Presentation is loading. Please wait.

Presentation is loading. Please wait.

Kscls kcclma How the Clinical Laboratory Enhances Patient Care Fred V. Plapp, MD PhD Medical Director Saint Luke’s Regional Laboratories kscls kcclma.

Similar presentations


Presentation on theme: "Kscls kcclma How the Clinical Laboratory Enhances Patient Care Fred V. Plapp, MD PhD Medical Director Saint Luke’s Regional Laboratories kscls kcclma."— Presentation transcript:

1 kscls kcclma How the Clinical Laboratory Enhances Patient Care Fred V. Plapp, MD PhD Medical Director Saint Luke’s Regional Laboratories kscls kcclma

2 kscls kcclma Diagnosis of Meningitis Expediting Patient Care Infection of tissues surrounding the brain & spinal cord Bacterial or viral ◦ Mostly viral Viral usually mild Bacterial is life- threatening

3 kscls kcclma Diagnosis of Meningitis Traditional Practice Patient presents to Emergency Room Lumbar puncture to collect CSF ◦ Bacterial cultures require 3 days ◦ Viral cultures require 10 days Patient admitted to hospital Treated with IV antibiotics until likely that bacterial culture will be negative Discharged with outpatient antibiotics

4 kscls kcclma Viral Meningitis Traditional Diagnosis 4 – 10 Days

5 kscls kcclma Viral Meningitis Real Time PCR Diagnosis 1 million viral copies in 30 minutes instead of 10 days

6 kscls kcclma New Meningitis Algorithm

7 kscls kcclma Meningitis Outcomes Downstream Cost Savings Traditional Approach ◦ Average LOS is 2.8 days ◦ Average hospital charge is $14,050 ◦ IV antibiotics during admission ◦ Outpatient antibiotics for 10 – 14 days SLH Molecular Approach ◦ Avoid admission if Enterovirus detected ◦ Avoid unnecessary antibiotics

8 kscls kcclma Rapid ID of CoNS Improved Antibiotic Stewardship Peptide Nucleic Acid FISH ◦ Non-amplified fluorescent molecular probe  Recognizes species specific RNA ◦ Distinguishes Coagulase Negative Staph from Staph aureus ◦ Advantages  Timely & accurate same day results  Minimal equipment requirement  Other probes for Gram-negatives & yeast ◦ Disadvantages  Expensive cost per test  Must batch test due to $$$$$

9 kscls kcclma Rapid ID of CoNS Lab & Pharmacy Cost Savings Time to IDAntibiotic Dose per Patient Cost per Patient* Culture Alone 132 hours5.8$72.02 Culture + PNA 38 hours2.8$14.28 Cost per patient included antibiotics & laboratory tests

10 kscls kcclma Rapid ID of CoNS Downstream Cost Savings SLHS performed 23,652 blood cultures in contaminants (1.9%) ◦ 350 were CoNS Each contaminant adds ~$5000 to cost of hospital stay Rapid ID of CoNS saves ~$1.75M per year by preventing  LOS kscls kcclma

11 kscls kcclma Recombinant rFVIIa Usage Laboratory as a Watchdog Recombinant Factor VIIa (Novoseven) Binds directly to tissue factor & activates FX FDA approved for hemophilia with acquired inhibitor Off label use for acute bleeding  ◦ Very expensive ( $1 per ug) ◦ Short half-life of 2-3 hours ◦ Possible thromboembolic events

12 kscls kcclma Reining in the Outlier Surgeon1Q091Q10 1$5450$ $12,220 5$98,690$16,000

13 kscls kcclma Open Heart Surgery Transfusion Review OHS transfused ~one third of components Clinical Pathologist analyzed blood usage each year ◦ Surgeon specific usage ◦ Reviewed with CTS team ◦ Evaluated risk factors, meds,practice variations Published transfusion guidelines & risks Presented to surgeons, Department Chair, Chief Medical Officer

14 kscls kcclma Average Number of Units Transfused per OHS Case

15 kscls kcclma Benefits of Decreased Transfusion $260,000 cost savings in blood products per year Transfusion reaction risks decreased Blood Bank workload decreased Nursing time for transfusion decreased

16 kscls kcclma Order Sets Ensuring Appropriate Testing Nurses & physicians write order sets Clinical Pathologists review lab tests ◦ Additions, deletions, substitutions Suggestions returned to authors Order sets published Test utilization monitored before & after

17 kscls kcclma 70 Order Sets Impact on Test Utilization YearCases/YrTests/CsTest/Yr , ,609 Diff ,188 % Diff+9%-12%-4%

18 kscls kcclma Inpatient Tests per Discharge

19 kscls kcclma Specimen in Lab Policy Decreasing Wastage Worked with Blood Management Team to reduce iatrogenic blood loss SIL Policy implemented ◦ Stored blood specimens for 1 week ◦ Publicized in Lab Letter & Nursing publications ◦ Avoided redrawing patients for add-on testing

20 kscls kcclma Specimen in Lab Policy SLH Outcomes 11,244 requests for tests on SIL $51,726 savings in labor & supplies Avoided 11,244 venipunctures Conserved 71,428 mL of blood ◦ Equivalent to 140 units of RBCs

21 kscls kcclma POC Blood Glucose Testing Improving Patient Safety Manual Patient ID entry ◦ 12,000 tests per month ◦ 9.7% average error rate ◦ ~450 unidentified results per month PI project to reduce errors ◦ Accu-Chek Inform & RALS Plus ◦ Barcoded armbands & handheld devices

22 kscls kcclma Glucose Meter ID Errors

23 kscls kcclma Test Utilization Ideas Test Utilization Ideas


Download ppt "Kscls kcclma How the Clinical Laboratory Enhances Patient Care Fred V. Plapp, MD PhD Medical Director Saint Luke’s Regional Laboratories kscls kcclma."

Similar presentations


Ads by Google