Going Beyond Laboratory Automation: Do Less Accomplish More. Swedish Covenant Hospital

Transcription

1 Going Beyond Laboratory Automation: Do Less Accomplish More Susan Dawson, MBA, MT(ASCP) Swedish Covenant Hospital Chicago, IL Swedish Covenant Hospital Open Heart Oncology Birthing Unit Community Outreach Program 325 Beds 15,000 admissions / year 46,000 ER visits / year Culturally diverse patient population Employees speak 40 different languages 1

2 Swedish Covenant Hospital Lab 69.4 FTEs (40:60 technical : non-technical) 18.4 FTEs for Chematology section 1,200,000 tests / year Continuous flow process 2

3 Do More Accomplish With Less How can we do less? Pre-Analytical Total Process Management Analytical Efficiently Less Stress Post-analytical High Quality Streamline processes 3

4 Pre-Analytical Processes CPOE Sample Distribution Patient ID System No Aliquoting Pneumatic tube Analytical Processes 4

5 Employee Demographics Techs range in age from 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 expense 85% in BT/FTE 11.5% in total expense/100 BT 5

6 Analytical Processes Repeats QC Reagent change Criticals Delta Dilutions CRR Indicies Hemo, Icterus, Lipemia Algorithms Hepatitis TSH Computer connectivity 6

7 Coag UA Hemo Hemo I C I C I 7

8 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 8

9 The Big Screen 9

10 Post- Analytical Processes Autovalidation Single largest contributor to relieving stress and improving consistency, quality and turnaround time. If a tech would/should take an action on the result, then it should not be autovalidated. 10

11 Quality Control Stops patient results from being reported for an assay that has failed QC Stop results from autovalidating if 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 11

12 Delta Checks and Instrument Flags Delta checks Clinically useful Not for every assay Instrument flags Translate important information (linear limit, clots) Autovalidation: Rules and Effect QC Review ranges Delta checks Instrument flags LIS Reviewed by tech Quality Labor 12

13 Patient demographic information Test information Actions 13

14 Hematology Differentials Slide review/ Manual differential? N Y Review criteria 14

15 Differentials Slide review/ Manual differential? N Y Review criteria Complex rules for differentials Slide review/ Manual differential? N Review criteria Y 15

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17 Impact On Hematology TAT for hematology Auto-validation Connected to middleware Online differentials 0 FY02 FY03 Q304 Q404 Q105 FY06 FY07 FY09 Impact On ER Specimens 20 Auto-validation ER TAT for hematology Connected to middleware Online differentials 11 min 5 0 FY03 Q204 Q304 Q404 FY05 FY07 FY09 17

18 120 Impact Of Automation & Auto-validation Automation 0600 TAT for chemistry Auto-validation 51 min 0 FY02 FY03 Q104 FY04 FY05 FY06 FY07 FY09 Impact On ER ER TAT for chemistry Big Screen Auto-validation 28 min FY03 Q104 FY04 FY05 FY06 FY07 FY09 18

19 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 19

20 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 Any of these techs can simultaneously manage the entire process from order to result verification for Hemo, Coag, Chemistry, and Immunoassay. Central Desk Chemistry Workstation 20

21 Cost Effectiveness Total Expense / 100 Billed tests Operational Indicators Inpatient BT/adjusted discharge Utilization Productivity Hours paid per 100 billed tests Total billed tests / Lab FTE Productivity SCH Lab Services: Clinical Operations (Chemistry, Hematology, Coagulation, Urinalysis, Microbiology, Paratechnical) Solucient KPI Benchmarking FYE 3Q 2009 Cost Ratio Labor Expense/100 Billed Tests SCH Clin. Lab SCH % Ranking 6.90% Percentile 25th 50th th Cost Ratio Total Expense/100 Billed Tests % Productivit y Hours Paid/100 Billed Tests % Workload Total Billed Tests/Lab FTE 17, % 12, , , Staffing Skill Mix: Technologists % % Utilization InPt Billed Tests/Acute Dish. N/A N/A N/A N/A N/A Operational indicators of cost effectiveness, productivity and staffing compare very favorably to the targeted 25 th percentile. Utilization statistics not available from Solucient at this time. 21

22 Test volume vs FTE Test volume FTE

23 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 23

24 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 Dawson sdawson@schosp.org Swedish Covenant Hospital Chicago, IL 24