Clinical Safety

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Clinical Safety Effectiveness
Reducing TAT in the Clinical Cytogenetics
Laboratory- Phase 2
DATE
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What do we do in the Clinical Cytogenetics
Laboratory?

• Cytogenetics is the study of heredity and
  variation by the methods of both cytology and
  genetics.
• Constitutional Studies
• Inherited
• Acquired Studies
• Changes that happen after birth, which are cancer
  related

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What do we do in the Clinical Cytogenetics
Laboratory?

• Examine chromosomes to identify abnormalities
• Abnormalities are markers for diagnosis,
  prognosis, and treatment.
• Culture cells for days to weeks before analysis
  begins

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Clinical Cytogenetics Laboratory Personnel
Denise Lovshe, BS. CG(ASCP) Laboratory Manager
Terry Van Fleet Supervisor (Night )Team 7
Cytogenetics Technologists Technicians Romona
Francis Aruna Uppal Tomaro McChriston
Linda/Zeb/Lenore
Protacio Martin Emerson Huang Rodney
Thomas Darryl Mitchell Avelina Varilla
Cytogenetics Technologists Shelley Miao S Lina
Wu S Joey Pena Carol Tran Juan Flores Roland
Delgado Wenping Dai Shelli Cardona
Cytogenetics Technologists Sarita Bakhru
S Sheba Philip Ruba Nassar S Christi Taft
S Kaher Sari Jessica Reyes Jennifer Yarman
S Anamaria Fals S
Cytogenetics Technologists Technicians
Cytogenetics Technologists Danielle Saldi
S Joanne ChengS Taryn Gomez Yuan Yang S Ken
Futrell Smita Trivedi Michael Liang Ricardo
Fernandez
Cytogenetics Technologists Robert Chang Bing
Bai S Mercedes Lovell S Roshini Thomas S Helia
Forouzan Jennifer Stewart
Cytogenetics Technologists Christina Coleman
S Binh Vo Shanita Bhakta S Su Yang S Minh
Vu Steven Sfamenos
Vivian Guadarrama Lab technical asst. Jing
Bao
Administrative asst. Senior Secretary
8/1/2015
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Workload

• 22,215 specimens per year
• 98 hematologic malignancies
• 2 solid tumors
• Conventional karyotypic analysis
• 50 of tests
• 3 hours per case (after specimen culture
  processing)
• FISH (Fluorescence In Situ Hybridization)
• 50 of tests (100 different probes)
• 1.5 hours per case (after specimen culture
  processing)

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The Team

• Martha Johnson-Hamilton Pathology and
  Laboratory Medicine Quality
  Technologist
• Denise Lovshe Cytogenetics Laboratory
  Manager
• Elizabeth Harper Cytogenetics
  Supervisor
• Soo Ha Cheong Cytogenetics Supervisor
• Sarita Bakhru Sr. Cytogenetics
  Technologist
• Lisa Honore Cytogenetics Supervisor

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What We Are Trying to Accomplish?

• AIM STATEMENT

The aim of this project is to reduce the TAT for
resulting neoplastic bone marrow specimens
submitted for Cytogenetics analysis to 21
calendar days for 90 of specimens by June 2011.
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Background

• The Cytogenetics Laboratory and Lab Quality
  Improvement group wanted to improve on its 2008
  CSE Project (Phase 1) which had 85 of its
  neoplastic bone marrow specimens completed within
  a 21 day period.
• Strategic Alignment
• We will continue to increase the quality, safety
  and value of our clinical care.

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Baseline Data Percent Completed Within 21
Days
Previous Project Results
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Baseline Data Order to Verify TAT
Previous Project Results
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Cytogenetics Process Map
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Fishbone Diagram
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Major Identified Issues

• Overwhelmed Cytogenetics Technologists
• Manual Slide Analysis
• Decrease in Efficiency
• Delay in the transcription of cases
• Increase in the workload
• Space Limitations

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Implemented Solutions

• No Patient Left Behind (Jan 2009)

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Implemented Solutions

• Banding Process Change (May 2009)
• Hired Full Time Secretary (Sept 2009)
• Genetix Slide Loader (GSL)
• (March 2010)

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Implemented Solutions

• Cross Trained Cytogenetics
• Technologists (Mar 2010)
• Changed the sample media (Sept 2010)
• Changed the staffing hours (Jan 2011)
• Acquired space for the Breast pathologists to
  sign out remotely (Jan 2011)

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TAT Results- Order to Verify
21 Improvement
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TAT Results Percent Completed within 21 Days
13 Improvement
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Return on Investment

• Hard Savings
• Annualized margin increase of 547,200
• Jan 2008 - Apr 2010 vs. May 2010 - Jun 2011
• The lab began keeping over 61 of the cases that
  they were previously sending out to a reference
  lab.

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of Send Outs by Stages
Fewer Test being sent out per month
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Next Steps

• Go paperless with the updated version of our
  Cerner computer system. (Dec 2011)
• Interface the GSL analyzer with the updated
  Cerner system. (Dec 2011)
• Train the Lab Technicians to do more tasks

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Lessons Learned

• Careful planning pays off
• Change Management is not as simple as it sounds
• You cant communicate too much!
• Data-driven decisions work
• Collaboration improves buy-in
• Input feedback from stakeholders are
  important
• Automation can create capacity

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Thank you!