improving efficiency in clinical laboratory dr farooq ghani aga khan university

Improving Efficiency in Clinical Laboratory

Dr Farooq Ghani

Aga Khan University

The FUTURE of

Clinical Laboratory Medicine

Farooq Ghani, M.D.,Ph.DDirector, Bayer HealthCare

Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

Over 70% of Healthcare Decisions are based on

Medical Tests

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

Clinical Lab Process Improvement

• Online connectivity of the main lab to11 regional labs and 187 phlebotomy centers throughout the country

• Barcoding samples at collection site

• Lab Automation

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

Online Connectivity & Barcoding

Routine Lab Practice

Blood Samples

Whole blood

Serum based / plain blood

~25 %

~75 %

Chemistry / Immuno chem

Other assays

~ 90 %~ 10 %

Hematology

Automation

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

• “The first rule of any technology used in an organization is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency”

Bill Gates

Increase

Capacity

Faster

TAT

Personnel Optimisati

on

Space

Utilization

Reduce

Errors Laboratory Automation

Resulting18%

Loading4%

Troubleshooting4%

Documentation5%

Delivery4%

Testing13%

Sorting6%

Accessioning27%

Aliquoting15%

Centrifugation4%

Frontend52%

High Gain Opportunities

Turnaround Time

Fewer steps equalfaster, more consistentturnaround

Productivity Increases

Costs&

TAT

• Samples manually logged into laboratory

• Verification of Collectionat LIS

• Load individual tubes intocentrifuge

• Centrifuge Samples• Unload each tube from

centrifuge• Split samples for separate

workstation• Distribute samples to each

workstation• Visualize Serum Indices• Check QC• Load sample tube on wheel• Results validated and

verified at LIS• Samples Stored• Delta Checking• Program tests not validated• Rerun tests not validated• Identify samples for reflex

testing• Reflex Testing

• Samples manually loggedinto laboratory

• Verification of Collectionat LIS

• Load racks into centrifuge• Centrifuge samples• Unload racks from

centrifuge• Place racks on analyzer• Rerun tests not validated• Identify samples for reflex

testing• Reflex Testing

• Samples placed into inletstation

• Place racks on analyzer• Rerun test not validated• Reflex Testing

automatically• Samples stored

• Samples placed into inletstation

• Review by exception• Samples stored

Current LabProcess

System-BasedAutomation

DiscreteAutomation

ConnectedAutomation

17 Steps

9 Steps

5 Steps

3 Steps

Goal: Reduce Costs and Turnaround Time

Steps Automated in the Diagnostic Laboratory

Pre-AnalyticalPost-Analytical

prepare order

transport to lab

collect sample

accession sample

centrifuge

decap tubes

pre-sort/aliquot

transport to analyzertechnical validation

Sample retrieval

store samples

dispose of waste

post-sort

transmit test results

Analytical

Receive into lab

Sort Sampletubes

EDTA tubes

Load centrifuge

Unloadcentrifuge

DecapLabel

aliquottubes

Aliquot Sort

Load onanalyzer

Verify atLIS

Unloadanalyzer

Recaptube

Archivetubes

Storeracks

Walk toanalyzers

Load analyzers

Locateexceptions

Verifyat LIS

Rerunexceptions

Verify/Manage

exceptions

Unloadanalyzers

Walkto storage

area

Recaptubes

Findtube

Archivetubes

Storeracks

Pre-Analytics (100% of tubes / >50% of labor)

Post-Analytics (100% of tubes / 8% of labor)

Exceptions (10% of tubes)

XX

X

Track

XXX XX XX

Informatics

X X X XX X X

Tube Storage & Retrieval

X X X X X X XPre-Analytics

Load inInput Queue

Solutions to Streamline the Process

Process Mapping

• Analyze your processes

• Identify opportunities

• Eliminate waste

Understanding your Processes

Metrics for Success

California Hospital Medical CenterTotal Samples by Hour - Thursday, Jan 6, 2005

318 Routine, 238 STAT

6 5 4 4

2 2 3

13

20

16

23

11

17

14

18

9

4

16

6

14

11

8

2

10

2

0

5

30

15

51

45

10

6

9

13

8

8

32

9

12

13

7

11

7

1 7

8

9

8

5

34

17

53

48

23

26 25

36

25

46

27

21

17

23

17

21

12

15

10

1919

9

0

10

20

30

40

50

60

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Hour of Day

Nu

mb

er o

f S

amp

les

STAT Routine

• Tube Arrival• Test/TubeCalifornia Hospital Medical Center

Tests per Tube DistributionJan. 3 through 10, 2005

33%

6%

2%

1% 1%

2%

27%

8%

7%

1% 1% 0% 0%

4%

1%

2%

1%

1% 0% 0% 0% 0% 0%

20%

7%

1% 2%

1%

2%

21%

15%

3% 3% 4%

3%

4%

6%

2% 2%

3%

1% 1% 0% 0% 0% 0%

0%

5%

10%

15%

20%

25%

30%

35%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Number of Tests per Tube

Fre

qu

en

cy

Routine

STAT

Estimated Annual IA Volume by Order/Assay

2,52

5

275

7,15

0

3,70

0

306

104

160

357

1,20

0

0

2,35

0

100

1,39

2

3,07

5

450 82

5

300

41

8,47

5

2,45

0

0 0

2,27

4

3,69

2

208

4,42

0

4,16

0

52 260

52

364

52 156

156

1,19

6

3,48

4

104 46

8

52 156

10,2

44

468 676

572 93

6

1,71

6

0

2,000

4,000

6,000

8,000

10,000

12,000

BN

P

CA

RB

AM

CK

CK

MB

FO

LAT

E

FR

EE

T3

FT

4

HB

SA

B

HB

SA

G

HC

GQ

L

HC

GQ

N

HC

YS

T-A

RU

P

HE

PF

PN

L

MY

OG

LOB

IN

PS

A

RU

BG

-NH

MC

T3

T4

TR

OP

ON

IN

TS

H

VAN

CO

P

VAN

CO

RD

M

VAN

CO

T

Order/Assay

Nu

mb

er o

f O

rder

s p

er Y

ear

Stated

Extrapolated

• Testing Volume Histogram of Sample TAT: Order to Result Verified

0.00

5.00

10.00

15.00

20.00

25.00

30.00

-3.647656257to

25.156249993

25.156249993to

53.960156243

53.960156243to

82.764062493

82.764062493to

111.567968743

111.567968743to

140.371874993

140.371874993to

169.175781243

169.175781243to

197.979687493

197.979687493to

226.783593743

226.783593743to

255.587499993

255.587499993to

284.391406243

Minutes

Num

ber

USL 60.00Cp -0.16

Cpk -0.16

Pp -0.11

Ppk -0.11Cpm 0.15

Stdev 48.24Max 255.59

Min 25.16

Zbench -0.34CpkU -0.16

ZTarget 0.22

%Defects 0.59

%Expected 0.63DPMO 586206.90

Expected 631608.88

Mean 76.21Median 62.89

• TAT Analysis

• TAT AnalysisACCELERATOR

Automated Processing System

Chemistry Sample TAT by Hour of Day

0

10

20

30

40

50

60

0:00 3:00 6:00 9:00 12:00 15:00 18:00 21:00 0:00

Arrival Time

TA

T (

min

)

RoutineSTAT

St. Dev.

CC TAT Summary

Mean

Routine STAT

36.0 29.4

3.6 2.9

• Capacity Planning

ACCELERATORARCHITECT® c8000™ Throughput Utilization

2%

1% 2%

0%

0% 2

%

2%

31

%

44

%

30

%

29

%

26

%

14

%

13

%

10

%

6%

6%

11% 13

%

4%

8%

1% 2%

1%

0%

20%

40%

60%

80%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Hour of Day

Pe

rce

nt

of

To

tal C

ap

ac

ity

At Risk

At Target

Target

• Efficiency

Core Lab

Regional Labs

Satellite Labs

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

ADVIA® Automation

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

ADVIA® Automation Solution User Outcomes

2004 2006 2007 2008

Reporting errors

60%reductionin error

Individual results may vary.

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

lthcare Diagnostics Inc.

Process Efficiency

$1,600savings

%

100

75

50

25

Aliquots

98%reduction

Tubes (thousands)

5

4

3

2

Primary tubes

1

Source: ACM

Individual results may vary.

Technology Adoption Life Cycle

0

25

50

75

100

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

The FUTURE of



Tarrytown, New York

Thank You

improving efficiency in clinical laboratory dr farooq ghani aga khan university

Documents

validatedidentify samples

countrybarcoding samples

centrifugesplit samples

lisload racks

analyzerrerun tests

centrifugeplace racks

process efficiency

inlet stationplace racks