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Petri Dishes R.I.P.? How Automation, LEAN, and Real Time Dashboards are Transforming Workflow in Microbiology

By Anne Beall

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Objectives !! Have exposure to “New Technology” in Microbiology

!! Understand why Change is necessary

!! Understand that the “metric” of time can be used in microbiology

!! People are important to the process

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Across the industry today, Clinical Laboratories have been Leaned,

Automated and Measured for Performance with the Exception of

Microbiology

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Today Health Care Pressures are causing Lab Directors to turn their focus on Microbiology Operations

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Today’s Microbiology Operations !! Processes are largely

manual

!! Critical shortage of skilled technologists

!! Microbiology has remained unchanged in the last 30+ years.

!! What will happen to the Petri Dish?

Far Side: Gary Larson 1989:136 5

Change is Here and More is Coming

Technology is changing the way microbiology will be done 6

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Front End Automation !! Automated plate

streakers & Automated Gram Stainers have been around for 10+ years

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2nd Generation Front End Automation !! Eliminate manual

steps

!! Eliminate labeling errors

!! Eliminate variability !! Streaking patterns !! Tech to Tech !! Shift to Shift

!! Improve Quality !! Standardize 24/7

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Blood Cultures Systems!! Semi-automated

blood culture systems around since the early 80’s: Remember the Bactec 460

!! 2ND GENERATION Incubators, shaker, and automated detection at the turn of the century

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Introducing the Next Generation Blood Cultures

!! Fully automated loading of blood culture bottle

!! Fully automated unloading of negative blood cultures at 5 days

!! Fully automated unloading of positive blood culture bottles !! Eliminate manual processes !! Real time resulting of “Negative

Cultures” !! Increase capacity real time

!! *Available late 2013 10

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Modular System for changing workloads

Mass Spec!! From bacterial colony to ID in minutes

instead of hours

!! Sample preparation on target slide !! No purification required

!! Wide coverage !! bacteria, yeast, mycobacterium

!! Revolutionize TAT in microbiology

Colony

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Smart Incubator Systems!! Incubator & Imager

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The Future Microbiology Laboratory

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The future of information flow…

today

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•! Continuous operational improvement"

•! Improved clinical relevance"

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Availability of Information

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Planning, Design & Implementation is key to success

!! Planning for automation needs to happen sooner than later !! Budget, Budget, Budget

!! Space planning

!! Design new process around automation, not the other way around

!! Involve the people in the process

!! Establish timelines and priorities

!! Delegate responsibilities 17

Status Quo is no longer acceptable:

!! Protocol length does not equal TAT! !! Blood Culture protocol is 5 days !! Urine Culture protocol is 48 hours !! Wound Culture protocol 3 days

!! If you want different results – change the process

!! Let me introduce you to Erica

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The Microbiology Pathway: From Collection to Care

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We identify and eliminate waste, to help you improve productivity, reduce errors and speed up clinical decision support.

Let’s Look at TAT!! How many of you actively measure TAT for

microbiology cultures in your facility?

!! What should the TAT for a positive Blood Culture be?

!! Median TAT for Positive Blood Culture is 71.5

$'58;% '*58;% #$58;% +)58;% !$,58;%,58;%

68hrs

87hrs 71.5hrs 134hrs

69hrs 48hrs

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Rapid Microbiology Culture Result – is Achievable

!!Disrupt !!Shake up !!Challenge !!Evolve !!Change

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Leadership is key to making “change” happen

!! Know what your current state is

!! Define the desired results in clear terms !! Let the people know what the benefits of the change are !! Provide support to help facilitate the change

!! Hire experts in Microbiology to help you get results !! What are the consequences of failing to obtain the

desired results !! Recognize the successes

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Plan & Monitor!! Establish a project plan

!! Establish timelines and stick to them

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Establish Targets

!! Don’t set the target to your current performance, set it to challenge your processes

!! Look at the Q3 or longest TAT – find root cause 30

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Measure, trend carefully

!! Before process improvement – Median was 48 hours

!! Decrease by 22 hours & sustained over time 31

Change is inevitable !! Technology is here and more is coming

!! People will have to change !! Focus on process first not people !! New people, ideas and strategies can

lead to behavioral and performance changes

!! Don’t be afraid to let resistant employees go

!! Review your hiring process to be sure you are recruiting the talent needed to change your organization

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Summary: Patient’s Comes First !! Investigate how and what automation can help your lab

!! Do a deep dive into your processes, know what is really going on !! Design, Implement and Monitor

!! Develop people that will understand, implement and sustain change

!! “Although there is no progress without change, not all change is progress.” John Wooden

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The Key to Getting Better Results !! Re-evaluate processes , Automate where possible, and

measure performance continuously.

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The Petri Dish is Here to Stay for a Little While Longer

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Thank You

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