detroit medical center - medical automation | health care
TRANSCRIPT
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Laboratory Automation , Instrumentation & Autoverification: Methods for Maximizing Quality &
Efficiency
William Neeley, MD, FCAP, DABCCMedical Director
Detroit Medical Center University LaboratoriesDetroit, Michigan
Detroit Medical Center
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Lab Automation, Instrumentation & Autoverification
• Good news—improved instrumentation
• Wide selection of lab automation systems
• Challenge is to select the one that most
closely meets your particular needs
• Lab automation alone will not produce
efficiency
• Autoverification—dramatically improving
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Detroit Medical CenterHuron Valley HospitalHarper & Hutzel HospitalsChildren's Hospital
Sinai-Grace HospitalOrthopedic Hospital
University Health Center &Core Laboratory
Detroit ReceivingHospital
Rehabilitation Institute
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Interesting Statistics
• 8 Hospitals and 1 Institute
• 1,800 Licensed Beds
• 3,000 Affiliated Physicians
• 11,100 Full-Time Equivalents
Detroit Medical Center
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Detroit Medical Center
General Lab Information
• Over 12 million billable tests/year
• 48% of volume is outreach
• < 0.8 % of testing sent to outside labs
• Core Laboratory
• Routine & STAT testing
• Specialized testing
• Outreach testing
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Detroit Medical Center
Strategies & Objectives
• Develop a clear vision
• Visit automation sites—apply common sense
• Ask if the benefits are worth the cost
• Unify methodology across entire system
• Apply lean principles & clean up sample flow
• Reduce manual handling & transport of samples
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Detroit Medical Center
Strategies & Objectives
• Consolidate tests from multiple areas
• Instruments should function well with and
without automation
• Instruments should enhance automation
• Automation should handle STATs
• Support our 29-minute ER initiative
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Strategies & Objectives
• Autoverification— essential & not an option
• 1st Generation Autoverification
• 2nd Generation Middleware
• 3rd Generation Autoverification
Detroit Medical Center
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Detroit Medical Center
Centrifugation
• Automation or manual?
• Worth the cost? ($80K-$120K each)
• Is automated or manual centrifugation faster?
• To re-centrifuge or not re-centrifuge?
• Results of our study
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Detroit Medical Center
General Criteria for Selecting Instrumentation for Lab Automation
• Long term calibration stability
• Highly stable electrolytes
• System handles a wide variety of tubes—
depends on particular environment
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Detroit Medical Center
General Criteria for Selecting Instrumentation
• Chemical and instrument stability reduces total
number of controls
• Low maintenance (saves labor)
• Maintenance costs inversely related to reliability
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Detroit Medical Center
General Criteria for Selecting Instrumentation
• Minimize consumables—watch for hidden costs
• Disposable tips are very important for
automation—no cross contamination
• Measure indices—bilirubin, hemoglobin &
lipemia
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Detroit Medical Center
Criteria for Selecting Instrumentationfor Lab Automation Systems
• Clot detection
• Low repeat rate—minimizes cost
• Highly reliable results over wide dynamic
ranges
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Detroit Medical Center
Criteria for Selecting both Instrumentation& Lab Automation
Systems
• Direct tube sampling from automated conveyor system
• Extremely important for attaining highest efficiency
• Point-In-Space Sampling
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Detroit Medical Center
Criteria for Selecting both Instrumentation
& Lab Automation Systems
• Maximize the number of different tube sizes that can be used with automation
• Very important for attaining high efficiency, especially in competitive outreach market
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Detroit Medical Center
Criteria for Selecting Both Instrumentation
& Lab Automation Systems
• Short draws are a major source of inefficiency, ~20% samples
• Critical to handle short draws with minimal labor
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Detroit Medical Center
Criteria for Selecting Instrumentation
for Lab Automation Systems
• Small tubes in pediatrics
10 x 65 mm
• Critical to handle most pediatric samples with automation
• Major pediatric hospital in Michigan
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Detroit Medical Center
Sample Aliquoting
• Front or back of automate track?
• Is an automated aliquoter worth $350K?
• Are STATS done faster or slower with robotic aliquoter?
• More or fewer incidents of QNS?
• Does direct tube sampling plus aliquoting at end of automation line provide higher efficiency?
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Detroit Medical Center
Robotic Storage
• Robot to remove samples from track & place
them in storage rack
• Robot can remove tube from storage & place
back on conveyor for re-testing or add-on
tests
• Refrigerated storage areas are good but $$$
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Detroit Medical Center
Earliest Systems Before Autoverification
Home grown but powerful (1992)
Clearly demonstrated basic principles
Allowed complex algorithms using many
different parameters
Clearly notified tech as to nature of problem as
well as lab policy for correction
History of Autoverification
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Detroit Medical Center
History of Autoverification
1st Generation Autoverification
• A disappointment but a start
• Not enthusiastically supported by LIS
• Limited to simple testing to see if a result is
within a specified range
• Complex algorithms
• Major labor savings
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Detroit Medical Center
2nd Generation Autoverification
• “Middleware” created to fill a void
• Positioned between instrument & LIS
• Allows complicated algorithms or rules
• Can examine many results simultaneously
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Detroit Medical Center
• Philosophy—Provide the user with tools to develop
algorithms or rules of their own choosing based on medical
experience that can be uniformly applied to each an d every
result.
• Utilize all information that is available to evalua te results
before they are released.
• Utilize information from EMR such as CC, HPI, famil y
history, medications, etc.
3rd Generation of Autoverification
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Detroit Medical Center
Autoverification Statistics
• Automated general chemistry
- 87 % outreach
- 83 % outreach and inpatients (combined)
• Automated hematology
- 93 %
• Coagulation
- 81 %
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Detroit Medical CenterDaily Workload Automated Chemistry
Tue 05/15/2007
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86
104114
5746
51 4836
141
107
143
240
277
207 209202
274
176
218229
146
42
76
0
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Tub
es p
er H
our
Time of Day
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Detroit Medical Center
DAILY WORKLOAD
0
500
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3500
M T W T F S S M T W T F S S
DAYS OF WEEK
TU
BE
S
2004
2006
Automated Chemistry
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Detroit Medical Center
Over a 5-year period the labor savings is $9,290,98 8
Chemistry Savings to Bottom Line
1500000
1550000
16000001650000
1700000
1750000
1800000
18500001900000
1950000
2000000
1 2 3 4 5
Sav
ings
$$
Years
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Detroit Medical Center
Summary• Significant improvements in service, quality, &
efficiency can be obtained by appropriate
choices & integration of Lab Automation,
Instrumentation, & Autoverification
• The fewer times a sample is touched the higher
the efficiency, fewer errors & lower costs
• Questions: [email protected]
Phone:313-966-0005