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Clinical Pathology Quality Dashboard

Clinical Pathology Quality Dashboard. September 2013. Clinical Pathology Patient Care Quality Blood Bank.

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Clinical Pathology Quality Dashboard

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  1. Clinical Pathology Quality Dashboard September 2013

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

  3. Clinical Pathology Patient Care QualityChemistry Goal: Inpatient/Outpatient STATs=60 minutes; Internal project to reach 45 minutes. Routines=120 minutes.

  4. Clinical Pathology Patient Care QualityHematology 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.

  5. 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.

  6. Clinical Pathology Patient Care QualityMicrobiology 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.

  7. 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.

  8. 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.

  9. Clinical Pathology SafetySafety Walk Audits 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.

  10. 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 BiofireFilmarray 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.

  11. CP Process Improvement HighlightHematology-Path Reviews Description of Problem: Many Hematology 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 2nd 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.

  12. 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 1st, 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.

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