCRABL

Y

Y

8/27/13

Molecular Diagnostics



EGFRF

Y

Y

Date

Lab

Lab Section

Test/Procedure

Relevent questions
answered (Y/N)

Corrective Action

4/2/13

Chem

Automation Line

CREAT

Y

None

4/2/13

Chem

Specials

CYCLO

Y

None

4/9/13

Micro

Specimen Processing

CDIFF

Y

None

4/9/13

Micro

Bloods

BLD

Y

None

7/2/13

Trans Med

Blood dispensing

TS

Y

None

7/2/13

Trans Med

Blood dispensing

Verax

Y

None

8/15/13

Histocompatibility



HLAS

Y

None

8/15/13

Histocompatibility



HLCTD

Y

None

8/16/13

MCTP



CTC

Y

None

8/16/13

MCTP



PCA3

Y

None

8/27/13

Molecular Diagnostics



BCRABL

Y

None

8/27/13

Molecular Diagnostics



EGFRF

Y

None

Clinical Pathology
QA Meeting Highlight


Microbiology
-
Respiratory Virus Screening Methods



Description of Problem:
The current
respiratory virus screening methods
include both screening and
comprehensive assays. The screening
test (PCRFL/PCRRSV/PCRSC) takes
approximately 6.5 hours to complete with
throughput of 26
-
29 patients per shift.
Comprehensive testing (PCRIR) has a
TAT of 6.5 hours with a throughput of 26
patients per shift.

Impact of Problem:
Approximately 4000
tests were performed in 2012 with a
positivity rate of 27%. Of the positives,
82% were influenza A/B/RSV, and the
remaining percentage were
parainfluenza

virus, adenovirus, and
human
metapneumovirus
. 70% of orders
are for the comprehensive panel which is
not the best utilization of resources
relative to time, cost, and staff labor.

Reporter of Problem:

Bill LeBar, Dr.
Bachman

Description of Solution:
Use the Focus
Influenza assay for screening (TAT=55
minutes for 6 patients) utilizing 3
instruments. The
Biofire

Filmarray

test
will be used for the comprehensive panel
(TAT=60 minutes for one sample)
utlizing

four instruments. Develop an algorithm
for triaging testing. Only inpatients and
immunocompromised

patients who test
negative for the screening test will have
the comprehensive panel performed.



These changes should increase the
capacity to perform testing on more
patients, appropriate utilization of
testing to decrease costs, and
require less labor.











How we know it worked:
This
algorithm will be fully implemented
upon acquisition of the
Biofire

analyzers. TAT and patient
outcomes will be monitored to
determine the effectiveness of these
changes.


CP Process Improvement
Highlight

Hematology
-
Path Reviews

Description of Problem:

Many H
ematology specimens with
unusual
results
require
a pathologist to
review the results in question.

Impact of Problem:

Having a Pathologist review can increase
the cost to the patient and may not
always be the best utilization of the
Pathologists time.

Reporter of Problem:
Eileen Putnam,
Denise Sulavik, Jo
-
Anne Vergilio, Usha
Kota, Megan Lim

Description of Solution: How we
know it worked:

We have added a screener who is a
medical technologist with advanced
training and has access to patient
information that allows for 2
nd

review
by technologist and cancelation of
the pathologist review. This
technologist then sits through
pathologist review of the remaining
cases, and is educated on cases
that could also have been canceled.
This is a continuous improvement
process
. This process was primarily
assigned to the day shift and efforts
have begun to train afternoon staff
as well.

Clinical Laboratory
News, Notes, and Kudos

------------------------------------------------------------------------------------


Labs that are working on process improvement projects that
would like to display data can contact Kristina Martin
(
martkris@umich.edu
)
for future
dashboards.



Kudos


Dr. David Keren
-
Effective November 1
st
, Dr.
Keren will assume the interim role of Director of
Clinical Pathology. We would like to thank
Dr.
Jeff Warren

for over 20 years of service in this
role.