Blending Work Cell Automation, Middleware, and Lean to Reduce TAT, Decrease Required Specimen Volume, and Boost Productivity

Size: px

Start display at page:

Download "Blending Work Cell Automation, Middleware, and Lean to Reduce TAT, Decrease Required Specimen Volume, and Boost Productivity"

Maude Dickerson
6 years ago
Views:

1 Blending Work Cell Automation, Middleware, and Lean to Reduce TAT, Decrease Required Specimen Volume, and Boost Productivity Donald Giacherio, Ph.D Clinical Associate Professor of Pathology Director, Chemistry Section Laboratories University of Michigan Health System Ann Arbor, MI

2 University of Michigan Health System

3 Chemistry Lab University of Michigan Hospital Serving three hospitals, 40 health centers, 120 outpatient clinics and medical and nursing schools 8.5million chemistry and immunodiagnostics tests per year 3500 tubes a day

4 Laboratory Decisions Driven by cost pressures Driven by workload increases Driven by restructuring Driven by personnel shortages Driven by TAT demands Driven by test menu demands No matter the driving force, increased automation has to at least be in the conversation as part of the solution.

5 Previous Philosophy Ready Fire Aim

7 Self-Assessment What is the driver for change? What are your goals for the process? Create a team Include representatives from all areas affected by the decision

8 Remember, it s not what you don t know that gets you into trouble. It s what you know for sure that just ain t so. Yogi Berra

9 Simplify your goals Replace aging equipment Increase efficiency Shorten TAT Enhance capacity for future growth Decrease costs (or slow the rate of increase) Allow better utilization of skilled labor Reduce blood draw volumes

10 Self-Assessment Identify peak throughput needs What is your workload? Samples per day Samples per hour of the day STAT s per hour of the day Ordering patterns Turnaround times (TAT) Frequency of arrival

11 Get the data first, then distort it with your judgement. Mark Twain

12 2005 Chemistry Sample Arrivals Routine 140 STAT :30 2:00 3:30 5:00 6:30 8:00 9:30 11:00 12:30 14:00 15:30 17:00 18:30 20:00 21:30 23:00 Time

13 Accessions per hour April 2012 workload Routine Stat Hour of the Day

14 Refrig Refrig Refrigerators and Freezers Centrifuges PC s and Work Bench PC s and Work Bench The Chemistry Lab 2005 Offices Special Chem Space Window PC s and Phones Refrigerators Laboratory Main Corridor

15 Refrig Refrig Refrigerators and Freezers Centrifuges PC s and Work Bench PC s and Work Bench Offices Special Chem Space Window PC s and Phones Refrigerators Laboratory Main Corridor

16 Our initial labcell configuration 3 - Advia 2400 s 3 - Advia Centaur s 2 - Sample managers 2 - Centrifuge XL s 2 - Decapper modules

17 Refrig Refrig Refrigerators and Freezers Centrifuges PC s and Work Bench Plan for Automation Offices Integra Specimen drop Special Chem Space Window PC s and Phones Refrigerato rs Laboratory Main Corridor

20 Impact of Technology ADVIA Centaur ADVIA 2400 High Throughput Workload processed faster On-Board Dilutions Decreased hands on time

21 Centrifuge XL / Decapper Units

22 XL centrifuge platforms Reduced operation time More intelligent tube detection No downtime in 6 months Easy to forget they are running. Decapper Modules Reduced exposure Reduced repetitive motion issues Improved front end processing Techs love them!

23 Impact of Technology ADVIA CentraLink Auto-Verification Less opportunity for error ADVIA LabCell Sample manager Automatic Sample Storage/Retrieval Minimal time required to search for samples

24 Maximizing productivity with automation and middleware Streamline data flow 8 LIS interfaces to 1 LIS backup Decrease TAT Autoverification Automate manual processes Increase quality Standardized processes Improve staff efficiency Focus on things they do well Enhance customer service Physician and patient satisfaction

25 Automation improvements were driven by: LEAN tools Retraining cycles Procedural changes Siemens improvements

26 Lean Initiatives Putting change in the hands of the technologists Posting accomplishments 50 employees trained HealthCare Certificate U of MI classes

28 Refrig Refrig Refrigerators and Freezers Centrifuges PC s and Work Bench Pre November 8, 2007 Offices Integra Specimen drop Special Chem Space Refrigerators PC s and Phones Window Laboratory Main Corridor

29 Refrig Refrig Refrigerators and Freezers Centrifuges PC s and Work Bench Post November 8, 2007 Offices PC s and Phones Integra Specimen drop Special Chem Space Refrigerators Window Laboratory Main Corridor

30 LEAN Processes Maintenance Carts Statistical graphing Lean huddles Distribution lean project

31 Lean Visual Cues Instrument boards Instrument test off Service chalk board Track loading status

32 Lean in Reagent handling End of lot pull cards Tagged Reagent pairing

33 Area trained Impact of Retraining Benefit Validation Line operations Line communication Downtimes - Track - LIS - Centralink Improved TAT s Reduced repeats Improved results Less SIQ samples Improved efficiency Improved knowledge Quicker problem resolution Quicker response impact on operation Less Stress!!!

34 A central role for middleware

35 Drilling down in Validation: Using TAT Audits

36 Great tool to assess Validation Skills and TAT s!

37 Sample review: QC severity

38 Patient moving averages

39 Automating routine processes Sample repeat

40 Automating routine processes Sample repeat Hepatitis and HIV algorithms

41 Sample storage and retrieval

42 Procedural changes Use of a float position Strict enforcement of dilutions Test on/off tracking logs Minimizing front loading and use of welded bullets Extra maintenance like mini 2400 decontaminations Use of primary operators Using 1 SM to load and 1 to unload Lot change procedure Set up carts

43 Overall our process changes have allowed continually improving TAT s almost monthly, even after 4 years. Absorb increasing workload, bring in new tests. improved tech job satisfaction and buy in to the process. Promoted a Team atmosphere.

44 Siemens improvements Instrument related Line software Centrifuge XL upgrade Decapper modules ADVIA 1800 chemistry analyzers

45 2400 improvements Concentrated reagents Reagent Pause 3 liter ISE bottles Upgraded mixers

46 Centralink and Linemaster New and larger Centralink Numerous Centralink and linemaster Upgrades Linemaster SIQ logs New Centralink Dashboard Linemaster Gate routes

47 Gate routes An important tool for load balancing U of M Gate Averages for Tubes 2010 CTG 1 CTG 2 Cent 1 Cent 2 Cent % 42% 39% 40% 20% 34% 33% 34%

48 Benefits of Middleware Better Organized Workflow Improved Turn-Around-Times Improved Quality Decreased Time for Sample Storage & Retrieval Better Use of Tech Time Improved Customer Service

49 Reduction in Blood Volume Quote from head of surgical ICU: If a patient is in the ICU for more than a week, we have to transfuse them because the lab needs so much blood. Now, primary tube for chemistry and immunoassay is a 3.5 ml SST. Outpatient blood draw stations complemented us on reduction in their work.

52 Turn around time improvements

53 TAT Data Pre-automation 2005 Laboratory TurnAround Time 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Routine TAT Total Tests STAT TAT Jan-05 Feb-05 Mar-05 Oct-05 Nov-05 Dec % 98.00% 96.00% 94.00% 92.00% 90.00% 88.00% 86.00% 84.00% 82.00% 80.00%

54 TAT Data Early Post-automation 2007 Laboratory TurnAround Time 90,000 80,000 70,000 60,000 50,000 Total Tests Routine TAT STAT TAT % 95.00% 90.00% 85.00% 40, % 30, % 20, % 10,000 0 Refocus training/lean Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec % 60.00%

55 Percentage Chemistry Sample Turn-Around Time Oct 07 - Feb 2011 Routine >60 min ST >45 In pt. ST >45 min Out pt ST

56 Turnaround time improvement

57 % Overdue Posting Daily Statistics Percent Overdue Accessions MN % ACCN overdue DAY % ACCN overdue PM % ACCN overdue 24HR % ACCN overdue BY SHIFT & 24 HOUR 1= 60min OD/ 2= 45min OD 1.3

58 Posting Daily Statistics 4/16/12 > 60 mins. > 45 mins. % over 60 % over 45 # STATS # Routines Midnight Day Evening All Shifts Of the STAT accessions over 45 min, 8 of 10 were < 50 min

59 UMHS Chemistry Laboratory Financials CDM s 1,955,586 2,140,660 2,340,560 2,474,990 2,541,672 2,653,013 2,803,927 CDM Growth % CDM Growth Expense $ $ per CDM 185, , ,430 66, , , % 9.34 % 5.74 % 2.69 % 4.38 % 5.69 % 8,232,434 8,082,193 9,145,892 9,822,100 10,186,815 11,029,205 11,319,715 $ 4.31 $ 3.78 $ 3.91 $ 3.96 $ 4.01 $ 4.16 $ 4.04 FTE s

60 What we would do differently Better appreciation of change management Pay more attention to different learning styles More focused training, emphasis on teamwork More effort at standardizing job duties Better communication

61 Change is inevitable. Everybody resists change. W Edward Deming

62 Reasons for Our Success Decision team Committed to Vision Staff involved in the Project Continue training and process review Encourage and Empower Staff Recognized staff had to work as team now instead of individual contributors let them as a group continue to fine-tune operations.

63 Staying True to our Mission Confidence in Decision Believe and Persevere LEAN teams continue working on best workflow in lab Error identification Heparin plasma separator tubes Labeling of invasive venous sampling studies Continue to drive cost savings with new tests brought in lab Continue to work well with Siemens to enhance and expand capabilities of the system

65 The old adage People are your most important asset turns out to be wrong. People are not your most important asset. The right people are. Jim Collins Good to Great: Why Some Companies Make the Leap... and Others Don t. New York: HarperCollins Publishers, 2001.

66 First Who... Then What... they first got the right people on the bus, the wrong people off the bus, and the right people in the right seats and then they figured out where to drive it. Jim Collins Good to Great: Why Some Companies Make the Leap... and Others Don t. New York: HarperCollins Publishers, 2001.

67 Sue Stern Eric VasBinder Administrative Manager Automation Supervisor Primary Automation Line Operators 68

68 THANK YOU

Tailored automation solutions that fit. Automation system solutions component overview

Tailored automation solutions that fit Automation system solutions component overview Blood Banking Centrifugation Chemistry Flow Cytometry Hematology Hemostasis Immunoassay Information Systems Lab Automation