using keele data to demonstrate efficiency and effectiveness jim allison
TRANSCRIPT
Background SCBMDN has to engage with the
Keele benchmarking process. Improve the consistency of the data
returned by Scottish labs Seek to influence the introduction of
new questions within the Keele database
Enable greater use of this data to plan service delivery
Background :National Pathology Benchmarking Service at Keele University Performance management tool.
Peer comparison of key indicators.
Internal comparison of year on year performance.
Separate data collection and benchmark reports are offered for Clinical Biochemistry, Haematology/Blood Transfusion, Histopathology/Cytology, Immunology and Microbiology/Virology.
Background :Keele Benchmarking – difficult and time consuming process. Questionnaires sent out electronically during April 2012. Completed questionnaires returned to Keele in June Data checking exercise undertaken. Data is processed at Keele, and a specialist panel - made up
of clinicians from the relevant discipline - meet to discuss the data.
Panel write a commentary on the findings, providing interpretation of the data which is included in the final report.
Generic report produced in December for each participant, plus a separate analysis tool enabling you to drill down into the data further and create their own charts and tables.
In January, participants are invited to a user group meeting, where the findings of the report are discussed, and the participants get the opportunity to influence future development of the programme
Keele and the SCBMDN
1. What information /markers of efficiency and effectiveness Keele provides the SCBMDN.
2. Identify areas of inconsistency.3. Recent interactions of the SCBMDN
with Keele.4. What the SCBMDN might do with
Keele in the future.
Engagement with Keele:
SCBMDN questionnaire (Sept 2011); 8 out of 15 Health Boards responded.
Efficiency and Productivity Cost per test and request Requests and Tests per WTE
Effectiveness A&E turnaround times Other ideas
Keele Information:
Biochemistry is a local lab for local people.
There’s no need for benchmarking here!!!
Keele Information: Test Workload per 1000 Population
Health Board Children
Adults Total
Ayrshire & Arran 63,210 299,850 363,060
Borders 19,840 92,050 111,890
Dumfries & Galloway
24,430 122,190 146,620
Fife 64,610 293,160 357,770
Forth Valley 53,670 232,770 286,440
Grampian 95,620 441,550 537,170
Greater Glasgow & Clyde
207,670 975,050 1,182,720
Highland 53,010 250,970 303,980
Lanarkshire 105,580 451,900 557,480
Lothian 140,450 676,880 817,330
Orkney 3,380 16,560 19,940
Shetland 4,220 17,940 22,160
Tayside 67,750 325,070 392,820
Western Isles 4,440 21,510 25,950
Keele Information: Workload: Like for Like U&E?
Serum Creatinine Workload per 1000 Population
0
100
200
300
400
500
600
Ayr
shire
&A
rran
Bor
ders
Fife
For
th V
aley
Abe
rdee
n
NH
S G
GC
NH
SH
ighl
and
NH
SLa
nark
shire
RIE
St J
ohn'
s
WG
NH
SLo
thia
n
NH
ST
aysi
de
Lab / Region
Ce
rea
t R
eq
/10
00
po
p
Creatinine
Keele Information: Workload: Like for Like TFTs?
TSH & FT4 workload per 1000 Population
0
50
100
150
200
250
300
NH
S A
yrsh
ire
&A
rra
n
NH
S B
ord
ers
NH
S F
ife
NH
S F
ort
hV
alle
y
NH
S G
ram
pia
n
NH
SG
GC
NH
S H
igh
lan
d
NH
SL
an
ark
shir
e
NH
S L
oth
ian
NH
S T
ays
ide
Region
Req
/ 1
000 P
op
Tests Per 1,000 GP Population: T4 (Free)
Tests Per 1,000 GP Population: TSH
Keele Information: Workload: Like for Like Lipids?
Chol, Trig & HDL Workload Per 1000 Pop
0
50
100
150
200
250
300
Ayrs
hir
e &
Arr
an
Bo
rde
rs
Fife
Fo
rth
Va
lle
y
Ab
erd
ee
n
NH
S G
GC
NH
S
Hig
hla
nd
NH
S
La
na
rksh
ire
NH
S L
oth
ian
NH
S T
aysid
e
Region
Req
/1000 P
op
Triglyceride
Cholesterol
HDL (+D-LDL)
Keele Information: Workload: Like for Like HbA1c?
HbA1c and Micro Alb Workload per 1000 Population
0
10
20
30
40
50
60
70
80
90
100
Ayrs
hire &
Arr
an
Bord
ers
Fife
Fort
h V
alle
y
Aberd
een
NH
S G
GC
NH
S H
ighla
nd
NH
S
Lanark
shire
NH
S L
oth
ian
NH
S T
aysid
e
Region
Req
/1000 P
op
Albumin/Microalbumin (urine)
HbA1c
Keele Information: Staffing
% Change 2010-2011 All Teaching Non
Teaching
Total Medical Staff (including Trainees) -14.76% -13.63% -19.39%
Total WTE Biomedical Scientists -3.47% -4.48% -1.78%
WTE MLA / Support Workers -3.05% -1.29% -6.23%
Total WTE Clinical Scientists -12.24% -10.73% -15.99%
Keele Information: Staffing
Lab Staff AfC band 4 and Below + Band 5 and Above
0
10
20
30
40
50
60
70
80
90
100
Ayr
shire
and
Arr
an
Bor
ders
Fife
For
th V
alle
y
Abe
rdee
n
Elg
in
Cly
de
Nor
thG
lasg
ow
Sou
thG
lasg
ow
Hig
hlan
d
NH
SLa
nark
shire
RH
SC
RIE
St
John
'sH
ospi
tal
Wes
tern
Gen
eral
Tay
side
Wes
tern
Isl
es
Lab / Region
Nu
mb
ers
of
Sta
ff
Total Staff: AfC Band 4 andBelow
Total Staff: AfC Band 5 andAbove
Keele Information: Finance
Total Pay Cost Per Test
0
0.5
1
1.5
2
2.5
3
3.5
Ayrs
hire a
nd A
rran
Bord
ers
Fife
Fort
h V
alle
y
Aberd
een
Elg
in
Cly
de
Nort
h G
lasgow
South
Gla
sgow
Hig
hla
nd
NH
S L
anark
shire
RH
SC
RIE
St
John's
Hospital
Weste
rn G
enera
l
Taysid
e
Weste
rn I
sle
s
Lab / Region
pay c
ost/
test
(£) Total Pay Cost Per Test
Keele Information: Finance
Total Pay Cost Per Test
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Ayr
shire
and
Arr
an
Bor
ders
Fife
For
th V
alle
y
Abe
rdee
n
Elg
in
Cly
de
Nor
th G
lasg
ow
Sou
thG
lasg
ow
Hig
hlan
d
NH
SLa
nark
shire RIE
St
John
'sH
ospi
tal
Wes
tern
Gen
eral
Tay
side
Wes
tern
Isl
es
Lab / Region
pay
co
st/
test
(£)
Total Pay Cost Per Test
Keele Information: Finance
Total Pay Cost Per Test
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Ayr
shire
and
Arr
an
Bor
ders
Fife
For
th V
alle
y
Abe
rdee
n
Cly
de
Nor
thG
lasg
ow
Sou
thG
lasg
ow
Hig
hlan
d
NH
SLa
nark
shire RIE
St
John
'sH
ospi
tal
Wes
tern
Gen
eral
Tay
side
Wes
tern
Isl
es
Lab / Region
pay
co
st/
test
(£)
Total Pay Cost Per Test
Keele Information: Finance
Biomedical Scientists Out of Hours Payments (Including Trainees)
£0
£200,000
£400,000
£600,000
£800,000
£1,000,000
£1,200,000
Ayr
shire
and
Arr
an
Bor
ders
Fife
For
th V
alle
y
Abe
rdee
n
Elg
in
Cly
de
Nor
th G
lasg
ow
Sou
th G
lasg
ow
Hig
hlan
d
NH
S L
anar
kshi
re
RH
SC
RIE
St
John
's H
ospi
tal
Wes
tern
Gen
eral
Tay
side
Wes
tern
Isl
es
Lab / Region
Co
st
(£)
Biomedical Scientists Out ofHours Payments (IncludingTrainees)
Keele Information: Efficiency and Productivity
i) Efficiency – Cost per test and cost per request.
ii) Productivity - Number of tests per WTE.
Keele Information: Efficiency
Total Pay and Non Pay Cost per Test
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Ayr
shire
an
d A
rran
Bo
rde
rs
Fife
Fo
rth
Va
lley
Ab
erd
een
Elg
in
Cly
de
Nor
th G
lasg
ow
So
uth
Gla
sgo
w
Be
lford
Cai
thn
ess
Ob
an
Rai
gm
ore
Lan
ark
shir
e
RH
SC
RIE
St
Joh
n's
WG
Ta
ysid
e
We
ste
rn Is
les
Lab /Region
Co
st
(£)
Total Pay Cost Per Test
Total Non Pay Cost Per Test
Grand Total
Keele Information: Efficiency
Total Pay and Non Pay Cost per Test
0
0.2
0.4
0.6
0.8
1
1.2
Ayr
shire
an
d A
rran
Bo
rde
rs
Fife
Fo
rth
Va
lley
Ab
erd
een
Cly
de
Nor
th G
lasg
ow
So
uth
Gla
sgo
w
Lan
ark
shir
e
RIE
St
Joh
n's
WG
Ta
ysid
e
Lab /Region
Co
st
(£)
Total Pay Cost Per Test
Total Non Pay Cost Per Test
Grand Total
Keele Information: Productivity
Tests Per Total WTE Staff
020000
4000060000
80000100000120000
140000160000
180000200000
Ayr
shire
and
Arr
an
Bor
ders
Fife
For
th V
alle
y
Abe
rdee
n
Elg
in
Cly
de
Nor
th G
lasg
ow
Sou
th G
lasg
ow
Oba
n
Lana
rksh
ire
RH
SC
RIE
St
John
's
Wes
tern
Gen
eral
Tay
side
Wes
tern
Isl
es
Lab/Region
Tes
ts /
To
tal
WT
E
Tests Per Total WTE Staff
Keele Information: Productivity
Tests Per Total WTE Staff
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
Ayr
shi
re a
ndA
rran
Bor
der
s
Fife
For
th V
alle
y
Abe
rdeen
Cly
de
Nor
th G
lasgo
w
Sou
thG
lasgo
w
Lana
rkshi
re
RIE
St
John'
s
West
Gen
Tay
side
Lab/Region
Te
sts
/WT
E
Tests Per Total WTE Staff
Keele Information: Efficiency and Productivity
These workload variations do not impact significantly on Keele efficiency and productivity figures.
Tot Tests Tot ExpendTotal WTE
Cost / Test
Tests / WTE
Average Lab 5,000,000 £3,500,000 48 £0.70 104,166
Plus extra 80,000 FT4, 50,000Trigs and
30,000HbA1C 5,160,000 £3,540, 000 48 £0.69 107,291
Keele Information: Effectiveness
Keele - U&E TAT for A&E
What is the target TAT for U&E requests from A&E?
What proportion of A&E requests for U&E are reported within this target?
Keele Information: U&E TAT for A&E
U&E Target TAT for A&E
0
20
40
60
80
100
120
140
Ayr
shire
& A
rran
Bor
ders
Fife
For
th V
alle
y
Abe
rdee
n
Elg
in
Cly
de
Nor
th G
lasg
ow
Sou
th G
lasg
ow
Bel
ford
Cai
thne
ss
Oba
n
Rai
gmor
e
Lana
rksh
ire
RH
SC
RIE
St
John
's
WG
Tay
side
Wes
tern
Isl
es
Lab Location
TA
T (
Min
)
0
10
20
30
40
50
60
70
80
90
100
% W
ithin
Targ
et
Target TAT for U&E
% of requests reported within this target
Keele Information: Future Inclusion of RCPath KPIs
KPI: A&E blood sciences turn-around-times
Baseline: Percentage of core investigations, i.e. renal function, liver function tests and full blood counts from A&E completed within 1 hour of receipt, including out of hours
Challenge: 85% by Apr 2012 increasing to 90% by Apr 2014. The standard will move to 1 hour from sample collection by April 2015.
SCBMDN: Agreement to adopt this RCPath KPI.
Keele Information: Effectiveness Vetting Work Referred to Outside Laboratories Identifying Duplicate Requests and Standard Rejection
Procedure Providing Requestors with Key Performance Indicators Participation in Training Events for Requestors and
Utilisation of Order Comms for Education Disease/Symptom-specific Profiles, Requestor/Grade-
specific Testing, Clinical Pathway Development Processes to Improve the Efficiency and Quality of
Service Does your clinical biochemistry laboratory have a
formal risk management policy ?
Engagement with Keele: SCBMDN New Questions in Keele Availability of clinical advice.
Repertoire of tests available on an emergency basis?
Communication of critical results; timeliness and number/ frequency.
Number of urgent/emergency requests processed in last year?
What percentage of reports contain interpretative comments?
Number of complaints /critical incidents
SCBMDN & KEELE Availability of Clinical Advice
Q2-5-1
Which member(s) of staff provide clinical interpretative advice? UA
When does this service operate?
Is this 24 hours
per day, 365(6)
days per year?
If no please state start and finish time (please use
the format HH:MM)
Start time Finish time
Q2-5-2 Monday to Friday UA 09:00 17:00
Q2-5-3 Saturday UA 09:00 17:00
Q2-5-4 Sunday UA 09:00 17:00
Q2-5-5 Public Holiday UA 09:00 17:00
SCBMDN & KEELEPlasma/Serum/Blood Column 1 Column 2 Column 3 Column 4
Test NameTotal Tests In-
house
Number of Tests
Performed for Primary Care
Tests Referred Out (change to 'yes' only if you refer the test
out)
Is Test Provided as an Emergency
(change to 'yes' only if available 24/7, 365)
1,25 Hydroxy Vitamin D UA No No
11-Deoxycortisol UA No No
17 Hydroxy Progesterone UA No No
25 Hydroxy Vitamin D UA UA No No
ACTH UA No No
Adrenaline UA No No
Albumin UA No No
Alcohol (Ethanol) UA No No
Ongoing Dialogue with Keele
Getting more out of the existing questionnaire
Incorporating further markers of effectiveness
Invitation to David Holland to attend SCBMDN meeting later this year.
Example of Improvement in Clinical Effectiveness of Laboratory Service NHSG Primary Care – ongoing problem with spurious
hyperkalaemia due to long transportation times.
Jan 2010, <20% of SST samples from primary care spun at source.
Centrifugation of SST tubes in primary care practices introduced in July 2010.
Jan 2011, 95% of SST samples from primary care spun at source
Clinical Effectiveness
Retrospective audit conducted to reviewthe impact on patient care of introduction ofcentrifugation in primary care:
a) Pre-GP centrifugation Jan – June 2010 b) Post-GP centrifugation Jan – June 2011
Classification of follow-up of hyperkalaemia Appropriate admission: Genuine hyperkalaemia in a GP
sample resulting in admission to acute medical receiving where the hyperkalaemia has been confirmed
Appropriate GP follow-up: Genuine hyperkalaemia in a GP sample resulting in a repeat sample from the GP where the hyperkalaemia has been confirmed
Inappropriate admission: Pseudohyperkalaemia in a GP sample due to delay in sample centrifugation resulting in admission to acute medical receiving where the follow-up serum potassium is within the reference interval
Inappropriate GP follow-up: Pseudohyperkalaemia in a GP sample due to delay in centrifugation resulting in a repeat sample from the GP where the follow-up serum potassium is within the reference interval