Clinical PathologyQuality Dashboard
April 2009
Clinical Pathology Quality Dashboard
Inpatient Phlebotomy First AM Blood Draws University Hospital
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2008 2009
8am
9am
10am
Drawn by
Mott Hospital
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2008 2009
8am
9am
10am
Drawn by
Clinical Pathology Quality Dashboard
Inpatient Phlebotomy First AM Blood Test Results:
PT/PTT, CBCP, and Comprehensive Panel University Hospital
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2008 2009
0
100
200
300
400
Av
g D
ail
y V
olu
me
8am
9am
10am
Results by
Mott Hospital
0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2008 2009
0
2
4
6
8
10
12
Av
g D
ail
y V
olu
me
8am
9am
10am
Results by
Inpatient Phlebotomy DrawsFiscal Year 2009
Clinical Pathology Quality Dashboard
21,182
23,348
19,773
26,062
19,75920,459
19,598 19,795
21,992
0
5,000
10,000
15,000
20,000
25,000
30,000
July Aug Sep Oct Nov Dec Jan Feb Mar
2008 2009
Clinical Pathology Quality Dashboard
Turnaround Times
Emergency Department Cardiac MarkerVolume and Turnaround Time
0
200
400
600
800
1000
1200
1400
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2008 2009
Mo
nth
ly V
olu
me
> 2 hours
1-2 hours
<1 hour
TAT
CSF Gram StainVolume and Turnaround Time
0
20
40
60
80
100
120
140
160
April May June July Aug Sept Oct Nov Dec Jan Feb Mar2008 2009
Mo
nth
ly V
olu
me
> 1 hour
30 min-1 hour
<30 minutes
TAT
Clinical Pathology Quality Dashboard
Molecular Diagnostics Laboratory
Specimens Received and Turnaround TimeJanuary 2002 - December 2008
0
200
400
600
800
1000
1200
1400
January2002
July 2002 January2003
July 2003 January2004
July 2004 January2005
July 2005 January2006
July 2006 January2007
July 2007 January2008
July 2008
Month/Year
# of
Spe
cim
ens
rece
ived
0
1
2
3
4
5
6
7
8
9
10
TAT
(day
s)
# Specimens TAT Linear (# Specimens) Linear (TAT)
Clinical Pathology Quality Dashboard
Chemistry In-Lab Turnaround Times
Sample Turn-Around Time
0
5
10
15
20
25
30
35
Aug 07 - Mar 09
Per
cent
age
RT ST> 60 min IP ST> 45 mins. OP ST> 45 mins
Clinical Pathology Quality Dashboard
New Clinical Assays Added in Last Year
Yeast identification system: (Vitek II automated)Yeast antimicrobial susceptibility: (Vitek II automated)EBV viral loadHIV-1 quantification (COBAS Ampli Prep – COBAS Taqman)
(includes extraction, amplification)MRSA surveillanceVRE surveillanceC.difficile surveillanceBCR/ABL1 Kinase Mutation Analysis (Sequencing)Human Erythrocyte Antigen Genotyping (Microarray analysis)IGH/BCL2 Translocation Detection (Real-time PCR)JAK2 V167F Mutation Detection (Allele-specific PCR)KIT D816V Mutation Detection (Allele-specific PCR)KIT Mutation Detection for GISTKIT Mutation Detection of MelanomaNPM1 Mutation Detection (PCR w/ capillary electrophoresis
detection)Microsatellite instability analysisPML/RARA t(15;17) Translocation Detection (Real-time PCR)Urovysion – FISH, Bladder Cancer DetectionHER2 Amplification – FISH, Breast CancerUGT1A1 Promoter GenotypingK-Ras Mutation Detection 1,25 Dihydroxy vitamin DSensitive beta-2 transferrin assay
UMHS Blood Product Utilization
Clinical Pathology Quality Dashboard
Blood Product Utilization
0
1000
2000
3000
4000
5000
6000
7000
8000
Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar
2008 2009
0
1000
2000
3000
4000
5000
6000
7000
8000
Pa
tie
nt
Po
pu
lati
on
Random Platelets
Allo RBC Units
Plasma Units
Cryo Units
Partial Units
SD Platelets
AdjustedDischarges
Units Used
Crossmatch/Transfusion Ratio
1.3
1.4
1.5
1.6
1.7
1.8
1.9
Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar
2008 2009
Threshold
Wasted RBC
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar
2008 2009
Threshold
Wasted Platelets
0%
2%
4%
6%
8%
Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar
2008 2009
Threshold
Wasted Plasma
0%
1%
2%
3%
4%
5%
6%
Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar
2008 2009
Threshold
Wasted Cryoprecipitate
0%
5%
10%
15%
20%
25%
30%
Apr May J une J uly Aug Sep Oct Nov Dec J an Feb Mar
2008 2009
Threshold
Clinical Pathology Quality Dashboard
CAP Proficiency Testing
3rd Quarter FY 2009
Clinical Pathology24 = Number of Challenges
100% = Satisfactory Results
Anatomic Pathology0 = Number of Challenges
N/A = Satisfactory Results
Department Total24 = Number of Challenges
100% = Satisfactory Results
Clinical Pathology Scores
0
100
200
300
400
500
600
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr
Nu
mb
er
of
Ch
all
en
ge
s
50
60
70
80
90
100
Pe
rce
nt
Sa
tis
fac
tory
FY2008 FY2009
Clinical Pathology Quality Dashboard
CP Financial Measures
*excludes Blood Bank and Phlebotomy
Clinical Path Expense per Test*
$4
$5
$6
$7
$8
$9
$10
Total Expense per Test
Clinical Path Tests per FTE and Total TestsBy Month
1,000
1,100
1,200
1,300
1,400
1,500
1,600
1,700
1,800
1,900
2,000
Tes
t p
er F
TE
275,000
300,000
325,000
350,000
375,000
400,000
425,000
To
tal T
ests
Tests per FTE Total Tests
•Discontinue Cancer Center Hematology Lab (move to Main Lab) – Will Finn, MD, lead
•Improvement of Critical Value Callback process – Brenda Schroeder, lead
•Impact of Earlier AM Blood Draw in UH – OMS 490 students and Holly Eliot, leads
•Improvement of Communication with Patient Care Units – Beverly Smith and Brenda Schroeder, leads
•Customer Service Initiative – Beverly Smith, lead
•Lab Formulary Committee – Office of Clinical Affairs, FGP, Pathology
•Lean Process Improvement Projects – many!
•Laboratory Safety focus – Brenda Schroeder, lead
•Improvement of Blood Draw Wait Times- Cancer Center- Taubman 2- Taubman 3
•Creation of Blood Product Utilization Lean Team – Tim Laing, MD, (OCA), lead
Clinical Pathology Quality Dashboard
Clinical Laboratory Operations Initiatives
•Clostridium difficile toxin screening algorithm – 1/09
•On-demand unit-specific antibiograms – 2/09
•Expedited (rules – based) release of ANCs (absolute neutrophil counts) – 2/09
•Integrated hematopathology reports – 2/09
•Troponin point-of-care (ED) – 3/09
Clinical Pathology Quality Dashboard
Clinical Laboratory Service Enhancements
Kudos
Clinical Pathology Quality Dashboard
• Thank you to the Phlebotomy Team and Harry Neusius; Julius Alexander and John Hamilton (Pathology Informatics); Tom Morrow, Brenda Schroeder, John Perrin, and Holly Eliot (Pathology Administration) for their excellent work with Ross Business School OMS 490 students – in the development of a new tool to better match early AM blood drawing resources with service demand.
• Thank you to the Chemistry Lab and the Emergency Department Point-of-Care Lab for implementation of rapid troponin assay in the ED. See the marked improvement in ED Cardiac Marker TAT!
• Congratulations to Drs. Lloyd Stoolman (Pathology) and Matthew Velkey (Cell and Developmental Biology) who received one of only five University of Michigan Provost’s 2009 Teaching Innovation Prizes – for the project entitled “Virtual Microscopy for Life Sciences Education”! More than 100 projects were nominated. Please see the Pathology Website for a link to a more detailed description of this outstanding innovation.
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