Using Keele data to demonstrate efficiency and effectiveness Jim Allison.

Using Keele data to demonstrate efficiency and effectiveness

Jim Allison

Background SCBMDN has to engage with the

Keele benchmarking process. Improve the consistency of the data

returned by Scottish labs Seek to influence the introduction of

new questions within the Keele database

Enable greater use of this data to plan service delivery

Background :

Background :National Pathology Benchmarking Service at Keele University Performance management tool.

Peer comparison of key indicators.

Internal comparison of year on year performance.

Separate data collection and benchmark reports are offered for Clinical Biochemistry, Haematology/Blood Transfusion, Histopathology/Cytology, Immunology and Microbiology/Virology.

Background :Keele Benchmarking – difficult and time consuming process. Questionnaires sent out electronically during April 2012. Completed questionnaires returned to Keele in June Data checking exercise undertaken. Data is processed at Keele, and a specialist panel - made up

of clinicians from the relevant discipline - meet to discuss the data.

Panel write a commentary on the findings, providing interpretation of the data which is included in the final report.

Generic report produced in December for each participant, plus a separate analysis tool enabling you to drill down into the data further and create their own charts and tables.

In January, participants are invited to a user group meeting, where the findings of the report are discussed, and the participants get the opportunity to influence future development of the programme

Keele and the SCBMDN

1. What information /markers of efficiency and effectiveness Keele provides the SCBMDN.

2. Identify areas of inconsistency.3. Recent interactions of the SCBMDN

with Keele.4. What the SCBMDN might do with

Keele in the future.

Keele Information:

Workload

Staffing

Finance

Efficiency & productivity

Quality & effectiveness

Engagement with Keele:

SCBMDN questionnaire (Sept 2011); 8 out of 15 Health Boards responded.

Efficiency and Productivity Cost per test and request Requests and Tests per WTE

Effectiveness A&E turnaround times Other ideas

Keele Information:

Keele Information:

Biochemistry is a local lab for local people.

There’s no need for benchmarking here!!!

Keele Information: Test Workload per 1000 Population

Health Board Children

Adults Total

Ayrshire & Arran 63,210 299,850 363,060

Borders 19,840 92,050 111,890

Dumfries & Galloway

24,430 122,190 146,620

Fife 64,610 293,160 357,770

Forth Valley 53,670 232,770 286,440

Grampian 95,620 441,550 537,170

Greater Glasgow & Clyde

207,670 975,050 1,182,720

Highland 53,010 250,970 303,980

Lanarkshire 105,580 451,900 557,480

Lothian 140,450 676,880 817,330

Orkney 3,380 16,560 19,940

Shetland 4,220 17,940 22,160

Tayside 67,750 325,070 392,820

Western Isles 4,440 21,510 25,950

Keele Information: Workload: Like for Like U&E?

Serum Creatinine Workload per 1000 Population

0

100

200

300

400

500

600

Ayr

shire

&A

rran

Bor

ders

Fife

For

th V

aley

Abe

rdee

n

NH

S G

GC

NH

SH

ighl

and

NH

SLa

nark

shire

RIE

St J

ohn'

s

WG

NH

SLo

thia

n

NH

ST

aysi

de

Lab / Region

Ce

rea

t R

eq

/10

00

po

p

Creatinine

Keele Information: Workload: Like for Like TFTs?

TSH & FT4 workload per 1000 Population

0

50

100

150

200

250

300

NH

S A

yrsh

ire

&A

rra

n

NH

S B

ord

ers

NH

S F

ife

NH

S F

ort

hV

alle

y

NH

S G

ram

pia

n

NH

SG

GC

NH

S H

igh

lan

d

NH

SL

an

ark

shir

e

NH

S L

oth

ian

NH

S T

ays

ide

Region

Req

/ 1

000 P

op

Tests Per 1,000 GP Population: T4 (Free)

Tests Per 1,000 GP Population: TSH

Keele Information: Workload: Like for Like Lipids?

Chol, Trig & HDL Workload Per 1000 Pop

0

50

100

150

200

250

300

Ayrs

hir

e &

Arr

an

Bo

rde

rs

Fife

Fo

rth

Va

lle

y

Ab

erd

ee

n

NH

S G

GC

NH

S

Hig

hla

nd

NH

S

La

na

rksh

ire

NH

S L

oth

ian

NH

S T

aysid

e

Region

Req

/1000 P

op

Triglyceride

Cholesterol

HDL (+D-LDL)

Keele Information: Workload: Like for Like HbA1c?

HbA1c and Micro Alb Workload per 1000 Population

0

10

20

30

40

50

60

70

80

90

100

Ayrs

hire &

Arr

an

Bord

ers

Fife

Fort

h V

alle

y

Aberd

een

NH

S G

GC

NH

S H

ighla

nd

NH

S

Lanark

shire

NH

S L

oth

ian

NH

S T

aysid

e

Region

Req

/1000 P

op

Albumin/Microalbumin (urine)

HbA1c

Keele Information: Staffing

% Change 2010-2011 All Teaching Non

Teaching

Total Medical Staff (including Trainees) -14.76% -13.63% -19.39%

Total WTE Biomedical Scientists -3.47% -4.48% -1.78%

WTE MLA / Support Workers -3.05% -1.29% -6.23%

Total WTE Clinical Scientists -12.24% -10.73% -15.99%

Keele Information: Staffing

Lab Staff AfC band 4 and Below + Band 5 and Above

0

10

20

30

40

50

60

70

80

90

100

Ayr

shire

and

Arr

an

Bor

ders

Fife

For

th V

alle

y

Abe

rdee

n

Elg

in

Cly

de

Nor

thG

lasg

ow

Sou

thG

lasg

ow

Hig

hlan

d

NH

SLa

nark

shire

RH

SC

RIE

St

John

'sH

ospi

tal

Wes

tern

Gen

eral

Tay

side

Wes

tern

Isl

es

Lab / Region

Nu

mb

ers

of

Sta

ff

Total Staff: AfC Band 4 andBelow

Total Staff: AfC Band 5 andAbove

Keele Information: Finance

Total Pay Cost Per Test

0

0.5

1

1.5

2

2.5

3

3.5

Ayrs

hire a

nd A

rran

Bord

ers

Fife

Fort

h V

alle

y

Aberd

een

Elg

in

Cly

de

Nort

h G

lasgow

South

Gla

sgow

Hig

hla

nd

NH

S L

anark

shire

RH

SC

RIE

St

John's

Hospital

Weste

rn G

enera

l

Taysid

e

Weste

rn I

sle

s

Lab / Region

pay c

ost/

test

(£) Total Pay Cost Per Test



0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Ayr

shire

and

Arr

an

Bor

ders

Fife

For

th V

alle

y

Abe

rdee

n

Elg

in

Cly

de

Nor

th G

lasg

ow

Sou

thG

lasg

ow

Hig

hlan

d

NH

SLa

nark

shire RIE

St

John

'sH

ospi

tal

Wes

tern

Gen

eral

Tay

side

Wes

tern

Isl

es

Lab / Region

pay

co

st/

test

(£)




0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Ayr

shire

and

Arr

an

Bor

ders

Fife

For

th V

alle

y

Abe

rdee

n

Cly

de

Nor

thG

lasg

ow

Sou

thG

lasg

ow

Hig

hlan

d

NH

SLa

nark

shire RIE

St

John

'sH

ospi

tal

Wes

tern

Gen

eral

Tay

side

Wes

tern

Isl

es

Lab / Region

pay

co

st/

test

(£)



Biomedical Scientists Out of Hours Payments (Including Trainees)

£0

£200,000

£400,000

£600,000

£800,000

£1,000,000

£1,200,000

Ayr

shire

and

Arr

an

Bor

ders

Fife

For

th V

alle

y

Abe

rdee

n

Elg

in

Cly

de

Nor

th G

lasg

ow

Sou

th G

lasg

ow

Hig

hlan

d

NH

S L

anar

kshi

re

RH

SC

RIE

St

John

's H

ospi

tal

Wes

tern

Gen

eral

Tay

side

Wes

tern

Isl

es

Lab / Region

Co

st

(£)

Biomedical Scientists Out ofHours Payments (IncludingTrainees)

Keele Information: Efficiency and Productivity

i) Efficiency – Cost per test and cost per request.

ii) Productivity - Number of tests per WTE.

Keele Information: Cost per Request

PMS says …. No!

Keele Information: Efficiency

Total Pay and Non Pay Cost per Test

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Ayr

shire

an

d A

rran

Bo

rde

rs

Fife

Fo

rth

Va

lley

Ab

erd

een

Elg

in

Cly

de

Nor

th G

lasg

ow

So

uth

Gla

sgo

w

Be

lford

Cai

thn

ess

Ob

an

Rai

gm

ore

Lan

ark

shir

e

RH

SC

RIE

St

Joh

n's

WG

Ta

ysid

e

We

ste

rn Is

les

Lab /Region

Co

st

(£)


Total Non Pay Cost Per Test

Grand Total

Keele Information: Efficiency

Total Pay and Non Pay Cost per Test

0

0.2

0.4

0.6

0.8

1

1.2

Ayr

shire

an

d A

rran

Bo

rde

rs

Fife

Fo

rth

Va

lley

Ab

erd

een

Cly

de

Nor

th G

lasg

ow

So

uth

Gla

sgo

w

Lan

ark

shir

e

RIE

St

Joh

n's

WG

Ta

ysid

e

Lab /Region

Co

st

(£)


Total Non Pay Cost Per Test

Grand Total

Keele Information: Productivity

Tests Per Total WTE Staff

020000

4000060000

80000100000120000

140000160000

180000200000

Ayr

shire

and

Arr

an

Bor

ders

Fife

For

th V

alle

y

Abe

rdee

n

Elg

in

Cly

de

Nor

th G

lasg

ow

Sou

th G

lasg

ow

Oba

n

Lana

rksh

ire

RH

SC

RIE

St

John

's

Wes

tern

Gen

eral

Tay

side

Wes

tern

Isl

es

Lab/Region

Tes

ts /

To

tal

WT

E


Keele Information: Productivity


0

20000

40000

60000

80000

100000

120000

140000

160000

180000

Ayr

shi

re a

ndA

rran

Bor

der

s

Fife

For

th V

alle

y

Abe

rdeen

Cly

de

Nor

th G

lasgo

w

Sou

thG

lasgo

w

Lana

rkshi

re

RIE

St

John'

s

West

Gen

Tay

side

Lab/Region

Te

sts

/WT

E


Keele Information: Efficiency and Productivity

These workload variations do not impact significantly on Keele efficiency and productivity figures.

Tot Tests Tot ExpendTotal WTE

Cost / Test

Tests / WTE

Average Lab 5,000,000 £3,500,000 48 £0.70 104,166

Plus extra 80,000 FT4, 50,000Trigs and

30,000HbA1C 5,160,000 £3,540, 000 48 £0.69 107,291

Keele Information: Quality & Effectiveness

A&E TATs

Accreditation status

Keele Information: Effectiveness

Keele - U&E TAT for A&E

What is the target TAT for U&E requests from A&E?

What proportion of A&E requests for U&E are reported within this target?

Keele Information: U&E TAT for A&E

U&E Target TAT for A&E

0

20

40

60

80

100

120

140

Ayr

shire

& A

rran

Bor

ders

Fife

For

th V

alle

y

Abe

rdee

n

Elg

in

Cly

de

Nor

th G

lasg

ow

Sou

th G

lasg

ow

Bel

ford

Cai

thne

ss

Oba

n

Rai

gmor

e

Lana

rksh

ire

RH

SC

RIE

St

John

's

WG

Tay

side

Wes

tern

Isl

es

Lab Location

TA

T (

Min

)

0

10

20

30

40

50

60

70

80

90

100

% W

ithin

Targ

et

Target TAT for U&E

% of requests reported within this target

Keele Information: Future Inclusion of RCPath KPIs

KPI: A&E blood sciences turn-around-times

Baseline: Percentage of core investigations, i.e. renal function, liver function tests and full blood counts from A&E completed within 1 hour of receipt, including out of hours

Challenge: 85% by Apr 2012 increasing to 90% by Apr 2014. The standard will move to 1 hour from sample collection by April 2015.

SCBMDN: Agreement to adopt this RCPath KPI.

Keele Information: Effectiveness Vetting Work Referred to Outside Laboratories Identifying Duplicate Requests and Standard Rejection

Procedure Providing Requestors with Key Performance Indicators Participation in Training Events for Requestors and

Utilisation of Order Comms for Education Disease/Symptom-specific Profiles, Requestor/Grade-

specific Testing, Clinical Pathway Development Processes to Improve the Efficiency and Quality of

Service Does your clinical biochemistry laboratory have a

formal risk management policy ?

Quality and Effectiveness

SCBMDN engagement with Keele

Engagement with Keele: SCBMDN New Questions in Keele Availability of clinical advice.

Repertoire of tests available on an emergency basis?

Communication of critical results; timeliness and number/ frequency.

Number of urgent/emergency requests processed in last year?

What percentage of reports contain interpretative comments?

Number of complaints /critical incidents

SCBMDN & KEELE Availability of Clinical Advice

Q2-5-1

Which member(s) of staff provide clinical interpretative advice? UA

When does this service operate?

Is this 24 hours

per day, 365(6)

days per year?

If no please state start and finish time (please use

the format HH:MM)

Start time Finish time

Q2-5-2 Monday to Friday UA 09:00 17:00

Q2-5-3 Saturday UA 09:00 17:00

Q2-5-4 Sunday UA 09:00 17:00

Q2-5-5 Public Holiday UA 09:00 17:00

SCBMDN & KEELEPlasma/Serum/Blood Column 1 Column 2 Column 3 Column 4

Test NameTotal Tests In-

house

Number of Tests

Performed for Primary Care

Tests Referred Out (change to 'yes' only if you refer the test

out)

Is Test Provided as an Emergency

(change to 'yes' only if available 24/7, 365)

1,25 Hydroxy Vitamin D UA No No

11-Deoxycortisol UA No No

17 Hydroxy Progesterone UA No No

25 Hydroxy Vitamin D UA UA No No

ACTH UA No No

Adrenaline UA No No

Albumin UA No No

Alcohol (Ethanol) UA No No

Ongoing Dialogue with Keele

Getting more out of the existing questionnaire

Incorporating further markers of effectiveness

Invitation to David Holland to attend SCBMDN meeting later this year.

Example of Improvement in Clinical Effectiveness of Laboratory Service NHSG Primary Care – ongoing problem with spurious

hyperkalaemia due to long transportation times.

Jan 2010, <20% of SST samples from primary care spun at source.

Centrifugation of SST tubes in primary care practices introduced in July 2010.

Jan 2011, 95% of SST samples from primary care spun at source

Clinical Effectiveness

Retrospective audit conducted to reviewthe impact on patient care of introduction ofcentrifugation in primary care:

a) Pre-GP centrifugation Jan – June 2010 b) Post-GP centrifugation Jan – June 2011

Classification of follow-up of hyperkalaemia Appropriate admission: Genuine hyperkalaemia in a GP

sample resulting in admission to acute medical receiving where the hyperkalaemia has been confirmed

Appropriate GP follow-up: Genuine hyperkalaemia in a GP sample resulting in a repeat sample from the GP where the hyperkalaemia has been confirmed

Inappropriate admission: Pseudohyperkalaemia in a GP sample due to delay in sample centrifugation resulting in admission to acute medical receiving where the follow-up serum potassium is within the reference interval

Inappropriate GP follow-up: Pseudohyperkalaemia in a GP sample due to delay in centrifugation resulting in a repeat sample from the GP where the follow-up serum potassium is within the reference interval

Effectiveness of follow-up of primary care patients with hyperkalaemia

Sample centrifugation in primary care locations in NHSG has proven to be an excellent example in improving the clinical effectiveness of an existing laboratory investigations, whereby the same test deployed now secures a greater health gain for patients from the available resource.

Using Keele data to demonstrate efficiency and effectiveness Jim Allison.

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