Transcript Using Lean to Improve the Turn Around Time for Stat

Using Lean to Improve the Turn
Around Time for Stat
Crossmatches
Clinical Laboratory Blood Bank Lean Committee
Pat Bradford, Laurie Gillard, Colleen Jarosz, Barb
Mitchell, Cindy Pritchett, Beth Rossett, Joann Urani
Confidential: For Quality Improvement Purposes Only
Defining the Problem
• During a mock JCAHO inspection, a tracer
audit was performed for an urgent blood
transfusion
• The audit revealed a delay between the
time the blood was ordered and the time it
was available
Confidential: For Quality Improvement Purposes Only
Analysis of the Problem
• To determine if this event was isolated,
audits were performed on two separate
occasions
• Random sample of 44 STAT crossmatch
orders were audited
– Average TAT was 76 minutes
• The acceptable TAT for stat tests is within
60 minutes
Confidential: For Quality Improvement Purposes Only
This audit demonstrates the variation of time
required to crossmatch blood
Confidential: For Quality Improvement Purposes Only
Tube of blood
arrives in the blood
bank
Specimen is
time stamped
Situations causing delays:
1. Specimen/transfusion
requisition labeling issue
2. Specimen is not ordered in Epic
3. Current specimen already in BB
requiring the tech to call floor to
notify the nurse
4. Specimen is left in centrifuged
5. Irradiated blood not
immediately available. Other
products in process of being
irradiated
6.Specimen waiting to be ARC or
Rh confirmation (first time D neg
typing on ABS)
7. Walking back and forth in BB;
to centrifuge, to front counter,
back to ABS, to fridge, to label
printer
Check for
correct labeling
PMS:
* has coordinator announcing and
centrifuging Stat
* only uses ABS when there is a
new run about to begin
* notifies floor when blood is
available
*ABS tech hands off completed
ABSCN to bench tech to XM &
ARC
DAYS:
*coordinator announces Stat
*bench/ABS tech spins Stat
*Stat XM is done manually or on
the ABS
*ABS tech is responsible for all
XMs coming off instrument
Receive in
computor
Prioritize ABS
or STAT
Specimen sits
on counter
PM
Coordinator
announces &
spins STAT
Whoever is
free takes Stat
out of
centrifuge
Days
Tech doing
Stat will spin
Tech will take
specimen and
start
If done on ABS
requires 10 min
spin & 40 min
bench time
ABS Tech will
do XM
Tech begins
XM on bench
Tech will
select/irradiate
unit
Units are
selected/
irratiated
Tech will print
and tag unit
Tech will print
and tag unit
Days does not
call floor when
blood avail
Floor is notified
of availability
RBC available
Confidential: For Quality Improvement Purposes Only
Layout Considerations
• Use “spaghetti diagram” to determine
people, material, and information flow
• Concentrate on elimination of waste
• Create layout with cross-functional team
• Ergonomics, safety, point of use, material
handling
• Use 5S for improving layout (sort, set in
order, shine, standardize, sustain)
Confidential: For Quality Improvement Purposes Only
Confidential: For Quality Improvement Purposes Only
What Process Improvements Need
to Be Made
• Define the standardized work processes
and write the SOPs
• Purchase additional equipment to facilitate
efficiency (new instrumentation, continue
to develop visual cues for inventory
replenishment)
• Move the irradiator to a more central
location
Confidential: For Quality Improvement Purposes Only
Blood Bank Lean Accomplishments
Thus Far
• Relocation of centrifuges closer to work areas
• Irradiation of stock red cells to be available on
demand
• Developed visual cues: Organize specimens
according to type and urgency of work using
labeled racks
• Purchased high speed centrifuges
• Re-auditing the stat crossmatch TAT
demonstrated an improved time of 62 minutes
• Overall, reduced process variation in performing
crossmatch testing
Confidential: For Quality Improvement Purposes Only
Pre-Lean 90th percentile of stat crossmatches had a TAT of 119
minutes. After the partial implementation the 90th percentile was 105
minutes. The average Stat crossmatch TAT has improved from 76
minutes pre-Lean to 66 minutes after the partial implementation of the
changes identified by the Lean committee.
STAT Crossmatch TAT
Individuals
Partial implementation: UCL=165.29, Mean=66.48, LCL=-32.32 (not shown) (39-72) (mR=2)
UCL
200
Partial Lean implementation
UCL
150
100
Mean
Mean
50
Confidential: For Quality Improvement Purposes Only
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Next Steps- Long Term
• Submitted a project planning request to evaluate
the Blood Bank area for improved workflow
• Create areas for specific tasks (blood
component preparation and testing)
• Purchase new testing analyzers
• The post-Lean audit showed a reduced TAT,
however the average time did not meet our
laboratory requirements of having the TAT of 60
or less.
• Stay tuned for new developments!
Confidential: For Quality Improvement Purposes Only