Improving Turnaround Times through a Process Improvement Initiative Involving Barcoding, Floorplans, Dual Measuring Cells, Chemistry Analyzers, and Staff Shifts.

BACKGROUND: Specimen turnaround time (TAT) is an important metric for laboratory safety and quality. Various methods to improve TAT have seen success using process improvement initiatives. However, there are limited data on barcoding, pneumatic receiving proximity to modular preanalytics, 1 vs 2 measuring cells, and upgrading to Cobas 8000. The example describes the complete execution of a process improvement initiative to improve TAT within these areas over a 20-month period. The study aimed to improve specimen timeliness by decreasing the TAT for preanalytic and analytic specimen processing through a systematic process improvement initiative and to empower staff to "own" their scientific method. METHODS: The primary outcome TAT was reported from a prospective quality initiative beginning January 2017 for 2 analytes: troponin and potassium. TATs for albumins from the complete metabolic panels were added to the study design retrospectively during team rounds. Mean TAT was defined as time from arrival to verified times. Process improvement tools within the study design were borrowed from Lean management. RESULTS: After implementation of the process improvement initiative, the number of steps medical laboratory assistants and technologists performed per specimen decreased from 8 to 5. Mean TATs decreased for all analytes. Preimplementation to postimplementation comparisons from 2017 to 2018 decreased for all 3 analytes and within 2017. The number of troponin specimens verified within 60 min improved from 70% in January 2017 to 95% in August 2018, with an improvement from 64% in January 2017 to 87% in August 2018 during peak hours. CONCLUSIONS: A systematic process improvement initiative whereby employees "own" the scientific process within specimen preanalytic and analytic testing phases can significantly improve metrics for laboratory quality and safety.

Implications of autoverification for the clinical laboratory.

In an era of financial stress, the clinical laboratory must maximize the efficiency of its operations. In this context, Centralized Laboratory Services, Inc., Long Island City, New York, attempted to introduce autoverification into its chemistry department. We discuss some of the issues associated with implementation of autoverification and also our effort to get an approximate quantitative estimate of the extent of productivity improvement related to the initiation of autoverification at Centralized Laboratory Services (CLS). We used payroll and expense records for 4-week periods preceding and following the introduction of autoverification to construct such an estimate. On an annualized basis, CLS data suggests a maximum savings of approximately 0.3 FTEs from the introduction of autoverification. This represents 3.1% of the workforce in the chemistry department at CLS.