1 Going Beyond Laboratory Automation: Do Less Accomplish More Susan Dawson, MBA, MT(ASCP) Swedish Covenant Hospital Chicago, IL 325 Beds 15,000 admissions / year 46,000 ER visits / year Culturally diverse patient population Employees speak 40 different languages Swedish Covenant Hospital Open Heart Birthing Unit Community Outreach Program Oncology
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Going Beyond Laboratory Automation: Do Less Accomplish More · 2017-04-02 · 1 Going Beyond Laboratory Automation: Do Less Accomplish More Susan Dawson, MBA, MT(ASCP) Swedish Covenant
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Going Beyond Laboratory Automation:
Do Less Accomplish More
Susan Dawson, MBA, MT(ASCP)Swedish Covenant Hospital
• Most attended college when they were still typing on typewriters
• First computers used were at work• Retention rate is good• Pay rate is 65% of top pay in the area
Work Statistics
Solucient™ benchmarking
7.4% ranking in labor expense85% in BT/FTE11.5% in total expense/100 BT
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Analytical Processes
Repeats
Dilutions
AlgorithmsIndicies
QC
CriticalsDelta
CRR
HepatitisTSH
Hemo, Icterus, Lipemia
Reagent change
Computer connectivity
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CI
CII
Coag
UAHemo Hemo
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Wireless Headset
Hands are free
“Lean” things
• Phone, LIS terminal, automation terminal
• Controls in rack in the order they are loaded on the instrument
• One touch per tube• Stat bench• Wireless headset
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The Big Screen
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Post- Analytical Processes
Autovalidation
Single largest contributor to relieving stress and improving consistency, quality and turn-around time.
If a tech would/should take an “action” on the result, then it should not be autovalidated.
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Quality Control
• Stops patient results from being reported for an assay that has failed QC
• Stop results from autovalidatingif QC has not been run in the past xx hours
Review Ranges
• Don’t stop every abnormal• Actionable result• Hemolysis comment –
automatically generated• Critical values
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Delta Checksand Instrument Flags
• Delta checks–Clinically useful–Not for every assay
• Instrument flags–Translate important information
(linear limit, clots)
Autovalidation: Rules and Effect
LaborQualityLIS
QCReview rangesDelta checks
Instrument flags
Reviewed by tech
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Patient demographic information
Test information
Actions
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Hematology
Differentials
Review criteria
N
Y
Slide review/ Manual
differential?
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Differentials
Review criteria
N
Y
Slide review/ Manual
differential?
Complex rules for differentials
Review criteria
N
Y
Slide review/ Manual
differential?
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0600 TAT for hematology
Impact On Hematology
FY02 FY03 Q3040
40
60
70
Q404 Q105 FY06 FY07 FY09
50
30
20
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Connected tomiddleware
Auto-validation
Onlinedifferentials
ER TAT for hematology
Connected tomiddleware
FY03 Q2040
10
15
20
Q304 Q404 FY05 FY07 FY09
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Auto-validation
Onlinedifferentials
Impact On ER Specimens
11 min
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0600 TAT for chemistryAutomation
Auto-validation
FY02 FY03 Q1040
40
80
120
FY04 FY05 FY06 FY07 FY09
Impact Of Automation& Auto-validation
51 min
ER TAT for chemistry
Auto-validation
Impact On ER
FY03 Q1040
30
40
50
FY04 FY05 FY06 FY07 FY09
20
10
28 min.
Big Screen
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Advantages of Autovalidation
• Objective, not subjective review of results
• Rule violations will be captured• Every rule is consistently applied and
not dependent on personal preference or tech capability.
Post analysis tasks
• Add on testing • Reflex orders• Post analysis sorting• Reports• Phone calls• Send outs
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One Touch
Maximize the use of all automated processes–Auto repeats–Auto dilutions–Hemolysis grading–Add-on testing–Reflex orders–Archiving and specimen retrieval
Advent of the Centra-tech!
Hematology Manual differentials
Central Desk Chemistry Workstation
Any of these techs can simultaneously manage the entire process from order to result verification for Hemo, Coag, Chemistry, and Immunoassay.