lead presentation class 2016
TRANSCRIPT
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Central AccessioningJonathan Dryjowicz-Burek MLS(ASCP)
Medical Technologist
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AccessioningThe process of accepting all orders or group
of tests on a specimen into the Laboratory information system (LIS) Vista.
ExampleWhite’s Café and Pastry Shop
R/CH 0527 455R/HE 0527 1083
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The Opportunity Failure to launch
History of unsuccessful EffortsEmployees hired for Specimen processing in our Send Out Dept.
Chemistry staff is doing the workMedical technologists doing medical technician work.
Deficient Specimen AccessioningMRSA, app. 280 specimens/week Microbiology; blood cultures, C.diff
Procedure NoneOn the job training
Drop off location Middle of the lab
Laboratory renovation projectWindow of opportunity
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Methodology: VA-TAMMCSVisionAnalysisTeamAimMapMeasureChangeSustain/Spreadhttp://www.paloalto.va.gov/docs/Improvement
Guide.pdf
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Vision Vision- Implement Central Accessioning
at the VA West Roxbury Laboratory
An Area at the entrance of the West Roxbury Clinical Laboratory where specimens get dropped off, entered in the LIS, processed, and delivered to the appropriate department for analysis.
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AnalysisBenchmarking against “best practices”
VA West Roxbury Chemistry Work Flow Specimen processing
Norwood Hospital Site Visit 12/18/2014Q and A Compared a similar hospital size/volume with a
Central Accessioning Department.
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Improvement Team Sheryl Dinisco- Laboratory Manager, mentor, meetings, project
outlines, deadlinesJonathan Dryjowicz-Burek-Medical Technologist, ownerJennifer Stelmach-Medical Technologist, logistics , specimen
processing expertMary Pitts- Send-out supervisor, key for coordination with
staffing, scheduling, training.Linda Farney- Medical technologist, chemistry supervisor,
coordinator, specimen processing and limitations, context expert.Theresa Wedekind- Details , context expert.Susan Bennett-Medical technologist, QA manager ,
documentation, limitations, training, data, competencies. Jackie Rosario- LIM, data collection
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The Plan Project Charter: 12/18/15 Define Scope 1/1/15
The central accessioning department will be implemented on February 1, 2015. It will operate during the day shift on weekdays All specimens including Hematology, Chemistry, Immunology, MRSA, blood culture
bottles, and send out tests will be accessioned and processed. Document QA issues
Set up work station and sample process 1/30/15 Centrifuges Aliquot tubes Sample racks
Write Procedure Implement: 2/2/2015 Collect data 1/2015-4/2015 Train Staff
3 weeks/employee Competencies
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AimFrom 2/1 to 4/1 decrease time from specimen
collection to laboratory arrival by 15% using the MRSA agar. TAT for STAT Glucose and CBC from the
Emergency Room as an Analytical metric.Previously used order numbers as the Patient
center care metric.
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Map/MeasureMap: Old Sample Flow vs. New Sample FlowMeasure-
Primary metric: MRSA Delay
The amount of time between specimen collection to accessioning. Pre-analytical metric
Secondary Metric CBC/Glucose TAT from ER
TAT from accession to result Analytical metric
Previously used order numbers Patient centered care metric = unnecessary collection Secondary outcome
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Pre Implementation Process Map
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Post Implementation Process Map
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Primary Metric:Average MRSA agar Accessioning Delay
Jan. 12-16
Feb. 2-6
Feb. 16-20
March 2-6
March 16-20
0
4
8
12
16
20 18.6
11.58(-37.2%)
14.38(-22.7%)14.65(-21.2%)
10.11(-45.6%)
Average MRSA Delay
avg. delay in hours (percent change)
Week
hour
s
Implemented
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Secondary Metric:Average complete blood count turn around time per week
Feb. 2-6 Feb. 9-13 Feb. 16-20 Mar. 2-6 Mar. 9-13 Mar. 16-200
2
4
6
8
10
12
14
16
18
12.73
14.51
16.46
12.44
14.31
12.6
Avg. CBC TAT/week
Avg TAT postavg tat pre CA
Week
Min
utes
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Secondary Metric:Average glucose turn around time per week
Feb. 2-6 Feb. 9-13 Feb. 16-20 Mar. 2-6 Mar. 9-13 Mar. 16-200
5
10
15
20
25
30
35
30.15
26.68
30
25.8727.98
32.01
Avg. Glucose TAT/Week
Avg tatavg tat pre CA
Week
Min
utes
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1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 530
10
20
30
40
50
60
70
80
Glucose Turn around Time from Emergency Department
TATAVG TAT
Specimen Number
Min
utes
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Secondary Metric:MRSA Prev. Used Order Numbers
OCT NOV DEC JAN FEB MARCH APRIL MAY JUNE JULY AUG0
5
10
15
20
25
30
35
40
13
8
13
5
14
22
31
18 17
35
24
Prev. Used Order #'s
Prev. Used Order #'s
Month
Num
ber
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Change PDSA• Current
state
• Frozen Section Hand Delivery
• OR specimens signed
• C.diff accessioning
• Notify Staff and begin process
• Reinforce the changes, adapt procedure to include the changes.
Act Plan
DoStudy
• Reinforce accessioning process with afternoon shift
• Spread MRSA Accessioning to afternoon/night shift
• Delegate to nightshift supervisor.
• Afternoon shift is deficient in accessioning
• Night shift has adopted
Act Plan
DoStudy
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Sustain/SpreadSustain:
All employees trained and competent.ProcedureResources
JDOS- home page>documents>manuals>laboratory Desk references
Leadership on boardContinuous monitoring
SpreadApply accessioning criteria to afternoon/overnight shifts.MRSA Blood cultures
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Leadership Competencies Leading people
Commitment to employees and VA. Empowers others Build high-performing teams
Building Coalitions Developed networks and builds alliances Collaborates with stakeholders to better achieve objectives Find common ground with a wide range of stakeholders to better serve veterans.
Leading Change Champions Innovation Communicates vision and drives change
Global Perspective Understands and integrates stakeholder perspectives and takes action to improve
the deliver of benefits and services to veterans. Business Acumen
Applies forward thinking human capital management principles Employs technology effectively
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Accessioning Processing
Specimen Drop Off
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Thank you !!!!Janet Ferguson Thomas LillySheryl Dinisco Mary PittsJennifer StalmechLinda FarneyBrenda MasciovecchioTheresa WedekindSusan BennettJackie RosarioDave McElwee
Dianne FitzsimmonsBob BocJodi PolifernoNorwood HospitalPatricia WatsonThe Lead ProgramWest Roxbury Clinical
laboratoryAshley KellyTufts Medical Center
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Questions?