Sutter Solano Laboratory Lean Six Sigma Project “Getting Our Ducks In A Row” Joe Wells, MT, MA, Laboratory Supervisor Progress as of July 22, 2008

Business Process Management Key Process Mapping Clinical Laboratory Processes Pre-Analytical Process Analytical Process Post Analytical Process Collection Labeling Delivery Receiving Specimen Processing 2

Define: ProcessExpressSM Project Charter Business Case: Expected laboratory turnaround times are not being met for ER samples and early morning draws. This impacts laboratory customer satisfaction, patient care and finances. Problem Statement Sutter Solano laboratory is not consistently meeting stated turnaround times for ER samples and early morning draws. Variability in testing turnaround times is resulting in customer dissatisfaction.  Results for early morning draws should be on the charts by 7:30am for ICU and 8 am for Med/Surg. Target= 95% 2007 Average= 85%

Organizational Pillars Service TAT AM & ER Physician & Patient Satisfaction Quality Reporting Timeliness Order entry errors Drawing Issues Finance Workload Balance Variance Overtime People Employee Satisfaction (EOW) Growth Community

Define: Process Map Routine AM

Fishbone & Brainstorming Notes

Root Causes Initial “Just do its” List of patients with lines on floor Supported by data Phlebs start time does not allow for completion by goal time Many ER calls for draw throughout the day Process imperatives Communication of PIC line patients is key to decreasing time in early morning draws Batching in early morning rounds needs to be reduced Initial “Just do its” List of patients with lines on floor Pick up of specimens by morning CLSs ER sample rack Share patient satisfaction survey comments at staff meetings Eliminate 2 sets of labels printing Labels for UA sent to departments: 2-3 labels STAT notification: Dynamic pending log Quick reference on floors for order codes Update physician phone directory Back time (duplicate) IT fix Provide charge nurse cell phone number for critical values

Majority of phone calls deal with: Transfer, Information or Results Measure: Phone Calls Measure / Analyze Observations: Rounded with AM Phlebotomists on early morning collection Collected data on phone call interruptions & peak draw times Sample Lounges Wasted Steps Majority of phone calls deal with: Transfer, Information or Results

Improve: Brainstorming Results Weekends should be staffed as weekdays (7) Autoverification (6) If ER prints order just go (6) Nurse education (6) CLS help if phlebs are short (5) Schedule break times (5) Use volunteers to run ER samples to lab (5) Monitor for pending draws (4) Critical value call process (4) Lab personnel in ER during peak times (4) Change phleb times (and possibly techs) to start earlier (4) Revise parameters for 8am TAT report Buttons for line draws on floors Add ons added as a test Stat spin centrifuge for coag Have dedicated person to receive labs in computer Second microscope set for AM diffs Have techs drawing pre-AM ask if can combine draws Scanners for quick entry Redesign of Heme and Chem (in process) Slidemaker/Stainer Add call in phlebs

Dynamic Pending Monitor Improve: Solutions Implemented Dynamic Pending Monitor Standardized Phlebotomy Carts

Improve: Additional “Aha” Moments and “Just Do It’s” Fix lab intercom I-Stats in ER (Go-Live July 30, 2008) Phlebotomy carts standardized and ready for use in AM 2-way cell phone for ER communication (Coming soon!) Regular pick up times on floors for early morning draws and nurse draws Getting current SRMF list of doctors

How We Track Our Success- Daily Report Daily metrics tracking keeps everyone focused

Share Results & Celebrate! TAT target goal of 95% achieved, significant improvement from 2007 average of 85%

Between 1/6/2008 and 4/13/2008, the standard deviation was 5 Between 1/6/2008 and 4/13/2008, the standard deviation was 5.4 and between 5/25/2008 and 8/17/2008 the standard deviation was 2.4. This represents a 54% reduction in the process variation.

Patient Satisfaction Scores Improved patient satisfaction percentile rank from 15 to >60 within six months

Reducing Waste: 5 S Applied to Lab Closet After Before

Kan-Ban in Lab Supply Closet Before After

Lessons Learned Keep employees informed-communicate the good, bad and the ugly along with the project goals Make sure everyone knows their role and are included in the decision processes Simple rewards and reminders keep everyone aware that the process is always active-never stops just because we hit the mark Advertise to the facility-share the information and get other departments involved (IT, nursing, physicians, other hospital staff) Next Steps: Evaluation of Phlebotomy Morning Start Times (4:30am versus 5am) Evaluation of workspace in laboratory and potential options for reorganization of work stations for optimal efficiency Evaluation of inventory control and par levels Finalize FMEA for mislabeled specimens 18