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Clinical PathologyQuality Dashboard
September 2009
Clinical Pathology Quality Dashboard
Inpatient Phlebotomy First AM Blood Draws University Hospital
0%
20%
40%
60%
80%
100%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2008 2009
8am
9am
10am
Drawn by
Mott Hospital
0%
20%
40%
60%
80%
100%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
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%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2008 2009
0
100
200
300
400
Avg
Daily V
olu
me
8am
9am
10am
Results by
Mott Hospital
0%
20%
40%
60%
80%
100%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2008 2009
0
2
4
6
8
10
12
Av
g D
ail
y V
olu
me
8am
9am
10am
Results by
Inpatient Phlebotomy Draws
Clinical Pathology Quality Dashboard
19,773
26,062
19,75920,459
19,598 19,795
21,992 21,71420,986
21,651 22,07322,675
0
5,000
10,000
15,000
20,000
25,000
30,000
Sep Oct Nov Dec Jan Feb Mar Apr May June July Aug
2008 2009
Clinical Pathology Quality Dashboard
Turnaround Times
CSF Gram StainVolume and Turnaround Time
0
20
40
60
80
100
120
140
160
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2008 2009
Mo
nth
ly V
olu
me
> 1 hour
30 min-1 hour
<30 minutes
TAT
Emergency Department Cardiac MarkerVolume and Turnaround Time
0
200
400
600
800
1000
1200
1400
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2008 2009
Mo
nth
ly V
olu
me
> 2 hours
1-2 hours
<1 hour
TAT
Point of Care service began
Clinical Pathology Quality Dashboard
Specimen Processing Turnaround TimeAverage Daily Turnaround Time + 1 standard deviation
for Inpatient Specimens going to Chemistry
September 2006 - July 2007
0:00
0:14
0:28
0:43
0:57
1:12
Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07
Tu
rnaro
un
d T
ime i
n M
inu
tes
October 2008 - August 2009
0:00
0:14
0:28
0:43
0:57
1:12
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09
Tu
rnaro
un
d T
ime i
n M
inu
tes
Clinical Pathology Quality Dashboard
Molecular Diagnostics Laboratory
Specimens Received and Turnaround TimeJanuary 2002 - August 2009
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 January2009
July 2009
Month/Year
Spe
cim
ens
Rec
eive
d pe
r M
onth
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 - Aug 09
Per
cent
age
Routine >60 min >45 Inpt STAT >45 Outpt STAT
UMHS Blood Product Utilization
Clinical Pathology Quality Dashboard
Crossmatch/Transfusion Ratio
1.3
1.4
1.5
1.6
1.7
1.8
1.9
Sep Oct Nov Dec J an Feb Mar Apr May J un J ul Aug
2008 2009
Threshold
Wasted RBC
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
Sep Oct Nov Dec J an Feb Mar Apr May J un J ul Aug
2008 2009
Threshold
Wasted Platelets
0%
1%
2%
3%
4%
5%
Sep Oct Nov Dec J an Feb Mar Apr May J un J ul Aug
2008 2009
Threshold
Wasted Plasma
0%
1%
2%
3%
4%
5%
6%
Sep Oct Nov Dec J an Feb Mar Apr May J un J ul Aug
2008 2009
Threshold
Wasted Cryoprecipitate
0%
5%
10%
15%
20%
25%
30%
Sep Oct Nov Dec J an Feb Mar Apr May J un J ul Aug
2008 2009
Threshold
Blood Product Utilization
0
1000
2000
3000
4000
5000
6000
7000
8000
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
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
AdjustedDischargesUnits Used
Clinical Pathology Quality Dashboard
CAP Proficiency Testing
4th Quarter FY 2009
Clinical Pathology 91 = Number of Challenges 92% = Satisfactory Results
Anatomic Pathology 0 = Number of Challenges N/A = Satisfactory Results
Department Total 91 = Number of Challenges 92% = Satisfactory Results
Clinical Pathology Scores
92
1009999.597
1009998
0
100
200
300
400
500
600
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Nu
mb
er o
f C
hal
len
ges
50
60
70
80
90
100
Per
cen
t S
atis
fact
ory
FY2008 FY2009
Clinical Pathology Quality Dashboard
CP Financial Measures
Monthly Amount Paid to Southeastern Michigan American Red Cross
1,000,000
1,050,000
1,100,000
1,150,000
1,200,000
1,250,000
1,300,000
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2008 2009
Do
llars
Clinical Path Expense per Test*
$4
$5
$6
$7
$8
$9
$10
* excludes Blood Bank and Phlebotomy
Clinical Path Tests per FTE and Total Tests By Month
1,000
1,200
1,400
1,600
1,800
2,000
Tes
t p
er F
TE
275,000
300,000
325,000
350,000
375,000
400,000
425,000
To
tal
Tes
ts
Tests per FTE Total Tests
• Lean Process Improvements – Many!
• Board access H1N1 influenza testing program
Clinical Pathology Quality Dashboard
Clinical Laboratory Operations Initiatives
• Design and implementation of new requisition for complex, multiple-site, multiple-times Interventional Radiology blood samples – by Chemistry
• Outstanding improvements in ED turnaround times for troponins, CBCs, basic panels, and urine analysis - by Chemistry
Clinical Pathology Quality Dashboard
Clinical Laboratory Service Enhancements
• Congratulations and Thank You to the entire Blood Bank/Transfusion Medicine group for a very successful rigorous FDA on-site inspection with “no observations”.
• Kudos to the Microbiology Laboratory (especially Marc Deroo and Jeana Vandorp) for “above and beyond” support of Pediatrics Critical Care Medicine patient in early September.
• Kudos to Duane Newton, Ph.D. (Director, Microbiology Laboratory) for his tireless and expert support of UMHS preparation for H1N1 influenza.
• Kudos to Steven Mandell, M.D. for his leadership in helping to develop a “Better Specimen Box”. Dr. Mandell organized a team of 25 people – including nurses, managers, phlebotomists, pathologists, housekeepers, and others – to create what is now officially called a “unit-based specimen drop box”.
Clinical Pathology Quality Dashboard
Kudos