what i do donald giacherio, ph.d. clinical associate professor of pathology director, chemistry...

What I Do

Donald Giacherio, Ph.D. Clinical Associate Professor of Pathology Director, Chemistry Section Laboratories Director, Specimen Processing Director, Ancillary Site Testing Services

Direct the Operations of the Chemistry Section Laboratories

• Automated Chemistry• Special Chemistry• Drug Analysis and Toxicology• Immunology• Point of Care Testing

Key Personnel

• Sue Stern -- Administrative Manager• Eric vasBinder -- Automation Supervisor• Mara Williams -- Special Chemistry Supervisor• Sheridan Mattson -- Toxicology Supervisor• Linda Thomas -- Immunology Supervisor• Melanie Herbert -- Evening and Midnight shift• Denise Twarkowski -- Point of Care

2005 2006 2007 2008 2009 2010

CDM’s 1,955586 2,140,660 2,340,560 2,474,990 2,541,672 2,653,013

CDM growth 185,072 199,900 134,430 66,682 111,341

% CDM growth

9.46 % 9.34 % 5.74 % 2.69 % 4.38 %

Expense $ 8,232,434 8,082,193 9,145,852 9,822,100 10,186,815 11,179,205

$ per CDM $ 4.31 $3.78 $ 3.91 $3.96 $ 4.01 $ 4.21

FTE 58 60 61 62 64 66

Chemistry Laboratory Financials

Limited budget growth despite significant new test growth

• CVC OR Lab • Quantiferon TB testing started• Cotinine• Hemoglobinopathy Evaluation• Troponin I testing in Emergency Department• Continued growth of transplant program support• Psychiatry Addiction Treatment Program support

– Ethyl glucuronide, GC-MS drug screens, Oxycodone, Buprenorphrine, Methadone

• Virus serology testing moved from Microbiology– EBV, HSV, CMV, Toxo, VZV, Mumps, Measles, H. pylori

Chemistry Laboratory Services

3500 tubes/day

Chemical Laboratory automation line volume

8 million tests/year

24 x 7 service

Our labcell configuration

3 - Advia 2400’s

2 - Sample managers

2 - Centrifuge XL’s

2 - Decapper modules

3 - Advia Centaur’s

“Lean” in Chemistry

• Redesign of sample handling area of the lab • Monitoring of STAT sample turnaround times• Visual cues system• Mail in immunosuppressant samples• TAT for inpatient immunosuppressant drugs• Selected as one of 11 health system wide

areas for new “Lean Implementation Teams” training of all techs

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Chemistry Sample Turn-Around Time

Routine >60 min ST >45 In pt. ST >45 min Out pt ST

Oct 07 - Feb 2011

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POCT at University Hospitals

Whole Blood Glucose: 280 meters, perform 600,000 patient, tests per year

Coag tests: 8 meters in OR’s of Main, Mott, and CVC for PT, aPTT, ACT

Blood Gas / electrolyte analyzers in OR’s and ED

Creatinine on i-STAT for three Interventional Radiology sites

Intra-operative PTH: Analyzer moved to OR for parathyroidectomies: 300 cases last year.Measure PTH at baseline, 10 min, and 15 min post excision.

Ancillary Site Laboratories: Key Personnel

• Mary Lou Erber -- Administrative manager• Theo Jones• Denise Brown• Suzanne Clark• Cindy Stutzman• Annette Collino

POCT at Health Care Centers

Hemoglobin A1C: 26 DCA Vantage analyzers at 14 sites, perform 30,000 tests per year

Lipid profile: Cholestech LDX at Domino Farms, CVC Blood draw station

Blood gas / Electrolytes: i-STAT at Kellogg Eye Center, EAA Surgery Center, Livonia Surgery Center, Canton Infusion Center

Specimen Processing

• 9000 samples per weekday distributed to labs• Sendout testing• Key Personnel

– Harry Neusius– Bonnie Grayson– Beth Lawless– Renee Stoklosa– Mary Deis– Michael Horgrow– Lakesha Holloway

Research

• 7.5 % effort on NIDDK funded Michigan Diabetes Research and Training Center

• Martin Myers, Ph.D. and William Herman, M.D.• Direct Chemistry Core Lab on 6th floor Brehm Bldg• Lab provides service for over 45 diabetes related

projects, performing 18,000 tests / year• Assays for Lipids, Hgb A1c, Glucose, Insulin, C-

peptide, Leptin, Adiponectin, Ghrelin, PAI-1, Luminex cytokine profiles

Research

• Development of POC assay for Apo B and Apo A1• With Alan Hunt, Ph.D. and Robert Brook, M.D.• Apo B is major protein of LDL, Apo A1 is the major

protein of HDL• Work on microfluidic cartridge device using

fluorescence polarization immunoassay.• $30,000 MICHR award, $95,000 seed money from

a venture capital company, Net Scientific

Teaching

• Coordinate rotation of Pathology Residents through the Chemistry Lab

• Review Hemoglobinopathy evaluations• Review 2nd trimester maternal serum prenatal

screen results (Quad Test)• Meet daily with residents to review lab issues

So Kurt, who do you think the Lions should draft this week?

Anthony Costanzo, OT, Boston CollegePrince Amukamara, CB, Nebraska