Clinical Pathology Quality Dashboard August 2013

Clinical Pathology Patient Care Quality Blood Bank Specimens The total number of errors for the month of July is higher than the average, but not markedly. The number of hemolyzed specimens has returned to the usual amount after a month of less than expected. Pathology is pursuing a two pronged approach to “specimen quality” in the ED. There is and has been ongoing discussions via Nursing Liaisons (Barb Wetula, RN, and Sheryl Woloskie) to addressing training for non-Pathology collected specimens. This focus has been on all of UMHS, with an emphasis on the ED. Marty Lawler (Pathology) is investigating possible deployment if additional Pathology personal in the ED POCT lab. These individuals would take over labeling and related issues.

Clinical Pathology Patient Care Quality Chemistry Parameters of observed data point changed from monitoring of “order to verify” to “received to verify” starting in June 2013. Due to variations of how specimens are ordered in the Emergency Department order to verify data has absurd data that is not indicative of any errors in process within the ED laboratory.

Clinical Pathology Patient Care Quality Hematology CBC & CBCD Turnaround Times (Received In Lab- Verified): Spot Comparison of Cerner in May 2013 vs. Soft in June 2013. Turnaround times for CBC and CBC with differential: Cerner versus Soft were compared. The data represent TAT from the time specimens were received in lab to times of verification.  TAT’s were predictably shorter due the deployment of “Auto-Receipt” (specimens are auto-logged into Received status by the instrumentation) concurrent with the deployment of Soft on June 1, 2013 TAT (in lab) after Soft deployment was shorter, but variation was greater. Performance will be reanalyzed after additional stabilization of Soft.

Clinical Pathology Patient Care Quality Microbiology TAT Goal ≤ 1 hour During the transition to the Soft LIS (Go-live; June 2, 2013) an increase in TAT was observed. This was attributed to downtime for the upgrade along with staff learning how to navigate effectively in the new system. July data indicates that operations have stabilized and TAT is back to normal levels.

Clinical Pathology Efficiency *Cost/adjusted discharge is the average cost per inpatient & outpatient discharge (Forty outpatient visits~ 1 hospital discharge). Pathology costs exclude: AP, Autopsy, blood products, specimen procurement, and Pathology Informatics. The Pathology percentage is the cost of an adjusted discharge that is contributed to by Pathology expenses.

Clinical Pathology Financials There was an increase in overtime hours worked during the run up to Soft go live (June 2, 2013). As the system stabilizes it is anticipated that staffing should return to normal levels.

Were Clerks and Receptionists helpful? Outpatient Phlebotomy Patient Satisfaction Survey 2012   Were Clerks and Receptionists helpful? Did Clerks and Receptionists treat you with courtesy? Did the person drawing your blood treat you with courtesy and respect? Did the person drawing your blood have success the first-try? Blood Draw Stations YES YES SOMEWHAT NO Briarwood Center for Women, Children and Young Adults 29 28 1 27 2 23 6 Briarwood Family Medicine 138 137 Briarwood Medical Group 103 18 105 16 109 13 Brighton Health Center 60 61 Cancer Center 827 3 837 21 841 19 828 Canton Health Center 97 98 101 Patients are queried annually via the Joint Venture Hospital Laboratories (JVHL) survey at all outpatient clinic blood draws stations. The phlebotomy areas have been a key focus area for Pathology relative to Service Excellence over the past several years.

2013 Quality Week Applicants Clinical Laboratory News, Notes, and Kudos ------------------------------------------------------------------------------------ Labs that are working on process improvement projects that would like to display data can contact Kristina Martin (martkris@umich.edu) for future dashboards. Kudos Sue Stern &Dr. Don Giacherio for implementing the EGFR calculation in Soft to meet the needs of nephrology physicians. 2013 Quality Week Applicants Lab Poster Blood Bank Implementation of Massive Transfusion Protocol-copartner with Transfusion Committee Chemistry PTHI platform and workflow change Hematology Better laboratory testing to optimize argatroban usage New LIS helps to eliminate manual scanning Screening technologists eliminate unnecessary pathologist reviews HLA Freezer reorganization Paper Reduction Quality Management Micro Blood Cultures and MALDI Respiratory Virus Implementation of Pre-Prostate Biopsy Screens Carbapenem Resistance Collaborative- copartner with MDCH and IC Pathology Clinical Pathology specimens collected in the OR Phlebotomy Outpatient-Improving Accuracy and Frist Time Quality of Cancer Center Lab Draws-copartner with Cancer Center Nursing C&W-Reducing Anxiety and Increasing Comfort for Blood draws in the Outpatient Area: Support staff training related to comfort strategies and coping skills-copartner with C & W Child Life Nursing POCT Improving Performance by Meeting Learning Needs of ACS Clinical Staff-copartner with Ambulatory Care