Clinical PathologyQuality Dashboard

July 2009

Clinical Pathology Quality Dashboard

Inpatient Phlebotomy First AM Blood Draws University Hospital

0%

20%

40%

60%

80%

100%

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

2008 2009

8am

9am

10am

Drawn by

Mott Hospital

0%

20%

40%

60%

80%

100%

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

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%

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

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%

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

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 21,71420,986

21,651

0

5,000

10,000

15,000

20,000

25,000

30,000

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

2008 2009

Clinical Pathology Quality Dashboard

Turnaround Times

CSF Gram StainVolume and Turnaround Time

0

20

40

60

80

100

120

140

160

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

2008 2009

Mo

nth

ly V

olu

me

> 1 hour

30 min-1 hour

<30 minutes

TAT

Emergency Department Cardiac MarkerVolume and Turnaround Time

0

200

400

600

800

1000

1200

1400

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

2008 2009

Mo

nth

ly V

olu

me

> 2 hours

1-2 hours

<1 hour

TAT

Point of Care service began

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 Turnaround Time

0

5

10

15

20

25

30

35

Aug 07 - May 09

Pe

rce

nta

ge

Routines >60 min stat

>45 min In pt stat >45 min Out pt stat

UMHS Blood Product Utilization

Clinical Pathology Quality Dashboard

Crossmatch/Transfusion Ratio

1.3

1.4

1.5

1.6

1.7

1.8

1.9

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

2008 2009

Threshold

Wasted RBC

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

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

2008 2009

Threshold

Wasted Platelets

0%

2%

4%

6%

8%

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

2008 2009

Threshold

Wasted Plasma

0%

1%

2%

3%

4%

5%

6%

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

2008 2009

Threshold

Wasted Cryoprecipitate

0%

5%

10%

15%

20%

25%

30%

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

2008 2009

Threshold

Blood Product Utilization

0

1000

2000

3000

4000

5000

6000

7000

8000

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

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

AdjustedDischargesUnits Used

Clinical Pathology Quality Dashboard

CAP Proficiency Testing

4th Quarter FY 2009

Clinical Pathology 91 = Number of Challenges 92% = Satisfactory Results

Anatomic Pathology 0 = Number of Challenges N/A = Satisfactory Results

Department Total 91 = Number of Challenges 92% = Satisfactory Results

Clinical Pathology Scores

92

1009999.597

1009998

0

100

200

300

400

500

600

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

Nu

mb

er o

f C

hal

len

ges

50

60

70

80

90

100

Per

cen

t S

atis

fact

ory

FY2008 FY2009

Clinical Pathology Quality Dashboard

CP Financial Measures

Monthly Amount Paid to Southeastern Michigan American Red Cross

1,000,000

1,050,000

1,100,000

1,150,000

1,200,000

1,250,000

1,300,000

1,350,000

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

FY 2009

Do

llars

Clinical Path Tests per FTE and Total Tests By Month

1,000

1,200

1,400

1,600

1,800

2,000

Tes

t p

er F

TE

275,000

300,000

325,000

350,000

375,000

400,000

425,000

To

tal

Test

s

Tests per FTE Total Tests

Clinical Path Expense per Test*

$4

$5

$6

$7

$8

$9

$10

*excludes Blood Bank and Phlebotomy

Clinical Pathology Quality Dashboard

New Clinical Assays Added in Current Year

Iohexol by UPLC-LC-MS/MS

Ethyl glucuronide by EIA

CEBPA mutation detection; prognosis in AML

Direct detection/differentiation of methicillin-sensitive Staph aureus (MSSA) and methicillin-resistant Staph aureus (MRSA) from blood cultures

Mycobacteria sp.-automated detection system

Many others listed in March-June dashboards

• Lean Process Improvements – Many!

• Work – station specific safety signs

• Blood Product Utilization Lean Team - Tim Laing, M.D. (OCA), Lead

Clinical Pathology Quality Dashboard

Clinical Laboratory Operations Initiatives

• Multiple new clinical assays (see list)

• Integrated hematopathology reports

• Improved turnaround times - hematopathology

Clinical Pathology Quality Dashboard

Clinical Laboratory Service Enhancements