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Clinical Pathology Quality Dashboard April 2009 Clinical Pathology Quality Dashboard Inpatient Phlebotomy First AM Blood Draws University Hospital 100% 80% Drawn by 60% 8am 9am 40% 10am 20% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2008 2009 Mott Hospital 100% 80% Drawn by 60% 8am 9am 10am 40% 20% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2008 2009 Clinical Pathology Quality Dashboard Inpatient Phlebotomy First AM Blood Test Results: PT/PTT, CBCP, and Comprehensive Panel University Hospital 100% 400 80% Results by 60% 8am 9am 40% 10am 200 100 Avg Daily Volume 300 20% 0% 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2008 2009 Mott Hospital 100% 12 Results by 8 60% 8am 9am 10am 6 40% 4 20% 2 0% 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2008 2009 Avg Daily Volume 10 80% Clinical Pathology Quality Dashboard Inpatient Phlebotomy Draws Fiscal Year 2009 30,000 26,062 25,000 23,348 21,992 21,182 20,459 19,773 20,000 19,759 19,598 19,795 Jan Feb 15,000 10,000 5,000 0 July Aug Sep 2008 Oct Nov Dec Mar 2009 Clinical Pathology Quality Dashboard Turnaround Times CSF Gram Stain Volume and Turnaround Time 160 140 Monthly Volume 120 TAT 100 > 1 hour 80 30 min-1 hour <30 minutes 60 40 20 0 April May June July Aug Sept Oct Nov Dec Jan 2008 Feb Mar 2009 Emergency Department Cardiac Marker Volume and Turnaround Time 1400 Monthly Volume 1200 1000 TAT 800 > 2 hours 1-2 hours 600 <1 hour 400 200 0 Apr May Jun Jul Aug Sep 2008 Oct Nov Dec Jan Feb 2009 Mar Clinical Pathology Quality Dashboard Molecular Diagnostics Laboratory Specimens Received and Turnaround Time January 2002 - December 2008 1400 10 9 1200 1000 7 6 800 5 600 4 3 400 2 200 1 0 0 January July 2002 January July 2003 January July 2004 January July 2005 January July 2006 January July 2007 January July 2008 2002 2003 2004 2005 2006 2007 2008 Month/Year # Specimens TAT Linear (# Specimens) Linear (TAT) TAT (days) # of Specimens received 8 Clinical Pathology Quality Dashboard Chemistry In-Lab Turnaround Times Sample Turn-Around Time 35 25 20 15 10 5 Fe b De c ct O Au g Ap r Ju n Fe b De c O ct 0 Au g Percentage 30 Aug 07 - Mar 09 RT ST> 60 min IP ST> 45 mins. OP ST> 45 mins Clinical Pathology Quality Dashboard New Clinical Assays Added in Last Year Yeast identification system: (Vitek II automated) Yeast antimicrobial susceptibility: (Vitek II automated) EBV viral load HIV-1 quantification (COBAS Ampli Prep – COBAS Taqman) (includes extraction, amplification) MRSA surveillance VRE surveillance C.difficile surveillance BCR/ABL1 Kinase Mutation Analysis (Sequencing) Human Erythrocyte Antigen Genotyping (Microarray analysis) IGH/BCL2 Translocation Detection (Real-time PCR) JAK2 V167F Mutation Detection (Allele-specific PCR) KIT D816V Mutation Detection (Allele-specific PCR) KIT Mutation Detection for GIST KIT Mutation Detection of Melanoma NPM1 Mutation Detection (PCR w/ capillary electrophoresis detection) Microsatellite instability analysis PML/RARA t(15;17) Translocation Detection (Real-time PCR) Urovysion – FISH, Bladder Cancer Detection HER2 Amplification – FISH, Breast Cancer UGT1A1 Promoter Genotyping K-Ras Mutation Detection 1,25 Dihydroxy vitamin D Sensitive beta-2 transferrin assay Clinical Pathology Quality Dashboard UMHS Blood Product Utilization Blood Product Utilization 8000 8000 6000 Random Platelets 7000 Adjusted Discharges 6000 5000 5000 4000 4000 3000 3000 2000 2000 1000 1000 Allo RBC Units Plasma Units Cryo Units Partial Units SD Platelets 0 Apr May June July Aug Sep Oct Nov Dec Jan 2008 0 Mar 2009 Crossmatch/Transfusion Ratio Wasted RBC 1.9 1.8 Feb Patient Population 7000 Units Used 3.0% Threshold 2.5% 1.7 2.0% 1.6 1.5% 1.5 1.0% 1.4 0.5% Threshold 0.0% 1.3 Apr May June July Aug Sep Oc t Nov Dec Jan 2008 Feb Apr Mar May June July Aug Sep Oc t Nov Dec Jan 2008 2009 Feb Mar 2009 Wasted Plasma Wasted Platelets 6% 8% 5% Threshold 6% 4% 4% 3% Threshold 2% 2% 1% 0% 0% Apr May June July Aug Sep Oc t Nov Dec Jan 2008 Feb Apr Mar May June July 2009 Aug 2008 Wasted Cryoprecipitate 30% 25% 20% 15% Threshold 10% 5% 0% Apr May June July Aug Sep 2008 Oc t Nov Dec Jan Feb Mar 2009 Sep Oc t Nov Dec Jan Feb Mar 2009 Clinical Pathology Quality Dashboard CAP Proficiency Testing Clinical Pathology Scores 600 100 90 400 80 300 70 200 60 100 0 50 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr FY2008 3rd Quarter FY 2009 Clinical Pathology 24 = Number of Challenges 100% = Satisfactory Results Anatomic Pathology 0 = Number of Challenges N/A = Satisfactory Results Department Total 24 = Number of Challenges 100% = Satisfactory Results 3rd Qtr FY2009 Percent Satisfactory Number of Challenges 500 Clinical Pathology Quality Dashboard CP Financial Measures Clinical Path Tests per FTE and Total Tests By Month 2,000 425,000 1,900 Test per FTE 1,700 375,000 1,600 1,500 350,000 1,400 325,000 1,300 1,200 300,000 1,100 1,000 275,000 5 l-0 Ju p Se 5 -0 ov N 05 06 r-06 -06 l-06 -06 -06 -07 r-07 -07 l-07 -07 -07 -08 r-08 -08 l-08 -08 -08 -09 r-09 p p p na ay ay ay ov Jan Ma o v J an M a o v J an M a a J u Se J u Se J u Se J M N N N M M M Tests per FTE Total Tests Clinical Path Expense per Test* $10 $9 $8 $7 $6 $5 Se Ju l-0 5 p05 N ov -0 5 Ja n06 M ar -0 M 6 ay -0 6 Ju l-0 6 Se p06 N ov -0 6 Ja n07 M ar -0 M 7 ay -0 7 Ju l-0 7 Se p07 N ov -0 7 Ja n08 M ar -0 M 8 ay -0 8 Ju l-0 8 Se p08 N ov -0 8 Ja n09 M ar -0 9 $4 Total Expense per Test *excludes Blood Bank and Phlebotomy Total Tests 400,000 1,800 Clinical Pathology Quality Dashboard Clinical Laboratory Operations Initiatives •Discontinue Cancer Center Hematology Lab (move to Main Lab) – Will Finn, MD, lead •Improvement of Critical Value Callback process – Brenda Schroeder, lead •Impact of Earlier AM Blood Draw in UH – OMS 490 students and Holly Eliot, leads •Improvement of Communication with Patient Care Units – Beverly Smith and Brenda Schroeder, leads •Customer Service Initiative – Beverly Smith, lead •Lab Formulary Committee – Office of Clinical Affairs, FGP, Pathology •Lean Process Improvement Projects – many! •Laboratory Safety focus – Brenda Schroeder, lead •Improvement of Blood Draw Wait Times - Cancer Center - Taubman 2 - Taubman 3 •Creation of Blood Product Utilization Lean Team – Tim Laing, MD, (OCA), lead Clinical Pathology Quality Dashboard Clinical Laboratory Service Enhancements •Clostridium difficile toxin screening algorithm – 1/09 •On-demand unit-specific antibiograms – 2/09 •Expedited (rules – based) release of ANCs (absolute neutrophil counts) – 2/09 •Integrated hematopathology reports – 2/09 •Troponin point-of-care (ED) – 3/09 Clinical Pathology Quality Dashboard Kudos • Thank you to the Phlebotomy Team and Harry Neusius; Julius Alexander and John Hamilton (Pathology Informatics); Tom Morrow, Brenda Schroeder, John Perrin, and Holly Eliot (Pathology Administration) for their excellent work with Ross Business School OMS 490 students – in the development of a new tool to better match early AM blood drawing resources with service demand. • Thank you to the Chemistry Lab and the Emergency Department Point-of-Care Lab for implementation of rapid troponin assay in the ED. See the marked improvement in ED Cardiac Marker TAT! • Congratulations to Drs. Lloyd Stoolman (Pathology) and Matthew Velkey (Cell and Developmental Biology) who received one of only five University of Michigan Provost’s 2009 Teaching Innovation Prizes – for the project entitled “Virtual Microscopy for Life Sciences Education”! More than 100 projects were nominated. Please see the Pathology Website for a link to a more detailed description of this outstanding innovation.