Leveraging Enhanced Specimen Management to …€¦ · · 2017-04-02Leveraging Enhanced Specimen Management to Achieve ... strategy lately? • Have you made or considered making

Path to the hear t o f hea l thcare

Leveraging Enhanced Specimen Management to Achieve

Strategic Goals and Boost Financial Performance

Megan Schmidt and Pawan Singh

Product Management

Sunquest Information Systems

© 2012 Sunquest Information Systems, Inc. | Confidential and Proprietary

Dear CxO,

• Do you have a strategy around specimen

management at your institution?

• Have you reviewed your specimen management

strategy lately?

• Have you made or considered making capital

investments in the area of specimen

management?

• Are you and your Lab leadership in synch on the

institutional needs and plans for specimen

management?


Goals for the Presentation

Convince CxOs to have a real strategy and

visibility around Specimen Management

– Discuss solutions and outcomes

– Demonstrate impact on future expansion

• ACO

• Molecular

• Digital Pathology


Agenda

• Define Enhanced Specimen Management

• Operational Benefits • Patient Safety

• Efficiency (Cost)

• Return on Investment

• Strategic Value • ACO

• Molecular

• Digital Pathology

• Q&A


Laboratory

Extends beyond the four walls of the lab

Specimen Lifecycle


Specimen Flow

Collection

Lab Testing

Storage/Discard


Enhanced Specimen Management

• Safe, Efficient, Effective handling of samples …

– From sample collection to storage (or discard)

– Throughout the pre-analytical, analytical and post-

analytical steps of the workflow

– Regardless of sample type (blood, tissue, etc.)

– Irrespective of the testing modality (AP, CP, etc.)

• The topic of bio-banking is not covered in this

presentation (but related)


It Only Takes One Mistake…

Johnson v The Methodist Hospital (2006)

• Patient tested positive for HIV during eighth month of

pregnancy

• Blood sent to Quest by Methodist

• Test was correct but Methodist had mislabeled

• Patient and baby were treated unnecessarily

• $50,000 damages awarded

Source: http://caselaw.findlaw.com/tx-court-of-appeals/1394508.html

http://caselaw.findlaw.com/tx-court-of-appeals/1394508.html









Navickas v. Unemployment Compensation Review

Board (2001)

• A higher standard of care applies to health care workers

and, therefore, the inadvertent failure of a phlebotomist

to label a patient's blood sample in accordance with

hospital procedure constituted willful misconduct

Source: http://caselaw.findlaw.com/pa-supreme-court/1086443.html

http://caselaw.findlaw.com/pa-supreme-court/1086443.html






NY Daily News (2009)

• New York City man sues hospital and three

doctors for negligence

• Erroneously diagnosed for cancer and

underwent radical mastectomy erroneously

• Allegedly due to biopsy sample mixed up with

another patient

Source: http://www.nydailynews.com/new-york/cruelest-cut-28-year-old-man-mastectomy-finds-didn-breast-cancer-article-1.408952

http://www.nydailynews.com/new-york/cruelest-cut-28-year-old-man-mastectomy-finds-didn-breast-cancer-article-1.408952





























Manufacturing Mindset


A systematic approach to

minimizing defects and costs

by controlling waste and variance

in a production process.

Lean, Six Sigma


Defects rework

Overproduction Resolving low priority as quickly as high priority

Waiting Idle and process

time

Not Using Talent

Mismatched skill sets and activities

Transportation Sample movement

Inventory Unused people

capacity

Motion Lack of standard

protocols

Extra Processing

Lack of automation

Typical Sources of Waste


Opportunities in AP and CP Labs

• Defects

– Misidentification

– Misplaced Specimen

– Sample mix up

• Waste

– Batch Label Printing

– Relabeling

– Manual Steps that could be automated


Specimen Lifecycle


• Gilbert v R. J. Taylor Memorial Hospital (218 Ga.

App. 399) 1995

Patient underwent a left breast biopsy to test for malignancy. The

tissue specimen was lost during transportation. Due to lack of

diagnostic information, the patient received cancer therapy that

included a lumpectomy, lymph node dissection, and radiation

therapy.

The hospital admitted negligence in losing the tissue sample.


Specimen Management at the Point

of Collection

• Positive Patient ID

• Instant Specimen Label

• Electronic Order to Lab

• Track Collection to Accession

Collection Management

at PoC

CP Lab AP Lab


Barcode Labeled from the get-go


SPOT= Specimen Point of Tracking

The Concept of SPOTs


3

1

2

SPOTs Defined Controlled Access

Real-time Tracking and Intelligence

End User Compliance


Specimen Routing and Workflow

• Ability to define ‘rules’ for a given sample

– SPOTs

– Activities

• System enforced rules, hints, record deviations

• Real time case progress, management reports

and dashboards for benchmarking and trending


+ +

= Safe, Consistent, Efficient

Handling of Specimen

Barcoding Routing Tracking

Comprehensive Solution Set

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38.3 40.0

41.8 42.0 40.0

35.8

32.2

25.0

30.0

35.0

40.0

45.0

50.0

55.0

60.0

65.0

Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10

Av

g.

Min

.

Phlebotomy STAT IP Collection TAT's (goal <30 min)

• Part of a 7 hospital system in Central Florida

• FH Orlando >1,000 beds

• Core Lab and Specialty Labs: Micro, Histology, Serology, Infectious

Disease, Molecular Diagnostics

FHO Collection Times


• Efficiencies – Handling an outside specimen reduced from 5 minutes to 1 minute.

– 50,000 outside samples a month = annual benefit over one million dollars.

• Quality – LIS tracking functionality reduced misplaced specimens from 10 a day to 0,

– Eliminated 25 minutes per misplaced specimen previously required to find them

• Turn Around Time – Route optimization resulted in 30% reduction in turnaround times for lab tests

– Added over 40% more capacity as a result, while actually reducing FTE

Outcomes at Gaston Memorial


LEAN Experience at MGH

Results:

• Reduced average routine surgical TAT from 48 hr to 20 hr

• Reduced average Biopsy TAT from 24 hr to 16 hr

• Reduced overtime from 3.5 FTE’s to 0.97 FTE’s

• Improved morale

Histology Redesign Project

MGH incorporated Lean concepts of workflow analysis, re-design, standardization, including a barcode system.

Thomas M. Gudewicz, MD Massachusetts General Hospital

Harvard Medical School


Quality Focus at Henry Ford

Results:

• Implemented 1,128 process improvements on their main campus including 150 in AP

• Reduced overall misidentification case rate by 62%, with 95% reduction in the more

common slide misidentification defects

• Increased throughput at histology microtomy station by 125%

• The number of routine biopsies completed in a single day improved from 73% to 92%

Barcoding with AP LIS

Henry Ford implemented barcoding along with their AP LIS to streamline workflow and employ an overall quality program.

“ Integration of the barcode technology into the histopathology labeling

process has resulted in process improvement by saving time and reducing

errors.”

– Dr. Mark Tuthill, Division Head of Pathology Informatics,

Henry Ford Health System


ACO Definition and Goal

• Accountable Care Organizations (ACOs) are groups of doctors,

hospitals, and other health care providers, who come together

voluntarily to give coordinated high quality care to their Medicare

patients.

• The goal of coordinated care is to ensure that patients, especially

the chronically ill, get the right care at the right time, while avoiding

unnecessary duplication of services and preventing medical errors.

http://www.cms.gov/


Why Specimen Management Matters

• ACO’s will deal with large specimen volumes

– 84% of Medicare patients are 65 or older

– 65 or older require 4-5 times more lab tests

• Existing error rates present risk and opportunity

– 160,000 adverse patient events/year from

misidentification or labeling errors (Ford CAP Today 2005; 19:34-40)

– Manually labeling items and batch-match tasks

produce 0.1 - 3% mislabeling/mismatch error rate (Balis. Advance Sept 2005 p86)


• $15bn - $25bn projected for Molecular and Genetic testing in 2021 (United Healthcare Study, 2012)

• Global genetic testing market is forecast to grow at an annual rate of approximately 26% between 2012 and 2015

(Global analyst RNCOS, “Global Genetic Testing Market Forecast to 2015”, Oct 2012)

Growth in Molecular Testing


Molecular: Sample Management

Increased need for …

• Sample sharing across pathology

• Sample retrieval for repeat/additional testing

• More complex sample prep

– Track and record reagents, process steps and QC

– Sample multiplexing and pooling

– Sample rework and confirmatory testing

• Tracking of send outs


Digital Pathology

Slide ID and Barcode start to matter, again


In Summary

Enhanced Specimen Management needs to be a CxO

agenda item because it is a catalyst for …

Patient Safety

Efficiency: Cost Savings

Future Expansion

Successful roll out and adoption requires change management, commitment and buy-in at all levels of the organization


Questions?

Documents

Leveraging Enhanced Specimen Management to …€¦ · · 2017-04-02Leveraging Enhanced Specimen Management to Achieve ... strategy lately? • Have you made or considered making