2005 IQLM Conference

1
2005 IQLM Conference

• IQLM NetworkMeeting Goals Meeting Needs
• Michael A Noble MD FRCPC
• Networks Committee
• April 29, 2005

2
Presentation Objectives

• Stating the goals of the network committee
• Characterizing the IQLM-Network project
• A Snap-shot View of Quality Management in
  Americas Hospital Clinical Laboratories
• Conclusions
• Acknowledgements
• IQLM Network Next Steps

3
Defining Network Objectives (2003)

• Identify a partner
• Develop laboratory networks
• Complete pilot study to determine potential of
  web based formatted survey
• Collect information on laboratory quality
  practice and services
• Determine respondents willing to participate in
  ongoing survey
• Track trends in a volunteer group of laboratories
  
• Develop process to obtain information on quality

4
Meeting the Objectives

• In the first meeting of the Networks Committee
  (Atlanta 2003), three organizations offered to
  consider developing a project.
• Following discussion, it was agreed that the
  Clinical Laboratory Management Association was in
  the best position to develop the initial pilot
  project.

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Developing the Pilot Project

• A CLMA study with assistance and support of the
  IQLM Networks Committee.
• Define the subject
• Develop the survey questionnaire design
• Pre-test and validate the questionnaire with two
  independent subgroups
• Advertise the questionnaire
• Let the questionnaire
• Capture and analyze the data
• Prepare for presentation

6
Survey Objectives

• To collect information on quality management
  activities in clinical laboratories
• Note that survey information was the product of
  two data formats
• Pre-defined specific answers
• Invited open format comment

7
Survey Respondents

• Targeted to U.S. hospital-based laboratories,
  including integrated delivery systems, university
  hospitals, government hospitals and independent
  labs owned by hospitals.
• One respondent per institution Most senior
  manager invited to participate given option to
  delegate to most appropriate person

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Survey Response

• Distribution pool 2,301
• Response pool 572 25

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Respondent Demographics
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Respondent Demographics
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Respondent Demographics
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Survey Response

• Over 25 of eligible CLMA members responded to
  the survey.
• The respondents represent a nationwide sample and
  distribution of laboratories that correlate
  closely with the distribution of CLMA member
  laboratories.

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• We consider this survey a success.
• Partnership?
• Information Gathering Instrument ?
• Snap-shot of Quality Activities ?

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A Snap-shot View of Quality Management in
Americas Hospital Clinical Laboratories
CLMA Quality Management Pilot Survey November
2004

• Julie Gayken, MT (ASCP)
• Administrative Director of Laboratory Services
• Regions Hospital St. Paul, Minnesota
• Chair CLMA Quality Advisory Council
• Member IQLM Networks Work Group

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Presentation Objectives

• Quality pilot survey objectives
• Summary of pilot survey results
• Conclusion from pilot survey results

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Quality Pilot Survey Objectives

• Collect information on quality management
  activities
• Identify types of events that lead to
  investigations and process used
• Determine indicators being used today and rank
  usage (poster)
• Determine steps used in patient ID process as
  example for benchmarking (poster)
• Gather list of safety/quality initiatives that
  have resulted in error reduction (poster)
• Determine topics for future surveys and
  benchmarking (poster)
• Gather list of individuals for a future targeted
  network

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Collect Information on Quality Management
Activities
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What Parts of Quality Management are Largely
Implemented?
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What Parts of Quality Management are Largely
Implemented? (Top 5)
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What Parts of Quality Management are Largely
Implemented? (Last 5)
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Quality Management ActivitiesKey Findings

• Most components recommended by guidelines are
  implemented to some degree
• Lowest implementation percentage for test
  utilization components
• Develop clinical guidelines for physician use on
  appropriate testing
• Institutional rules for frequency of tests

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Quality Management Assessments
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Which Components of Quality Assessment Do You
Conduct?
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Analysis of Quality Assessment Components
25
Analysis of Quality Assessment Components
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Analysis of Quality Assessment Components
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Quality Assessment Key Findings

• 70 conduct, code and trend quality reports and
  surveys
• intervention (i.e. contact or change) is needed

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Identify Types of Events that Lead to In-Depth
Investigations and Processes Used
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Which Laboratory Events Lead to Full (In-depth)
Investigations?
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How are Full Adverse EventInvestigations
Performed?
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How are Full Adverse EventInvestigations
Performed?
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How are Full Adverse EventInvestigations
Performed?
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How are Full Adverse EventInvestigations
Performed?
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Adverse Events In-Depth InvestigationsKey
Findings

• 53 state risk management director leads review
• Reviews conducted on lab, patient, nursing,
  physician information
• 92 use root cause analysis process
• 14 do not use a structured process for review
  and corrective action

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Which Laboratory Events Lead to Full (In-depth)
Investigations?
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What Steps are Used in Investigations?
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In-depth Investigations Key Findings

• Incident Reports, Physician Complaints, Patient
  Complaints, Employee Reports
• Laboratories utilize the same processes for
  investigating various quality reports and
  complaints
• investigation

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Determine Indicators Being Used Today and Rank
Usage
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Indicators Tracked
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Most Common Indicators Tracked
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Least CommonIndicators Tracked
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Indicators TrackedKey Findings

• All 30 total testing process indicators are
  being tracked to some degree
• The top 5 indicators most commonly tracked are
  required by regulation or patient safety goals
• The 5 indicators least tracked are in the areas
  of appropriateness of testing for best care
• Pre-analytic and post-analytic indicators
  monitored less than analytic
• Less than 35 monitor order and use of testing
  for best care
• Less than 10 monitor result interpretation by
  clinician or patient

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Determine Steps Used in Patient Identification
Process as Example for Benchmarking
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What Features Would You Like in a New Patient
Identification System?
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Patient Identification Systems Key Findings

• Most labs use two unique identifiers patient
  name and medical record number
• 50 of labs currently have the ability to print
  labels at the site of collection
• 80 would like future ID systems to include
  hand held devices that
• Read bar coded ID bands
• Could be used for blood administration

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Gather List of Safety/Quality Initiatives that
Have Resulted in Error Reduction
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Open Ended Question

• What is the most significant initiative your
  laboratory implemented in the last three (3)
  years that effectively reduced laboratory errors
  or improved patient safety?
• Total of Responses 557

48
Most Significant Initiatives
Other
18
Process/ System Redesign
Patient/ Specimen Identification
50
7
12
Quality Improvement/ Management System
13
Information Systems/ Laboratory Information
Systems
49
Significant Initiatives Key Findings

• 50 of initiatives emphasize accurate patient
  and specimen identification
• The use of technology at 13 is either an
  untapped safety tool or many hospital
  laboratories have already implemented necessary
  technology for safety improvement
• The response of 12 indicating that their most
  significant event was implementing new or
  improved quality management systems demonstrates
  an evolving quality management environment
• Process/system design at 7 demonstrates that
  hospital laboratories are starting to look for
  error reduction by addressing process and system
  issues

50
Determine Topics for Future Surveys and
Benchmarks
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What Topics Would You Like To See in Future
Surveys and Benchmarks?
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Gather List of Individuals for a Future
Targeted Network
53
472 or 83
Said
YES
To Participation in anOngoing Quality Network
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Conclusion Quality Pilot Survey Objectives Met

• Collected information on quality management
  activities
• Identified types of events that lead to
  investigations and process used
• Determined indicators being used today and rank
  usage
• Determined steps used in patient ID process as
  example for benchmarking
• Gathered list of safety/quality initiatives that
  have resulted in error reduction
• Determined topics for future surveys and
  benchmarking
• Gathered list of individuals for a future
  targeted network

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Next Steps Pilot Study

• Present survey data to CLMA members who responded
• Prepare information for publication

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Thank you

• CDC Julie Taylor, PhD, MS and Staff
• Mike Noble, MD, FRCPC and IQLM Network Workgroup
• Paul Epner, MBA, Abbott Diagnostics
• CLMA
• Charlie Fenstermaker, Staff Liaison
• Survey respondents
• Those who have agreed to be in the ongoing
  network
• Board of Directors
• Quality Advisory Council

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CLMA Quality Advisory Council

• Chair - Julie Gayken
• CLMA Board Liaison Anne Daley
• Staff Liaison Charlie Fenstermaker
• Members -
• Peggy Ahlin, Senior Vice President, Quality
  Compliance, ARUP Laboratories
• Lucia Berte, Quality Systems Consultant
• Paul Epner, Director, Global Business Research,
  Abbott Diagnostics
• Claudine Panick, Regional Director, Adventist
  Health Systems
• Special Advisors -
• Joanne Born, Executive Director, JCAHO,
  Laboratory Accreditation Program
• Cecelia Kimberlin, Ph.D., V.P. Quality Assurance,
  Regulatory Affairs Compliance,
• Abbott Diagnostics
• Barbara Mitchell, Proficiency Testing Manager,
  American Academy of Family Physicians
• Anne Pontius, President, Laboratory Compliance
  Consultants, Inc.
• Steve Raymond, Administrative Laboratory
  Director,
• Phoenix Indian Medical Center

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Working Together Our Patients Will Be Safer

• Thank You

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Conclusion

• Identify a partner
• Develop laboratory networks, pilot completed
• Pilot study to determine potential of web based
  formatted survey
• Collect information on laboratory quality
  practice and services
• Determine respondents willing to participate in
  ongoing survey
• Track trends in a volunteer group of laboratories
  
• Develop process to obtain information on quality

60
Acknowledgements

• CDC
• Joe Boone, PhD, MS
• James Handsfield, MPH
• Devery Howerton, PhD, MS
• Colleen Shaw, MPH
• Susan Snyder, PhD, MBA
• Robin Stombler

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IQLM Network Workgroup

• Co-Leaders
• Mike Noble, MD, FRCPC
• Barbara Goldsmith, PhD, FCAB
• CDC Co-Liaisons
• Julie Taylor, PhD, MS
• Steve Glenn, MS

• Team
• David Bruns, PhD
• Nancy Elder, MD, MSPH
• Julie Gayken, MT(ASCP)
• Paul Epner, MBA
• Jennifer McGeary, MT(ASCP), MSHA
• Charlie Fenstermaker
• Barbara Mitchell, MS, MT (ASCP)
• Margaret Piper, PhD, MPH
• Rusty Senac
• Shahram Shahangian, PhD, MS
• David Sundwall, MD
• Scott Young, MD

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Next Steps
Network Workgroup

• Define network project priorities
• Establish the ongoing process to foster further
  successful project partnerships
• Establish the process for information sharing