1. Using Keele data to demonstrate efficiency and effectiveness Jim Allison

2. Background  SCBMDN has to engage with the Keele benchmarking process.  Improve the consistency of the data returned by Scottish labs  Seek to influence the introduction of new questions within the Keele database  Enable greater use of this data to plan service delivery

3. Background :

4. Background : National Pathology Benchmarking Service at Keele University  Performance management tool.  Peer comparison of key indicators.  Internal comparison of year on year performance.  Separate data collection and benchmark reports are offered for Clinical Biochemistry, Haematology/Blood Transfusion, Histopathology/Cytology, Immunology and Microbiology/Virology.

5. Background : Keele Benchmarking – difficult and time consuming process.  Questionnaires sent out electronically during April 2012.  Completed questionnaires returned to Keele in June  Data checking exercise undertaken.  Data is processed at Keele, and a specialist panel - made up of clinicians from the relevant discipline - meet to discuss the data.  Panel write a commentary on the findings, providing interpretation of the data which is included in the final report.  Generic report produced in December for each participant, plus a separate analysis tool enabling you to drill down into the data further and create their own charts and tables.  In January, participants are invited to a user group meeting, where the findings of the report are discussed, and the participants get the opportunity to influence future development of the programme

6. Keele and the SCBMDN 1.What information /markers of efficiency and effectiveness Keele provides the SCBMDN. 2.Identify areas of inconsistency. 3.Recent interactions of the SCBMDN with Keele. 4.What the SCBMDN might do with Keele in the future.

7. Keele Information:  Workload  Staffing  Finance  Efficiency & productivity  Quality & effectiveness

8. Engagement with Keele: SCBMDN questionnaire (Sept 2011); 8 out of 15 Health Boards responded. Efficiency and Productivity  Cost per test and request  Requests and Tests per WTE Effectiveness  A&E turnaround times  Other ideas

9. Keele Information:

10. Biochemistry is a local lab for local people. There’s no need for benchmarking here!!!

11. Keele Information: Test Workload per 1000 Population Health BoardChildrenAdultsTotal Ayrshire & Arran63,210299,850363,060 Borders19,84092,050111,890 Dumfries & Galloway 24,430122,190146,620 Fife64,610293,160357,770 Forth Valley53,670232,770286,440 Grampian95,620441,550537,170 Greater Glasgow & Clyde 207,670975,0501,182,720 Highland53,010250,970303,980 Lanarkshire105,580451,900557,480 Lothian140,450676,880817,330 Orkney3,38016,56019,940 Shetland4,22017,94022,160 Tayside67,750325,070392,820 Western Isles4,44021,51025,950

12. Keele Information: Workload: Like for Like U&E?

13. Keele Information: Workload: Like for Like TFTs?

14. Keele Information: Workload: Like for Like Lipids?

15. Keele Information: Workload: Like for Like HbA1c?

16. Keele Information: Staffing % Change 2010-2011 AllTeaching Non Teaching Total Medical Staff (including Trainees)-14.76%-13.63%-19.39% Total WTE Biomedical Scientists-3.47%-4.48%-1.78% WTE MLA / Support Workers-3.05%-1.29%-6.23% Total WTE Clinical Scientists-12.24%-10.73%-15.99%

17. Keele Information: Staffing

18. Keele Information: Finance

22. Keele Information: Efficiency and Productivity i)Efficiency – Cost per test and cost per request. ii)Productivity - Number of tests per WTE.

23. Keele Information: Cost per Request PMS says …. No!

24. Keele Information: Efficiency

26. Keele Information: Productivity

28. Keele Information: Efficiency and Productivity These workload variations do not impact significantly on Keele efficiency and productivity figures. Tot TestsTot Expend Total WTE Cost / Test Tests / WTE Average Lab5,000,000£3,500,00048£0.70104,166 Plus extra 80,000 FT4, 50,000Trigs and 30,000HbA1C5,160,000£3,540, 00048£0.69107,291

29. Keele Information: Quality & Effectiveness  A&E TATs  Accreditation status

30. Keele Information: Effectiveness Keele - U&E TAT for A&E  What is the target TAT for U&E requests from A&E?  What proportion of A&E requests for U&E are reported within this target?

31. Keele Information: U&E TAT for A&E

32. Keele Information: Future Inclusion of RCPath KPIs KPI: A&E blood sciences turn-around-times  Baseline: Percentage of core investigations, i.e. renal function, liver function tests and full blood counts from A&E completed within 1 hour of receipt, including out of hours  Challenge: 85% by Apr 2012 increasing to 90% by Apr 2014. The standard will move to 1 hour from sample collection by April 2015.  SCBMDN: Agreement to adopt this RCPath KPI.

33. Keele Information: Effectiveness  Vetting Work Referred to Outside Laboratories  Identifying Duplicate Requests and Standard Rejection Procedure  Providing Requestors with Key Performance Indicators  Participation in Training Events for Requestors and Utilisation of Order Comms for Education  Disease/Symptom-specific Profiles, Requestor/Grade- specific Testing, Clinical Pathway Development  Processes to Improve the Efficiency and Quality of Service  Does your clinical biochemistry laboratory have a formal risk management policy ?

34. Quality and Effectiveness

35. SCBMDN engagement with Keele

36. Engagement with Keele: SCBMDN New Questions in Keele  Availability of clinical advice.  Repertoire of tests available on an emergency basis?  Communication of critical results; timeliness and number/ frequency.  Number of urgent/emergency requests processed in last year?  What percentage of reports contain interpretative comments?  Number of complaints /critical incidents

37. SCBMDN & KEELE Availability of Clinical Advice Q2-5-1 Which member(s) of staff provide clinical interpretative advice? UA When does this service operate? Is this 24 hours per day, 365(6) days per year? If no please state start and finish time (please use the format HH:MM) Start timeFinish time Q2-5-2 Monday to Friday UA09:0017:00 Q2-5-3 Saturday UA09:0017:00 Q2-5-4 Sunday UA09:0017:00 Q2-5-5 Public Holiday UA09:0017:00

38. SCBMDN & KEELE Plasma/Serum/BloodColumn 1Column 2Column 3Column 4 Test Name Total Tests In- house Number of Tests Performed for Primary Care Tests Referred Out (change to 'yes' only if you refer the test out) Is Test Provided as an Emergency (change to 'yes' only if available 24/7, 365) 1,25 Hydroxy Vitamin DUA No 11-DeoxycortisolUA No 17 Hydroxy ProgesteroneUA No 25 Hydroxy Vitamin DUA No ACTHUA No AdrenalineUA No AlbuminUA No Alcohol (Ethanol)UA No

39. Ongoing Dialogue with Keele  Getting more out of the existing questionnaire  Incorporating further markers of effectiveness  Invitation to David Holland to attend SCBMDN meeting later this year.

40. END

42. Example of Improvement in Clinical Effectiveness of Laboratory Service  NHSG Primary Care – ongoing problem with spurious hyperkalaemia due to long transportation times.  Jan 2010, <20% of SST samples from primary care spun at source.  Centrifugation of SST tubes in primary care practices introduced in July 2010.  Jan 2011, 95% of SST samples from primary care spun at source

43. Clinical Effectiveness Retrospective audit conducted to review the impact on patient care of introduction of centrifugation in primary care: a) Pre-GP centrifugation Jan – June 2010 b) Post-GP centrifugation Jan – June 2011

44. Classification of follow-up of hyperkalaemia  Appropriate admission: Genuine hyperkalaemia in a GP sample resulting in admission to acute medical receiving where the hyperkalaemia has been confirmed  Appropriate GP follow-up: Genuine hyperkalaemia in a GP sample resulting in a repeat sample from the GP where the hyperkalaemia has been confirmed  Inappropriate admission: Pseudohyperkalaemia in a GP sample due to delay in sample centrifugation resulting in admission to acute medical receiving where the follow-up serum potassium is within the reference interval  Inappropriate GP follow-up: Pseudohyperkalaemia in a GP sample due to delay in centrifugation resulting in a repeat sample from the GP where the follow-up serum potassium is within the reference interval

45. Effectiveness of follow-up of primary care patients with hyperkalaemia

46.  Sample centrifugation in primary care locations in NHSG has proven to be an excellent example in improving the clinical effectiveness of an existing laboratory investigations, whereby the same test deployed now secures a greater health gain for patients from the available resource.