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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 HospitalOpen Heart Birthing Unit

Community Outreach ProgramOncology

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69.4 FTEs (40:60 technical : non-technical)

18.4 FTEs for Chematology section

1,200,000 tests / year

Continuous flow process

Swedish Covenant Hospital Lab

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Do More With LessAccomplish

How can we do less?

Pre-Analytical

Analytical Post-analytical

EfficientlyLess StressHigh QualityStreamline processes

Total Process Management

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Pre-Analytical Processes

Patient ID

System

CPOE

Pneumatic tube

No Aliquoting

Sample Distribution

Analytical Processes

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Employee Demographics

• Techs range in age from 25-67. Most over 45.

• Longevity - worked at the lab for over 15 years

• 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

10

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.

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Inpatient BT/adjusted discharge

Total billed tests /

Lab FTE

Total Expense /

100 Billed tests

Hours paid per 100 billed tests

Utilization

ProductivityProductivity

Cost Effectiveness

Operational Indicators

SCH – Lab Services: Clinical Operations(Chemistry, Hematology, Coagulation, Urinalysis, Microbiology, Paratechnical)

Solucient KPI Benchmarking

N/AN/AN/AN/AN/AInPt Billed Tests/Acute Dish.Utilization

49.5238.2132.4410.34%22.72Skill Mix: Technologists %Staffing

16,597.7414,928.6512,989.4482.76%17,732.65Total Billed Tests/Lab FTEWorkload

15.5313.6711.7721.43%11.73Hours Paid/100 Billed TestsProductivity

728.91683.72615.8314.29%569.43Total Expense/100 Billed TestsCost Ratio

365.00327.49270.106.90%216.91Labor Expense/100 Billed TestsCost Ratio

75th50th25th

SCH%

Ranking

SCH Clin. Lab.

PercentileFYE 3Q 2009

Operational indicators of cost effectiveness, productivity and staffing compare very favorably to the targeted 25th

percentile. Utilization statistics not available from Solucient at this time.

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Test volume vs FTE

87.587.1

87.5

89.6

88.5

87.3

85.886.1

0

200000

400000

600000

800000

1000000

1200000

1400000

2002 2003 2004 2005 2006 2007 2008 2009

Test

vol

ume

80

82

84

86

88

90

92

FTE

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Do Less Accomplish More

• Pre-analytics– Specimen quality– Delivery of specimens– Accuracy– Computer connectivity of information

• Analytics– Eliminating manual processes– Visuals– Maximizing computer capabilities

Do Less Accomplish More

• Post Analytics–Autovalidation–Add-on and reflex test orders–Computer documentation–Specimen sorting–Reports

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National Employee Satisfaction survey ranked the laboratory in the top 10% in employee engagement.

Job satisfaction - 80% of staff rated it good or excellent.

We Do Less and Accomplish More !

Contact Information

Susan Dawsonsdawson@schosp.org

Swedish Covenant HospitalChicago, IL