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Clinical Safety & Effectiveness

Enhancing efficiency in a clinical cytogenetics laboratory to reduce turnaround time significantly, benefiting both patients and staff. Efforts include process improvements, personnel training, and advanced technology integration.

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Clinical Safety & Effectiveness

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  1. Clinical Safety & Effectiveness Reducing TAT in the Clinical Cytogenetics Laboratory- Phase2 DATE 1

  2. What do we do in the Clinical Cytogenetics Laboratory? • Cytogenetics is the study of heredity and variation by the methods of both cytology and genetics. • Constitutional Studies: • Inherited • Acquired Studies: • Changes that happen after birth, which are cancer related

  3. What do we do in the Clinical Cytogenetics Laboratory? • Examine chromosomes to identify abnormalities • Abnormalities are markers for diagnosis, prognosis, and treatment. • Culture cells for days to weeks before analysis begins

  4. Clinical Cytogenetics Laboratory Personnel Lynne V. Abruzzo, MD., Ph.D. Guohui (Gary) Lu, MD., FACMG Chief Director, Section of Cytogenetics Section of Cytogenetics Elizabeth Harper Supervisor (Day) Team 4 Lisa Honore Supervisor (Day) Team 2 Lian Zhao Supervisor (Day) Team 1 Melissa Robinson Supervisor (Evening) Team 3 Lawrence Frimpong Supervisor (Day/Evening) Team 5 Patrick Cheong Supervisor (Evening) Team 6 Denise Lovshe, BS. CG(ASCP) Laboratory Manager Terry Van Fleet Supervisor (Night )Team 7 Cytogenetics Technologists’ & Technicians’ Romona Francis Aruna Uppal Tomaro McChriston Linda/Zeb/Lenore Protacio Martin Emerson Huang Rodney Thomas Darryl Mitchell AvelinaVarilla Cytogenetics Technologists’ & Technicians’ Cytogenetics Technologists’ Sarita Bakhru S Sheba Philip Ruba Nassar S Christi Taft S Kaher Sari Jessica Reyes Jennifer Yarman S Anamaria Fals S Cytogenetics Technologists’ Shelley Miao S Lina Wu S Joey Pena Carol Tran Juan Flores Roland Delgado Wenping Dai Shelli Cardona Cytogenetics Technologists’ Danielle Saldi S Joanne ChengS Taryn Gomez Yuan Yang S Ken Futrell Smita Trivedi Michael Liang Ricardo Fernandez Cytogenetics Technologists’ Robert Chang Bing Bai S Mercedes Lovell S Roshini Thomas S Helia Forouzan Jennifer Stewart Cytogenetics Technologists’ Christina Coleman S Binh Vo Shanita Bhakta S Su Yang S Minh Vu Steven Sfamenos Vivian Guadarrama Lab technical asst. Jing Bao Administrative asst. Senior Secretary 12/21/2019

  5. Workload • ~22,215 specimens per year • 98% hematologic malignancies • 2% solid tumors • Conventional karyotypic analysis • ~50% of tests • 3 hours per case (after specimen culture & processing) • FISH (Fluorescence In Situ Hybridization) • ~50% of tests (~100 different probes) • 1.5 hours per case (after specimen culture & processing)

  6. The Team • Martha Johnson-Hamilton Pathology and Laboratory Medicine Quality Technologist • Denise Lovshe Cytogenetics Laboratory Manager • Elizabeth Harper Cytogenetics Supervisor • Soo Ha Cheong Cytogenetics Supervisor • Sarita Bakhru Sr. Cytogenetics Technologist • Lisa Honore’ Cytogenetics Supervisor 6

  7. What We Are Trying to Accomplish? The aim of this project is to reduce the TAT for resulting neoplastic bone marrow specimens submitted for Cytogenetics analysis to 21 calendar days for 90% of specimens by June 2011. AIM STATEMENT 7

  8. Background The Cytogenetics Laboratory and Lab Quality Improvement group wanted to improve on its 2008 CS&E Project (Phase 1) which had 85% of its neoplastic bone marrow specimens completed within a 21 day period. Strategic Alignment: We will continue to increase the quality, safety and value of our clinical care. 8

  9. Baseline Data: Percent Completed Within 21 Days Previous Project Results 9

  10. Baseline Data: Order to Verify TAT Previous Project Results 10

  11. Cytogenetics Process Map 11

  12. Fishbone Diagram

  13. Major Identified Issues • Overwhelmed Cytogenetics Technologists • Manual Slide Analysis • Decrease in Efficiency • Delay in the transcription of cases • Increase in the workload • Space Limitations

  14. Implemented Solutions • No Patient Left Behind (Jan 2009)

  15. Implemented Solutions • Banding Process Change (May 2009) • Hired Full Time Secretary (Sept 2009) • Genetix Slide Loader (GSL) (March 2010)

  16. Implemented Solutions • Cross Trained Cytogenetics Technologists (Mar 2010) • Changed the sample media (Sept 2010) • Changed the staffing hours (Jan 2011) • Acquired space for the Breast pathologists to sign out remotely (Jan 2011)

  17. TAT Results- Order to Verify 21% Improvement

  18. TAT Results: Percent Completed within 21 Days 13% Improvement

  19. Return on Investment Hard Savings: • Annualized margin increase of $547,200 • Jan 2008 - Apr 2010 vs. May 2010 - Jun 2011 • The lab began keeping over 61% of the cases that they were previously sending out to a reference lab. 19

  20. # of Send Outs by Stages Fewer Test being sent out per month

  21. Next Steps… • Go paperless with the updated version of our Cerner computer system. (Dec 2011) • Interface the GSL analyzer with the updated Cerner system. (Dec 2011) • Train the Lab Technicians to do more tasks

  22. Lessons Learned • Careful planning pays off • Change Management is not as simple as it sounds • You can’t communicate too much! • Data-driven decisions work • Collaboration improves buy-in • Input & feedback from stakeholders are important • Automation can create capacity 22

  23. Thank you!

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