Clinical Pathology Quality Dashboard

Clinical PathologyQuality Dashboard

May 2009

Clinical Pathology Quality Dashboard

Inpatient Phlebotomy First AM Blood Draws

Mott Hospital

0%

20%

40%

60%

80%

100%

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

2008 2009

8am9am10am

Drawn by

University Hospital

0%

20%

40%

60%

80%

100%

May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr2008 2009

8am9am10am

Drawn by


Inpatient Phlebotomy First AM Blood Test Results:PT/PTT, CBCP, and Comprehensive Panel

University Hospital

0%

20%

40%

60%

80%

100%


0

100

200

300

400

Avg

Dai

ly V

olum

e

8am9am10am

Results by

Mott Hospital

0%

20%

40%

60%

80%

100%

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

2008 2009

0

2

4

6

8

10

12

Avg

Dai

ly V

olum

e

8am9am10am

Results by

Inpatient Phlebotomy DrawsFiscal Year 2009


21,182

23,348

19,773

26,062

19,75920,459

19,598 19,795

21,992 21,714

0

5,000

10,000

15,000

20,000

25,000

30,000

July Aug Sep Oct Nov Dec Jan Feb Mar Apr

2008 2009


Turnaround TimesCSF Gram Stain

Volume and Turnaround Time

0

20

40

60

80

100

120

140

160

May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr 2008 2009

Mon

thly

Vol

ume

> 1 hour

30 min-1 hour

<30 minutes

TAT

Emergency Department Cardiac MarkerVolume and Turnaround Time

0

200

400

600

800

1000

1200

1400


Mon

thly

Vol

ume

> 2 hours

1-2 hours

<1 hour

TAT

Point of Care service beganPoint of Care service began


Molecular Diagnostics Laboratory

Specimens Received and Turnaround TimeJanuary 2002 - December 2008

0

200

400

600

800

1000

1200

1400

January2002

July 2002 January2003






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)


Chemistry In-Lab Turnaround Times

Sample Turn-Around Time

0

5

10

15

20

25

30

35

Aug 07 - Apr 09

Perc

enta

ge

Routines >60 >45 IN >45 OUT

UMHS Blood Product Utilization


Crossmatch/Transfusion Ratio

1.3

1.4

1.5

1.6

1.7

1.8

1.9

May J une J uly Aug Sep Oct Nov Dec J an Feb Mar Apr 2008 2009

Threshold

Wasted RBC

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

May J une J uly Aug Sep Oct Nov Dec J an Feb Mar Apr

2008 2009

Threshold

Wasted Platelets

0%

2%

4%

6%

8%


2008 2009

Threshold

Wasted Plasma

0%

1%

2%

3%

4%

5%

6%


2008 2009

Threshold

Wasted Cryoprecipitate

0%

5%

10%

15%

20%

25%

30%


2008 2009

Threshold

Blood Product Utilization

0

1000

2000

3000

4000

5000

6000

7000

8000

May June July Aug Sep Oct Nov Dec Jan Feb Mar Apr

2008 2009

0

1000

2000

3000

4000

5000

6000

7000

8000

Patie

nt P

opul

atio

n

Random Platelets

Allo RBC Units

Plasma Units

Cryo Units

Partial Units

SD Platelets

AdjustedDischargesUnits Used


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

Num

ber o

f Cha

lleng

es

50

60

70

80

90

100

Perc

ent S

atis

fact

ory

FY2008 FY2009


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

1,0001,1001,2001,3001,4001,5001,6001,7001,8001,9002,000

Test

per

FTE

275,000

300,000

325,000

350,000

375,000

400,000

425,000

Tota

l Tes

ts

Tests per FTE Total Tests


New Clinical Assays Added in Current Year

Protein S activity

Anti-Xa Arixtra (fondiparinux) assay

Hexagonal phospholipid neutralization (HEXAG) assay

Heparin-induced thrombocytopenia/thrombosis assay (improved IgG assay)

Automated Urinalysis platform (IRIS)

Rapid detection of Candida albicans and C. glabrata from blood cultures

BRAF V600 Mutation Detection

Clear Cell Sarcoma EWSR1/ATF1, t(12;22) Transcript Detection

UroVysion FISH for Bladder Cancer

KRAS Mutation Detection

NPM1 Mutation Detection

Warfarin Sensitivity Analysis

• Improvement of Critical Value Callback process- Brenda Schroeder, lead

• 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!

• Job-specific safety signs

• Creation of Blood Product Utilization Lean Team - Tim Laing, MD, (OCA), lead

• Improvement of Blood Draw Wait Times- Cancer Center- Taubman 2- Taubman 3


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 (prototype)

• 24/7 Microbiology Lab staffing

• Mycobacteriology culture – continuous monitoring

• Multiple new clinical assays (see list)


Clinical Laboratory Service Enhancements

Kudos


Thank you to the University of Michigan Department Pathology CAP Inspection Team for the successful completion of an off-site inspection in New York City on May 12-13, 2009.

Team included: Bill LeBar, Brenda Schroeder, Craig Newman, Dan Visscher, Diane Roulston, Don Giacherio, Eric Vasbinder, Jeff Warren, Jenny Sanks, John Perrin, Kalyani Naik, Kathy Davis, Larry Bischof, Mary Jane Liu, Nancy Renner, Sara Gay, Sue Stern, Suzanne Butch, Terry Downs, and Usha Kota. Dr. Brad Eisenbrey (Gift of Life) also participated.

Documents

Clinical Pathology Quality Dashboard