Optimization of Microbiology A Partnership in Patient Care ... · • Working smarter, not harder. • Look at the way we interface with Clinicians. • Talk to them, teach them,

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Optimization of Microbiology A Partnership in Patient Care Between Microbiology and Nursing

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Define

Seek

Solve

Sustain & Share

© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. CONFIDENTIAL 3

In a recent Institute of Medicine (IOM) report entitled Better Care at Lower Cost, the IOM recommends healthcare delivery organizations should:

“Continuously improve health care operations to reduce waste, streamline care delivery, and focus on activities that improve patient health. Care Delivery Organizations should apply systems engineering tools and process improvement methods to improve operations and care delivery processes.”

Define Philosophy

http://blog.skylight.com/patient-centric/patient-centered-care/


• VBP HAC impact on typical healthcare organizations with a teaching focus is between $1.1 and $1.8 M for fiscal year 2016.

• CLASBI Scores are coming under significant focus for 2017 with many institutions trying to limit the use of central lines because of related infections.

• Increased focus for 2017 with higher penalties for failures.

Value Based Purchasing Impact


Focus on Quality Care

Roadmap

Clinical Evidence

and Guidelines

Product Portfolio

Education and

Training Programs

Support Tools

Infection Prevention Nursing and Laboratory Focus on and Reduction in NIM’s


• It’s up to everyone in this room to do something to change.

• Microbiologists, Laboratory Medical Technologists are nearing the ends of their careers.

• Legislation is out there to allow those not trained and not knowledgeable to do what we do.

• One thing we all can do is work smarter.

• Improve the speed and information provided.

• Show our value to Clinicians.

So What Are We Going To Do?


• It’s time to change the way we work.

• Working smarter, not harder.

• Look at the way we interface with Clinicians.

• Talk to them, teach them, guide them.

• Listen to what they need to care for patients.

• Speed is necessary for success, accuracy and quality is paramount for sustainability.

• Look at what is available to us today to provide a better, faster, more accurate result to the Clinician.

Focus on Flow


• How are we going to succeed with fewer individuals able to make the subjective decisions that Microbiology Techs make everyday?

• What has to change in our industry? • Automation has always been the answer throughout the history

of the world. • From the time of walking, to horse and buggy, to trains, cars, &

planes there has been a clear path of automation. • Take the automobile…How has its manufacture changed over

the years? AUTOMATION was the answer! – Not all aspects of making a car are completely automated, but those aspects

that can are.

– Reproducibility (accuracy, no variation) and speed are the outcomes!

Focus on Workflow…


• Change is needed in all aspects of thinking. – What we test, how we test when we test must all be scrutinized.

• Clinicians will drive what we test. • We can drive when we test.

– Studying when something is needed and determining if and how we can deliver that result is up to us.

• Eliminating delays due to cultures not being in an incubator is a relatively easy step. – Blood cultures sitting at room temperature waiting to be transported to a lab

don’t grow as fast as those in an incubator. – Plated media sitting waiting to go into an incubator don’t grow.

• Get it in the incubator faster and leave it in there until it’s done! – Almost every oven today has a glass window to see if the food is done so we

don’t have to open the door to see if its done. – Worst case is we set a timer and don’t check it until the shortest amount of

time to cook has elapsed.

We’ve Always Done It That Way…


• Consolidation of Laboratories and increased volumes both from consolidation and organic growth. – Population aging equals more testing

• If you are used to 12K results per FTE per year, you can expect to go to 15K to 20K results per FTE per year. Efficiency improvement of about 20% to 30%!

What Can I Expect?

Infostratus • Workflow dashboards • Inventory management • Clinical decision support

SorterA – plate selection

BarcodA – plate barcoding

InoqulA+ – plate inoculation & streaking

ReadA Compact – plate incubation & imaging

ReadA Browser – plate review

Module 1 – MALDI-TOF ID prep

Module 2 – Integrated AST prep Phoenix M50 –

AST, CPO Detect

Imaging Apps – automatic negative release

BD Bruker MBT – MALDI-TOF ID

AUTOMATED

Lab Efficiency

Clinical Outcomes


BD Kiestra™ … Transforming Microbiology

… Enhancing Lab Efficiency

Automates time consuming, manual repetitive tasks of sample inoculation, incubation and plate review improving staff efficiency and lab productivity

… Advancing Quality and Standardization

Standardizes processes and increases quality and accuracy of results. Consistent and reproducible plate streaking using unique rolling bead technology, automated incubation and digital imaging allowing plates to be read at optimal time intervals

… Improving Patient Management and Care

Enabling the delivery of faster, more accurate results to clinicians and staff


Focus On Diagnostic Pathway Incubation &

Image Acquisition

Reading & Analyzing

Automation for MALDI-TOF / AST

Specimen Processing


Inoculate MALDI target plate /

Add FA and matrix

Select colonies on digital image

Pick colony & create common Suspension / Target is 2.0 McF

Automatic panel preparation for BD Phoenix M50

Isolate suspension used for DiscA alternate AST

Automation Colony Picking, Integration and Informatics MALDI-TOF Spotting and Panel Preparation

Inoculation Transfer sample to plate

Incubation Incubate plate to grow organism

Reading Determine if there is an

organism present

AST Determine what antibiotic will kill

bacteria

ID Identify bacteria

and strain

Result Sample

Manual

Growth

No Growth

Today

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjbh-rlnoLLAhVJbj4KHdl_Cr4QjRwIBw&url=http://labsuppliesusa.com/product/innoculating-loop-each/&bvm=bv.114733917,d.cWw&psig=AFQjCNHgCJBknS6OqIVzgbEax2pE2CCWJw&ust=1455916733833678

http://www.stylepinner.com/urine-sample-is-needed/dXJpbmUtc2FtcGxlLWlzLW5lZWRlZA/


Inoculate MALDI target plate /

Add FA and matrix

Select colonies on digital image

Pick colony & create common Suspension / Target is 2.0 McF

Automatic panel preparation for BD Phoenix M50

Isolate suspension used for DiscA alternate AST

Automation Colony Picking into a “Common Suspension” for MALDI-TOF Spotting and Phoenix Panel Preparation

* Products not available for sale or use.


Newer Technology is Morphing Faster into Automation

BD Phoenix M50

Disc Diffusion

Molecular assays

Common

Suspension

3rd Party Systems


Focus on Automation Solutions to Make a Real Difference in Patient Management and Outcomes…NOT Just Workflow!

Isolate Integrity, labor relief and reduction in repeat testing improving result quality and turn around time for MALDI-TOF identification and susceptibility

Specimen traceability and automation decreasing technical errors improving time to result for Disc Diffusion susceptibility

Improved image acquisition and diagnostic applications enabling better clinical decision making

Informatics solution enhancing lab workflow and data management from sample receipt to result

* Products not available for sale or use.


• Automation – Those steps that can be best done by robotics should be done by robots. – Those things best done by humans should be done by humans.

• Paying for Automation is no different in Micro than it is in Chemistry. – The ROI is predicated on ALL costs not just Microbiology costs and savings. – Look at the cost of poor quality! How long does it take to pay for

automation by avoiding poor quality?

• The cost of a preserved urine is more than unpreserved. – But the ROI on it is VERY short when you consider all costs. – Pharmaceuticals unnecessarily given lead to resistance and higher overall

costs.

What Needs to Change


• Change leads to more accurate specimen collections..

• …More reproducible in-lab-processes such as media inoculation..

• …faster time from receipt to result.. Using Maldi, timed incubation and growth detection..

• …more time to spend with clinicians teaching and talking to them about the specimens they collect.. Educating and mentoring..

• …Better relationships with our clinician counterparts..

• …Better value in the workplace for Microbiologists/Medical technologists..

• …A more rewarding career…

Change is Good!

© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company.

Thank you!

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Optimization of Microbiology A Partnership in Patient Care ... · • Working smarter, not harder. • Look at the way we interface with Clinicians. • Talk to them, teach them,

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