Transcript Slide 1

Clinical Pathology
Quality Dashboard
June 2009
Clinical Pathology Quality Dashboard
Inpatient Phlebotomy First AM Blood Draws
University Hospital
100%
80%
Drawn
by
60%
8am
9am
40%
10am
20%
0%
Jun
Jul
Aug Sep Oct Nov Dec Jan Feb Mar
2008
Apr May
2009
Mott Hospital
100%
80%
Drawn
by
60%
8am
9am
10am
40%
20%
0%
Jun
Jul
Aug Sep Oct
2008
Nov Dec Jan Feb Mar Apr May
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
Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2008
2009
Mott Hospital
100%
12
Results
by
8
60%
8am
9am
10am
6
40%
4
20%
2
0%
0
Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
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
20,986
20,459
19,773
20,000
19,759
21,714
19,598
19,795
Jan
Feb
15,000
10,000
5,000
0
July
Aug
Sep
2008
Oct
Nov
Dec
Mar
Apr
2009
May
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
June July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
2008
Mar
Apr
May
2009
Emergency Department Cardiac Marker
Volume and Turnaround Time
1400
Monthly Volume
1200
TAT
1000
> 2 hours
800
1-2 hours
<1 hour
600
400
Point of Care
service began
200
0
Jun
Jul
Aug
Sep
2008
Oct
Nov
Dec
Jan
Feb
Mar
Apr
2009
May
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
30
20
15
10
5
Aug 07 - May 09
Routines
>60
>45 IN
>45 OUT
ar
Ap
r
M
ay
M
Ja
n
Fe
b
Ju
n
Ju
l
Au
g
Se
p
Oc
t
No
v
De
c
ar
Ap
r
M
ay
M
Ja
n
Fe
b
0
Au
g
Se
p
Oc
t
No
v
De
c
Percentage
25
Clinical Pathology Quality Dashboard
UMHS Blood Product Utilization
Blood Product Utilization
8000
7000
Adjusted
Discharges
Units Used
Random Platelets
7000
6000
6000
5000
5000
4000
4000
3000
3000
2000
2000
1000
1000
Allo RBC Units
Plasma Units
Cryo Units
Partial Units
SD Platelets
0
June
July
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
2008
0
May
2009
Crossmatch/Transfusion Ratio
Wasted RBC
1.9
1.8
Apr
Patient Population
8000
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
June
July
Aug
Sep
Oc t
Nov
Dec
Jan
Feb
2008
Mar
Apr
June
May
July
Aug
Sep
Oc t
Nov
Dec
Jan
Feb
2008
2009
Mar
Apr
May
Apr
May
2009
Wasted Plasma
Wasted Platelets
6%
8%
5%
6%
4%
Threshold
3%
4%
Threshold
2%
2%
1%
0%
0%
June
July
Aug
Sep
Oc t
Nov
Dec
Jan
2008
Feb
Mar
Apr
June
May
July
Aug
Sep
Oc t
Nov
2008
2009
Wasted Cryoprecipitate
25%
20%
15%
Threshold
5%
0%
June
July
Aug
Sep
2008
Oc t
Nov
Dec
Jan
Feb
Mar
2009
Jan
Feb
Mar
2009
30%
10%
Dec
Apr
May
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
Test per FTE
375,000
1,600
350,000
1,400
325,000
1,200
300,000
1,000
5
l-0
Ju
275,000
c
O
5
t- 0
J
6
-0
an
6
r- 0
Ap
6
l-0
Ju
c
O
6
t- 0
J
7
-0
an
7
r- 0
Ap
7
l-0
Ju
c
O
7
t- 0
Tests per FTE
J
8
-0
an
8
l-0
Ju
8
r- 0
Ap
c
O
8
t- 0
J
9
-0
an
9
r- 0
Ap
Total Tests
Clinical Path Expense per Test*
$10
$9
$8
$7
$6
$5
pr
-0
9
A
Ja
n09
O
ct
-0
8
Ju
l-0
8
pr
-0
8
A
Ja
n08
O
ct
-0
7
Ju
l-0
7
pr
-0
7
A
Ja
n07
O
ct
-0
6
Ju
l-0
6
pr
-0
6
A
Ja
n06
O
ct
-0
5
Ju
l-0
5
$4
*excludes Blood Bank and Phlebotomy
Monthly Amount Paid to Southeastern Michigan American Red Cross
1,350,000
1,300,000
Dollars
1,250,000
1,200,000
1,150,000
1,100,000
1,050,000
1,000,000
Jul
Aug
Sept
Oct
Nov
Dec
Jan
FY 2009
Feb
Mar
Apr
May
Jun
Total Tests
400,000
1,800
Clinical Pathology Quality Dashboard
New Clinical Assays Added in Current Year
Protein S activity
Anti-Xa Arixtra (fondiparinux) assay
Hexagonal phospholipid neutralization (HEXAG)
assay
Heparin – induced thrombocytopenia/thrombosis
assay (improved IgG assay)
Automated Urinalysis platform (IRIS)
Rapid detection of Candida albicans and C. glabrata
from blood cultures
BRAF V600 Mutation Detection
Clear Cell Sarcoma EWSR1/ATF1, t(12;22)
Transcript Detection
UroVysion FISH for Bladder Cancer
KRAS Mutation Detection
NPM1 Mutation Detection
Warfarin Sensitivity Analysis
Clinical Pathology Quality Dashboard
Clinical Laboratory Operations Initiatives
• Improvement of Critical Value Callback process
- Brenda Schroeder, lead
• 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!
• Job-specific safety signs
• Creation of Blood Product Utilization Lean Team
- Tim Laing, MD, (OCA), lead
• Improvement of Blood Draw Wait Times
- Cancer Center
- Taubman 2
- Taubman 3
Clinical Pathology Quality Dashboard
Clinical Laboratory Service Enhancements
• 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
• 24/7 Microbiology Lab staffing
• Mycobacteriology culture – continuous monitoring
• Multiple new clinical assays (see list)
Clinical Pathology Quality Dashboard
Kudos
• Thank you to all personnel for our very successful biannual
unannounced CAP Inspection of our laboratories on May 20
– 21, 2009.
• Thank you to the following group for their outstanding work
with Ann Arbor Public School students who visited the
Department of Pathology last month.
• Chemistry: Sheridan Mattson, Merry Muilenburg, Melissa
Liebaert, Tony Sinay, Therese Horning, and Kevin Forbin.
• Microbiology: Michele Centi, Karen Machcinski and Robert
Whitney
• Cytology: Brian Smola
• Histology: Chris White and Danielle Fritzsche
• Administration: Beverly Smith
• Many positive comments were received from these AAPS
students.
•
Examples:
• “I learned how to look for cancer cells – every day I was
with four different people and ALL of them were helpful – I
really learned a lot”.
• “I not only gained a lot of knowledge in the clinical labs – I
became more confident. Sheridan…really encouraged me.
Sheridan was very helpful.”
• “I learned a lot. I learned about influenza and I got to see
bacteria on the microscope. There were a lot of helpful
people that were happy to help me and spend time
explaining everything.”
• “Got to see a wide variety of procedures…got a good
glimpse of what these jobs entail and a good sense of the
different jobs available.”