Clinical PathologyQuality Dashboard

April 2009

Clinical Pathology Quality Dashboard

Inpatient Phlebotomy First AM Blood Draws University Hospital

0%

20%

40%

60%

80%

100%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2008 2009

8am

9am

10am

Drawn by

Mott Hospital

0%

20%

40%

60%

80%

100%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2008 2009

8am

9am

10am

Drawn by

Clinical Pathology Quality Dashboard

Inpatient Phlebotomy First AM Blood Test Results:

PT/PTT, CBCP, and Comprehensive Panel University Hospital

0%

20%

40%

60%

80%

100%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2008 2009

0

100

200

300

400

Av

g D

ail

y V

olu

me

8am

9am

10am

Results by

Mott Hospital

0%

20%

40%

60%

80%

100%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2008 2009

0

2

4

6

8

10

12

Av

g D

ail

y V

olu

me

8am

9am

10am

Results by

Inpatient Phlebotomy DrawsFiscal Year 2009

Clinical Pathology Quality Dashboard

21,182

23,348

19,773

26,062

19,75920,459

19,598 19,795

21,992

0

5,000

10,000

15,000

20,000

25,000

30,000

July Aug Sep Oct Nov Dec Jan Feb Mar

2008 2009

Clinical Pathology Quality Dashboard

Turnaround Times

Emergency Department Cardiac MarkerVolume and Turnaround Time

0

200

400

600

800

1000

1200

1400

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2008 2009

Mo

nth

ly V

olu

me

> 2 hours

1-2 hours

<1 hour

TAT

CSF Gram StainVolume and Turnaround Time

0

20

40

60

80

100

120

140

160

April May June July Aug Sept Oct Nov Dec Jan Feb Mar2008 2009

Mo

nth

ly V

olu

me

> 1 hour

30 min-1 hour

<30 minutes

TAT

Clinical Pathology Quality Dashboard

Molecular Diagnostics Laboratory

Specimens Received and Turnaround TimeJanuary 2002 - December 2008

0

200

400

600

800

1000

1200

1400

January2002

July 2002 January2003

July 2003 January2004

July 2004 January2005

July 2005 January2006

July 2006 January2007

July 2007 January2008

July 2008

Month/Year

# of

Spe

cim

ens

rece

ived

0

1

2

3

4

5

6

7

8

9

10

TAT

(day

s)

# Specimens TAT Linear (# Specimens) Linear (TAT)

Clinical Pathology Quality Dashboard

Chemistry In-Lab Turnaround Times

Sample Turn-Around Time

0

5

10

15

20

25

30

35

Aug 07 - Mar 09

Per

cent

age

RT ST> 60 min IP ST> 45 mins. OP ST> 45 mins

Clinical Pathology Quality Dashboard

New Clinical Assays Added in Last Year

Yeast identification system: (Vitek II automated)Yeast antimicrobial susceptibility: (Vitek II automated)EBV viral loadHIV-1 quantification (COBAS Ampli Prep – COBAS Taqman)

(includes extraction, amplification)MRSA surveillanceVRE surveillanceC.difficile surveillanceBCR/ABL1 Kinase Mutation Analysis (Sequencing)Human Erythrocyte Antigen Genotyping (Microarray analysis)IGH/BCL2 Translocation Detection (Real-time PCR)JAK2 V167F Mutation Detection (Allele-specific PCR)KIT D816V Mutation Detection (Allele-specific PCR)KIT Mutation Detection for GISTKIT Mutation Detection of MelanomaNPM1 Mutation Detection (PCR w/ capillary electrophoresis

detection)Microsatellite instability analysisPML/RARA t(15;17) Translocation Detection (Real-time PCR)Urovysion – FISH, Bladder Cancer DetectionHER2 Amplification – FISH, Breast CancerUGT1A1 Promoter GenotypingK-Ras Mutation Detection 1,25 Dihydroxy vitamin DSensitive beta-2 transferrin assay

UMHS Blood Product Utilization

Clinical Pathology Quality Dashboard

Blood Product Utilization

0

1000

2000

3000

4000

5000

6000

7000

8000

Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

2008 2009

0

1000

2000

3000

4000

5000

6000

7000

8000

Pa

tie

nt

Po

pu

lati

on

Random Platelets

Allo RBC Units

Plasma Units

Cryo Units

Partial Units

SD Platelets

AdjustedDischarges

Units Used

Crossmatch/Transfusion Ratio

1.3

1.4

1.5

1.6

1.7

1.8

1.9

Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar

2008 2009

Threshold

Wasted RBC

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar

2008 2009

Threshold

Wasted Platelets

0%

2%

4%

6%

8%

Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar

2008 2009

Threshold

Wasted Plasma

0%

1%

2%

3%

4%

5%

6%

Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar

2008 2009

Threshold

Wasted Cryoprecipitate

0%

5%

10%

15%

20%

25%

30%

Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar

2008 2009

Threshold

Clinical Pathology Quality Dashboard

CAP Proficiency Testing

3rd Quarter FY 2009

Clinical Pathology24 = Number of Challenges

100% = Satisfactory Results

Anatomic Pathology0 = Number of Challenges

N/A = Satisfactory Results

Department Total24 = Number of Challenges

100% = Satisfactory Results

Clinical Pathology Scores

0

100

200

300

400

500

600

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr

Nu

mb

er

of

Ch

all

en

ge

s

50

60

70

80

90

100

Pe

rce

nt

Sa

tis

fac

tory

FY2008 FY2009

Clinical Pathology Quality Dashboard

CP Financial Measures

*excludes Blood Bank and Phlebotomy

Clinical Path Expense per Test*

$4

$5

$6

$7

$8

$9

$10

Total Expense per Test

Clinical Path Tests per FTE and Total TestsBy Month

1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

1,800

1,900

2,000

Tes

t p

er F

TE

275,000

300,000

325,000

350,000

375,000

400,000

425,000

To

tal T

ests

Tests per FTE Total Tests

•Discontinue Cancer Center Hematology Lab (move to Main Lab) – Will Finn, MD, lead

•Improvement of Critical Value Callback process – Brenda Schroeder, lead

•Impact of Earlier AM Blood Draw in UH – OMS 490 students and Holly Eliot, leads

•Improvement of Communication with Patient Care Units – Beverly Smith and Brenda Schroeder, leads

•Customer Service Initiative – Beverly Smith, lead

•Lab Formulary Committee – Office of Clinical Affairs, FGP, Pathology

•Lean Process Improvement Projects – many!

•Laboratory Safety focus – Brenda Schroeder, lead

•Improvement of Blood Draw Wait Times- Cancer Center- Taubman 2- Taubman 3

•Creation of Blood Product Utilization Lean Team – Tim Laing, MD, (OCA), lead

Clinical Pathology Quality Dashboard

Clinical Laboratory Operations Initiatives

•Clostridium difficile toxin screening algorithm – 1/09

•On-demand unit-specific antibiograms – 2/09

•Expedited (rules – based) release of ANCs (absolute neutrophil counts) – 2/09

•Integrated hematopathology reports – 2/09

•Troponin point-of-care (ED) – 3/09

Clinical Pathology Quality Dashboard

Clinical Laboratory Service Enhancements

Kudos

Clinical Pathology Quality Dashboard

• Thank you to the Phlebotomy Team and Harry Neusius; Julius Alexander and John Hamilton (Pathology Informatics); Tom Morrow, Brenda Schroeder, John Perrin, and Holly Eliot (Pathology Administration) for their excellent work with Ross Business School OMS 490 students – in the development of a new tool to better match early AM blood drawing resources with service demand.

• Thank you to the Chemistry Lab and the Emergency Department Point-of-Care Lab for implementation of rapid troponin assay in the ED. See the marked improvement in ED Cardiac Marker TAT!

• Congratulations to Drs. Lloyd Stoolman (Pathology) and Matthew Velkey (Cell and Developmental Biology) who received one of only five University of Michigan Provost’s 2009 Teaching Innovation Prizes – for the project entitled “Virtual Microscopy for Life Sciences Education”! More than 100 projects were nominated. Please see the Pathology Website for a link to a more detailed description of this outstanding innovation.