Pathology Service Improvement

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Pathology Service Improvement

• Ann Eason

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Pathology Service Improvement Team

• Funded and supported by Cancer Services
  Collaborative Improvement Partnership
• DH Funding for Pilot sites
• Progress to date
• National Framework for Service Improvement
• Toolkit - Practical Guide to redesign
• Discovery days
• 6 Pilot sites
• Workshops
• Website
• Discussion board
• Case Studies
• Rapport web based knowledge management system

3

Patient Pathway
spec
request
test
trans port
validate
issue
action
review
transport
Patient experience
95
NVA
5 VA
4
Tools and Techniques

• Define value for patient and users
• Mapping
• Process / value stream
• Service blue printing
• spaghetti
• Removal of waste
• 5s
• Improve flow match capacity to demand
• Reduce variation
• Continuous quality improvement

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Identify and remove waste

• Overproduction
• Waiting and delay
• Motion
• Processing
• Inventory
• Defects
• Underutilised staff

• Inappropriate systems
• Energy and Water Materials
• Service and Office Wastes
• Customer Time
• Defecting Customers

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What we have seen

• Chaotic systems
• Poor communication
• Over complicated
• No flow
• Lack of patient involvement
• Waste
• Duplication
• Risk

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Findings

• Patients
• Access is difficult
• Little information about tests
• Delays to results if at all
• Privacy and dignity
• Car parking

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Users

• Quality
• Access
• Information
• Results
• Turnaround

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Impact of service improvement

• Reduced turnaround times
• Better access to results
• Reduced costs
• Increased patient satisfaction
• Staff satisfaction improved
• Improved lay out / better use of space

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Waiting times for phlebotomy
11
Understand the process
Arrives at reception
OPD admin books patient onto EPR
Blue book taken from patient Pt Given ticket,
AC notes pulled
Blue book put on pile for Phlebotomist to bleed
Patient waits to be called
Specimen and blue book sent to Pathology Lab
via pneumatic tube
Patient called Bled by Phlebotomist
Patient called by AC nurse
Result and dosage Issued to patient
Nurse receives book
Sample arrives at reception
Sample Registered on clinisys
Test processed and INR result written in
patients book
Blue book sent to AC nurse in OPD
Follow up Appointment time given if required
TTA given if required
Patient leaves Hospital
gt2 hours
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Remove the waste

Patient arrives
Patient called by AC nurse
POCT machine Analyses blood
Dose Patient as per patient group
directions Input details on DAWN
Date and time of follow up appointment (if
required)
TTA issued if required
Patients thumb is lanced Blood dropped on
strip
Write result in blue book
20 mins max
13
Impact of redesign

• Waiting times reduced for 81 of patients
• Patient choice
• Increased patient focus for clinical staff
• Reduced administrative burden.
• Increased capacity within phlebotomy
• Projected annual cost benefit 20 496

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Staff skill mix

• Benefits
• freeing up staff time
• Departmental skill mixing
• job satisfaction
• increased opportunities

• Achievements
• Increased automation
• Extension of Advanced Practitioner role
• Extension of support grade roles
• Training Seminars
• Cross disciplinary working
• Requesting protocols

• Cost savings
• Addressing recruitment

Being trained to carry out testing using
Molecular methods has been very beneficial to me,
enabling me to learn and practice a new technique
as well as supporting my personal development and
improving the service Trainee Clinical Scientist
in Haematology
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Molecular Genetics staff time saved in a month by
changes to FVL requesting identified by process
mapping.
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Match Capacity to Demand
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Forms booked in
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Transport
GP vans
GP vans
phlebotomy
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Appropriateness of testing
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Understand flow
Complexity (Spaghetti) Mapping - Old
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Complexity (Spaghetti) Mapping (new)
Improve Flow
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Optimising skills of staff (efficiency)

• 1 reception staff walks 1.2 miles / day
• Cost 2298 - 2947
• Increase No Specimens
• prepared by 11520
• Turn around time reduced by 17mins

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Effective Space Utilisation current state
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Effective Space Utilisation future state
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Effective Utilisation of Equipment and Space

• 6s and cardboard engineering
• Strategic grouping of analysers
• Effective utilisation, need fewer analysers
• Eliminated requirements for rebuild

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Laboratory activity (Jackson)