1. UTMB Laboratory Pre-analytical Time Improvement
November 5, 2010

2. The Team Alexander Indrikovs Anthony Okorodudu Jeffrey Richards
Bert Nash
Theresa Friloux
SPONSOR:
Donna Sollenberger
CEO, UTMB Health System

3. Aim Statement
By September 1, 2010, decrease by one hour the time at which Sample Management completes processing of outpatient samples.

4. Why We Selected This Goal
Outpatient work accounts for 2/3 of all lab tests
Most of these samples arrive in the laboratory between 5 PM and 11 PM
Prolonged outpatient processing delays inpatient testing
Laboratory automation is approved for FY11. For maximum benefit, we must have a continuous flow of specimens into the automated line.

5. Scope of UTMB OUT PATIENT SERVICES: TDCJ Units, Regional Maternal & Child Health Clinics, & UTMB Community Based Clinics

6. Courier Arrival Times 6

7. Clinical Laboratory Workflow
EDTA
tubes
Receive
into lab
Sort
Sample
tubes
Bottleneck -
> 70% of pre-analytic time
Load
centrifuge
Unload
centrifuge
Decap
Label
aliquot
tubes
Aliquot
Sort
Walk to
analyzers
Pre-Analytics 70% of turnaround time
Load
analyzers
Analytics / Post-Analytics 30% of turnaround time
Store
racks
Archive
tubes
Recap
tubes
Walk
to storage
area
Unload
analyzers
Verify/ Manage
exceptions
Rerun
exceptions
Locate
exceptions
Verify
at LIS
To summarize, with Abbott you will have the flexibility to implement some or all of our solutions which will help streamline your process. This diagram depicts a typical laboratory process. By implementing a pre-analytic automation such as ACCELERATOR APS you will be able to automate the most labor intensive processes in the lab. Informatics can address many of the post-analytic steps such as archiving and results validation. Implementation of a track will eliminate the sneaker net and tube storage and retrieval will automate add-on and repeat testing. Furthermore, APS gives you the flexibility to any or all of these components at any time ensuring that your system will grow and change as you do.
Find
tube
Load on
analyzer
Verify at
LIS
Unload
analyzer
Recap
tube
Archive
tubes
Store
racks

8. Pre-printed Labels

9. Tube Sorting

10. 22.00 10

11. Sources of Lab Errors

12. Process Evaluation People Process Equipment Management
SOPs inadequate
Staff in SM not adequately trained
Inadequate training materials
SOPs written prior to transition to interfaced testing
Staff in SM not adequately trained
Orientation not well-organized
Multiple order entry processes
Multiple order entry processes
Most SM Staff not highly educated
Different processes for individual clients
Clients not knowledgeable about packaging
& submission requirements
Workstation pending lists inaccurate
Errors and delays in pre-analytical processing compromise full benefits of planned laboratory automation system
Orders placed for uncollected samples
Orders placed more than once
Clients not trained about the requirements?
Multiple sample packing systems
Staffing not adequate or aligned with workload?
Errors and delays in pre-analytical processing compromise full benefits of planned laboratory automation system
High turnover
Different clinics have their own preferences
Tecans, frequently fail
Inconsistent leadership in SM
Staff not knowledgeable on maintenance and repair
No team leader on the night shift.
Training not ongoing
TDCJ samples not bar-coded
Suboptimal use of information technology
Supervision has not had clear accountability since rebuilding
CES lacks parts and expertise maintain Tecans
CES not accountable for Tecan performance
Suboptimal use of information technology
Equipment
TDCJ samples not bar-coded
Management
No one to divide up work on the night shift
BC printers not available in units
Management
Equipment 12

13. Previous Receiving and In-Lab System
Courier
Arrives with
patient
samples
Verify
Receipts
with courier
Print
Manifest
Use
Manifest
to “In-Lab”
Print
CERNER
Labels
Find manifest;
Match Samples
with labels
& Label Tubes
Walk to
Analytical
Area
Tecan:
Aliquot &
Sort
Tecan:
Decap
Tubes

14. Interventions
Installed bar code label printers at 85 Texas Department of Criminal Justice (TDCJ) units
Trained TDCJ staff on use of new labeling process
Piloted new sample accessioning process with one TDCJ route
Implemented new process with all Regional Maternal Clinics

15. New Receiving and In-Lab System
Courier
Arrives with
patient
samples
Verify
Receipts
with courier
Print
Manifest
Use
Manifest
to “In-Lab”
Print
CERNER
Labels X
Pre-Receipt processing
In-Lab Samples,
Print Labels
And Place on Tubes
Modified
Streamlined from 9 to 6 steps and modified 3rd step in new system
Walk to
Analytical
Area
Tecan:
Aliquot &
Sort
Tecan:
Decap
Tubes

16. Benefits of Improved Process
Standardize to one process for receiving all interfaced orders
Decrease errors by printing labels and labeling tubes on one patient’s samples at a time
Finish processing Outpatient samples before AM Inpatient samples arrive in the lab
Allow testing areas to monitor pending workload
Eliminate batch processing to provide continuous flow of samples to the labs

17. Time of Day Last Samples are Ready for Analysis
April – July 2010
September – October 2010
10.00
Time Out
4.00
0.00

18. Summary Measure April –July 2010 Sept 15-Oct 29 Mean Time out 04:22
1:05
Standard Deviation
02:37
0:29

19. One Measure of Success: Turn Around Time (TAT) for Potassium
May 18, 2010
Oct 26, 2010
Average TAT (hrs)
4.8
2.2
SD (hrs) 6
2.5
% Completed within 4 Hrs of in-Lab 68 90

20. ROI: Financial
Decrease in Sample Management overtime by 46% in September, 2010 or cost reduction by $994; extrapolated to ~ $12,000 per year
Redirected effort of Client Services staff spent on troubleshooting order errors; now used for answering physician and/or provider phone calls
Gains in technical efficiencies/redirection of labor: to be determined
Potential impact of improved TAT on ALOS: to be determined

21. ROI: Patient Safety
Decreased pre-analytical errors with resultant increased reliability of lab results
Improved TAT can result in faster decisions for patient diagnosis and treatment

22. Next Steps
Train all Sample Management staff in new process - completed
Fully implement new process for all outpatient samples - completed
Monitor new process for error rates and turnaround time - ongoing
Implement Automated Track System – submit RFP

23. Thank You! Thank you for your time! Sample Management Division at UTMB
CMC Laboratory & Information Service Teams
UTMB Pathology Client Services Team
Regional Maternal & Child Health Clinics
Thank you for your time!