detroit medical center - medical automation | health care

1

Laboratory Automation , Instrumentation & Autoverification: Methods for Maximizing Quality &

Efficiency

William Neeley, MD, FCAP, DABCCMedical Director

Detroit Medical Center University LaboratoriesDetroit, Michigan

Detroit Medical Center

2

Lab Automation, Instrumentation & Autoverification

• Good news—improved instrumentation

• Wide selection of lab automation systems

• Challenge is to select the one that most

closely meets your particular needs

• Lab automation alone will not produce

efficiency

• Autoverification—dramatically improving

3

Detroit Medical CenterHuron Valley HospitalHarper & Hutzel HospitalsChildren's Hospital

Sinai-Grace HospitalOrthopedic Hospital

University Health Center &Core Laboratory

Detroit ReceivingHospital

Rehabilitation Institute

4

Interesting Statistics

• 8 Hospitals and 1 Institute

• 1,800 Licensed Beds

• 3,000 Affiliated Physicians

• 11,100 Full-Time Equivalents


5


General Lab Information

• Over 12 million billable tests/year

• 48% of volume is outreach

• < 0.8 % of testing sent to outside labs

• Core Laboratory

• Routine & STAT testing

• Specialized testing

• Outreach testing

6


Strategies & Objectives

• Develop a clear vision

• Visit automation sites—apply common sense

• Ask if the benefits are worth the cost

• Unify methodology across entire system

• Apply lean principles & clean up sample flow

• Reduce manual handling & transport of samples

7



• Consolidate tests from multiple areas

• Instruments should function well with and

without automation

• Instruments should enhance automation

• Automation should handle STATs

• Support our 29-minute ER initiative

8


• Autoverification— essential & not an option

• 1st Generation Autoverification

• 2nd Generation Middleware

• 3rd Generation Autoverification


9


Centrifugation

• Automation or manual?

• Worth the cost? ($80K-$120K each)

• Is automated or manual centrifugation faster?

• To re-centrifuge or not re-centrifuge?

• Results of our study

10


General Criteria for Selecting Instrumentation for Lab Automation

• Long term calibration stability

• Highly stable electrolytes

• System handles a wide variety of tubes—

depends on particular environment

11


General Criteria for Selecting Instrumentation

• Chemical and instrument stability reduces total

number of controls

• Low maintenance (saves labor)

• Maintenance costs inversely related to reliability

12


General Criteria for Selecting Instrumentation

• Minimize consumables—watch for hidden costs

• Disposable tips are very important for

automation—no cross contamination

• Measure indices—bilirubin, hemoglobin &

lipemia

13


Criteria for Selecting Instrumentationfor Lab Automation Systems

• Clot detection

• Low repeat rate—minimizes cost

• Highly reliable results over wide dynamic

ranges

14


Criteria for Selecting both Instrumentation& Lab Automation

Systems

• Direct tube sampling from automated conveyor system

• Extremely important for attaining highest efficiency

• Point-In-Space Sampling

15


Criteria for Selecting both Instrumentation

& Lab Automation Systems

• Maximize the number of different tube sizes that can be used with automation

• Very important for attaining high efficiency, especially in competitive outreach market

16


Criteria for Selecting Both Instrumentation

& Lab Automation Systems

• Short draws are a major source of inefficiency, ~20% samples

• Critical to handle short draws with minimal labor

17


Criteria for Selecting Instrumentation

for Lab Automation Systems

• Small tubes in pediatrics

10 x 65 mm

• Critical to handle most pediatric samples with automation

• Major pediatric hospital in Michigan

18


Sample Aliquoting

• Front or back of automate track?

• Is an automated aliquoter worth $350K?

• Are STATS done faster or slower with robotic aliquoter?

• More or fewer incidents of QNS?

• Does direct tube sampling plus aliquoting at end of automation line provide higher efficiency?

19


Robotic Storage

• Robot to remove samples from track & place

them in storage rack

• Robot can remove tube from storage & place

back on conveyor for re-testing or add-on

tests

• Refrigerated storage areas are good but $$$

20


Earliest Systems Before Autoverification

Home grown but powerful (1992)

Clearly demonstrated basic principles

Allowed complex algorithms using many

different parameters

Clearly notified tech as to nature of problem as

well as lab policy for correction

History of Autoverification

21


History of Autoverification

1st Generation Autoverification

• A disappointment but a start

• Not enthusiastically supported by LIS

• Limited to simple testing to see if a result is

within a specified range

• Complex algorithms

• Major labor savings

22


2nd Generation Autoverification

• “Middleware” created to fill a void

• Positioned between instrument & LIS

• Allows complicated algorithms or rules

• Can examine many results simultaneously

23


• Philosophy—Provide the user with tools to develop

algorithms or rules of their own choosing based on medical

experience that can be uniformly applied to each an d every

result.

• Utilize all information that is available to evalua te results

before they are released.

• Utilize information from EMR such as CC, HPI, famil y

history, medications, etc.

3rd Generation of Autoverification

24


Autoverification Statistics

• Automated general chemistry

- 87 % outreach

- 83 % outreach and inpatients (combined)

• Automated hematology

- 93 %

• Coagulation

- 81 %

25

Detroit Medical CenterDaily Workload Automated Chemistry

Tue 05/15/2007

17

86

104114

5746

51 4836

141

107

143

240

277

207 209202

274

176

218229

146

42

76

0

50

100

150

200

250

300

7:00AM

8:00AM

9:00AM

10:00AM

11:00AM

12:00PM

1:00PM

2:00PM

3:00PM

4:00PM

5:00PM

6:00PM

7:00PM

8:00PM

9:00PM

10:00PM

11:00PM

12:00AM

1:00AM

2:00AM

3:00AM

4:00AM

5:00AM

6:00AM

Tub

es p

er H

our

Time of Day

26


DAILY WORKLOAD

0

500

1000

1500

2000

2500

3000

3500

M T W T F S S M T W T F S S

DAYS OF WEEK

TU

BE

S

2004

2006

Automated Chemistry

27


Over a 5-year period the labor savings is $9,290,98 8

Chemistry Savings to Bottom Line

1500000

1550000

16000001650000

1700000

1750000

1800000

18500001900000

1950000

2000000

1 2 3 4 5

Sav

ings

$$

Years

28


Summary• Significant improvements in service, quality, &

efficiency can be obtained by appropriate

choices & integration of Lab Automation,

Instrumentation, & Autoverification

• The fewer times a sample is touched the higher

the efficiency, fewer errors & lower costs

• Questions: [email protected]

Phone:313-966-0005

29


Thank you

detroit medical center - medical automation | health care

Documents