Vancouver Coastal Health

Transcription

1 Effective Use of Automated Capture Panels and ImmuLINK for Cross-Site Antibody Identification Transfusion Medicine Transformation at Vancouver Coastal Health (VCH) Heather Mah, Regional Technical Practice Lead VCH Vancouver, Canada Immucor User Group 2016 Oakland California 1 Vancouver Coastal Health Province of British Columbia 357,000 sq miles ( California 163,700 sq miles) 4.5 million pop. Six Government funded Health Authorities administer health services Vancouver Coastal Health 2 Vancouver Coastal Health PHC Whistler PRGH SGH SMH LGH UBCH VGH RH 1

2 Service Delivery Model 46,000 T/S annually 7,000 T/S annually Lions Gate Hospital Average travel time from LGH for urgent antibody investigation samples is 67 minutes via the Lions Gate Bridge 7,000 T/S annually Vancouver General Hospital VGH serves as a hub site for 10 facilities Richmond Hospital 4 VCH TM Transformation Goals 2013/14 More effective automation for large hub site Lean workflow Scalable automation appropriate for community hospitals Centralized data management Efficient cross-site antibody identification 5 Better Automation at VGH Expanded test menu including testing of AI panels (T/S, ABR1, XM, panels, donor unit confirm,) Large through-put Continuous access to load and unload samples and reagents at any time Dynamic scheduling - run tests in any order 6 2

3 LEAN Principles Application VGH Original State 7 LEAN Principles Application VGH LEAN = Eliminating waste, cycle time reduction for STAT Group and Screen Testing Create a value-stream map of the original state Develop new workflow to reduce non-value added time Redesign bench configuration and analyzers placement Move NEO s to new location /Add Echo Measure various parameters to assess benefits. 8 LEAN Principles Application VGH ECHO 9 3

4 LEAN Principles Application VGH 10 LEAN Principles Application VGH Parameter Original State Renewed State Total travel distance 433 sq ft 145 sq ft Employee travel time to check results 1.25 hrs/day 0 hrs/day TAT for T/S from ER 1 hr 10 min (average for first 8 months) 1 hr 5 min (average since repositioning of NEOs) TAT increased at implementation 11 Scalable Automation ECHO Efficiency gains at LGH and RH Improved standardization of test set up and reading Opportunity to shift some Antibody Identification testing closer to patient 12 4

5 Centralized Data Management ImmuLINK 13 Centralized Data Management ImmuLINK NEO and Echo (Immucor) Analyzers ImmuLINK middleware allows web-based review of data from multiple instruments VNEO1 VNEO2 VIMLNK LIMLNK LECHO1 RIMLNK Sunquest ImmuLink server RECHO 14 ImmuLINK Implementation Process VCH MULTI-SITE TMS ANALYZER IMPLEMENTATION TIMELINE Dates: May 1, 2013 to July 31, 2014 List of Activities Days Jul/13 Jan/14 Jul/14 Implementation Processes at VCH NEO/ECHO Installation and Validation - VGH/LGH 98 VGH/LGH Analyzers & ImmuLINK LIVE KDC LIVE 20-Mar-2014 RH ECHO LIVE 15-Jul-2014 ImmuLINK Installation and Setup Nov-2013 Sunquest Software Development 63 1 ImmuLINK and Sunquest Configuration/Testing 49 2 Document Creation - Operating Procedures 161 Document Creation - Test Scripts 56 NEO and ImmuLINK Training - VGH 56 3 ECHO and ImmuLINK Training - LGH 119 ImmuLINK Virtualization at KDC 49 4 Security and Privacy Review Process 133 KDC ImmuLINK Server Installation and Validation 66 ECHO Installation and Validation - RH 28 ECHO and ImmuLINK Training - RH 64 * VGH - Vancouver General Hospital LGH - Lions' Gate Hospital RH - Richmond Hospital 15 5

6 ImmuLINK Implementation Challenges 4 ImmuLINK Virtualization Kamloops Data Center (KDC) Lack of redundancy, backup, and support on ImmuLINK server hardware Initiate plans to virtualize the server to KDC Application to HSSBC privacy office for review to fulfill security and privacy concerns Re-validation of ImmuLINK at KDC 16 Effective Use of Automated Capture Panels and ImmuLINK for Cross-Site Antibody Identification 17 Efficient Antibody Identification Reagent Panels Pre-dispensed Stable for 120 days from manufacture 3 different solid phase panels Easy to use on automated platform (automated panels) Assay TAT = 27 minutes on Echo 69% of investigations can be completed using only these panels 18 6

7 Automated Panels for AI Antibody investigations Can be performed using only automated panels 69% of the time (N=489) 19 ImmuLINK NEO and Echo (Immucor) Analyzers VNEO1 VNEO2 ImmuLINK middleware allows web-based review of data from multiple instruments Sunquest VIMLNK LIMLNK RIMLNK ImmuLink server RECHO LECHO1 20 ImmuLINK - Multiple Sites Test site LGH - panel results viewed at VGH 02:12 01:

8 ImmuLINK - Multiple Sites Report from ImmuLINK - Test site LGH (02:12) - Retrieved & interpreted at VGH (02:30) 22 ImmuLINK - Multiple Sites Sample arrives at VGH 02:45 Report from ImmuLINK - Anti-Fya interpretation at VGH (3:20 AM phone report to LGH) 23 LEAN Principles Application VCH LEAN = Eliminating waste, cycle time reduction for STAT Group and Screen Testing Create a value-stream map of the original state Develop new workflow to reduce non-value added time and incorporate technology enhancement Implement new workflow at LGH and VGH Measure TAT for urgent antibody investigations for 10 weeks to assess the benefit. 24 8

9 Cross-Site AI: Original State New Positive Antibody Screen LGH Activities Travel time = Waste Mean TAT for urgent crosssite antibody investigations was 4.6 hours. Target TAT is 4 hours. VGH Activities Complete Forms Notify VGH Package & and Send out Sample First Antibody ID Panel by Manual GEL Secondary Panels Phenotyping Report to LGH Start 2 hours 4 hours 1 hour 3 hours 5 hours 25 Cross-Site AI: Improved TAT New Positive Antibody Screen LGH Activities Change in mean TAT to 3.3 hours from 4.6 hours for original state First Antibody ID Panel Notify VGH Package & and Send out Sample First Panel Secondary Panels - typing Report to LGH VGH Activities First Panel Print Immu- LINK report First Panel Exclusions Secondary Panels Phenotyping Repo rt to LGH ImmuLINK Report Start 2 hours 4 hours 1 hour 3 hours 5 hours 26 9

10 Measure cont d 34 urgent antibody investigations with cross-site collaboration Specificity assigned in 59% of cases as indicated in table SPSA = pan-reactive, negative DAT, negative PEG Unidentified = exclusions complete, unexplained reactions in solid phase and/or PEG 28 Measure cont d 38% of the cases had nonspecific reactions (mean TAT for this group 3.1 hours) Immucor acknowledged higher rates of equivocal and unexpected results with Capture reagents Potential impact on patient care and additional resources Negates some of the benefits of panels and ImmuLINK for cross-site AI. SPSA = pan-reactive, negative DAT, negative PEG Unidentified = exclusions complete, unexplained reactions in solid phase and/or PEG 29 Conclusions Benefit of new workflow and technology was a change in mean TAT to 3.3 hours from 4.6 hours for original state 1 st panel results available to VGH via ImmuLINK shortly after referral by LGH and before arrival of sample Opportunities to further decrease TAT by testing with additional Ready-ID panels at referring sites 30 10

11 Conclusions VGH staff noted a reduction in hands-on time and TAT to complete the investigations LGH staff is pleased to have more involvement in the AI process and have ability to perform preliminary analysis of the first panel 31 Referral Antibody Investigation Flow RH / LGH Process NEW Positive Antibody Screen requiring STAT AI Process Run Ready-ID on ECHO STAT Order VAI* Test in Sunquest Ensure timing of Panel Completion is recorded Complete Referral AI Request Form Fax & Phone request for STAT AI to VGH Order Additional Samples if needed Package Samples for Sendout If Patient still at RH / LGH... Send out samples via CAB or COURIER Receive Call and run requested panel onto ECHO STAT Phone VGH when testing complete Crossmatch Units, Phenotyping as required RH / LGH to order Phenotyped Units if required Fax & Phone SAMPLES VGH Process received from RH / LGH, note time of Panel Completion Print Panel & Screen Report from ImmuLINK Perform Exclusions and Initial Conclusion If Additional Solid Phase Panels are... Required and if Samples have... Wait for NOT Arrived Arrived Contact RH / LGH to perform panel testing Samples arrive at VGH Complete AI Process Phone RH / LGH with Final Results Not Required Samples to arrive * RH use STAT priority LGH use Urgent priority 32 Transformation Goals Accomplished More effective automation for VGH LEAN workflow Scalable automation appropriate for LGH & RH Centralized data management - ImmuLINK Efficient cross-site antibody identification 33 11

12 Working Collaboratively with Immucor Issue: Files with multiple Master Lists (ML) Each of the 3 sites may have different Capture-R Ready-ID panels in use Potential for error when selecting (ML) on which to transcribe results from ImmuLINK report Time consuming to transcribe results 34 Working Collaboratively with Immucor Proposed ImmuLINK enhancements: 1. Panel Identification System selects lot number of panel ImmuLINK report results print on Master List 2. Algorithm for rule outs 3. Manual panels Save and store in data base Useful for select cells 35 Acknowledgements Executive Sponsor Medical Leads Technical Supervisor (VGH) Project Managers LIS Technical Support/Trainer Technical Support/ImmuLINK LEAN Project K/O Trainers, Site Champion Learning and Ideas Richard Walker Dr. Kate Chipperfield, Dr. Kristine Roland Pam Danesin Ellie Sheng (LIS) Heather Mah (Lab) Steve Arai Luca Rizzetto Lawrence Sham Margaret Walsh Pam Danesin, Kate Chan, Shelley Tapp (LGH) Teresa Sharp (RH) All staff! 36 12

13 Thank you Questions? 37 13