ABSTRACT
The basic technologies used in preanalytic processes for chemistry tests have been mature for a long time, and improvements in preanalytic processes have lagged behind improvements in analytic and postanalytic processes. We describe our successful efforts to improve chemistry test turnaround time from a central laboratory by improving preanalytic processes, using existing resources and the principles of lean production. Our goal is to report 80% of chemistry tests in less than 1 hour and to no longer recognize a distinction between expedited and routine testing. We used principles of lean production (the Toyota Production System) to redesign preanalytic processes. The redesigned preanalytic process has fewer steps and uses 1-piece flow to move blood samples through the accessioning, centrifugation, and aliquoting processes. Median preanalytic processing time was reduced from 29 to 19 minutes, and the laboratory met the goal of reporting 80% of chemistry results in less than 1 hour for 11 consecutive months.
Subject(s)
Chemistry, Clinical/organization & administration , Diffusion of Innovation , Efficiency, Organizational , Laboratories, Hospital/organization & administration , Process Assessment, Health Care , Quality Assurance, Health Care , Autoanalysis , Centrifugation/standards , Cost Control , Humans , Laboratories, Hospital/standards , Time Factors , WorkforceABSTRACT
Hypoplastic left heart syndrome (HLHS) affects infants and is uniformly fatal without surgical palliation. Post-surgery mortality rates are highly variable and dependent on postoperative management. A data acquisition system was developed for collection of 73 physiologic, laboratory, and nurse-assessed parameters. The acquisition system was designed for the collection on numerous patients. Data records were created at 30s intervals. An expert-validated wellness score was computed for each data record. To efficiently analyze the data, a new metric for assessment of data utility, the combined classification quality measure, was developed. This measure assesses the impact of a feature on classification accuracy without performing computationally expensive cross-validation. The proposed measure can be also used to derive new features that enhance classification accuracy. The knowledge discovery approach allows for instantaneous prediction of interventions for the patient in an intensive care unit. The discovered knowledge can improve care of complex to manage infants by the development of an intelligent bedside advisory system.
Subject(s)
Algorithms , Critical Care/methods , Decision Making, Computer-Assisted , Hypoplastic Left Heart Syndrome/physiopathology , Postoperative Care/methods , Humans , Hypoplastic Left Heart Syndrome/surgery , Infant, Newborn , Monitoring, PhysiologicABSTRACT
Turnaround time for Papanicolaou (Pap) tests became an important service quality issue at our institution. We studied Pap test turnaround time using engineering process improvement tools and benchmarked turnaround time against data published as a College of American Pathologists Q-Probes study. An IDEF3 process map revealed the complexity of the Pap test process and the opportunities for process improvement. We used these data and the action-research method to initiate changes in cytopathology laboratory operations with the goal of reducing turnaround time. Before intervention, mean Pap test turnaround time was highly variable; during a 6-month period, monthly means ranged from 2.5 to 10.8 days. A cycle time study conducted over a 2-week period validated these data. After system improvements were implemented, the monthly mean turnaround time decreased and became more consistent, with 11 of 12 months having a mean turnaround time of 3 days or less (range, 1.5-3.9 days). Our study illustrates the value of publishing Q-Probes data for use as external benchmarks and the benefits of using tools from other disciplines to improve laboratory processes.
