Improving Efficiency in Clinical Laboratory

Dr Farooq Ghani

Aga Khan University

 The FUTURE of
Over 70% of Healthcare
Decisions
Clinical are based
Laboratory on
Me dicine
Medical Tests

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 Clinical Lab Process Improvement

• Online connectivity of the main lab to11

The FUTURE of
regional labs and 187 phlebotomy centers
throughout the country
Clinical Laboratory Me dicine
• Barcoding samples at collection site

• Lab Automation
Farooq Ghani, M.D.,Ph.D
Director, Bayer HealthCare
Tarrytown, New York
 Online
Connectivity
& Barcoding The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 Routine Lab Practice

Blood Whole
Samples blood ~25 % Hematology

Serum based / plain ~75 %

blood

Chemistry / Immuno Other

chem assays

~ 90 %
Automation ~ 10 %
• “The first rule of any technology
used in an organization is that
The applied
automation FUTURE to anof efficient
operation will magnify the
Clinical Laboratory
efficiency. The second is Me dicine
that
automation applied to an inefficient
operation will magnify the
inefficiency”
Farooq Ghani, M.D.,Ph.D
Director, Bayer HealthCare
Tarrytown, New York

Bill Gates
 Increase
Capacity

Reduce Faster
Errors Laboratory TAT
Automation

Space Personnel
Utilization Optimisation
 Turnaround Time

Testing
13%
Delivery
4% Sorting
Frontend 6%
Documentation 52%
5% Accessioning
Troubleshooting 27%
4%
Loading Aliquoting
4% 15%
Centrifugation
Resulting 4%
18%
High Gain Opportunities
 Goal: Reduce Costs and Turnaround Time
17 Steps
• Samples manually logged
into laboratory
Fewer steps equal
• Verification of Collection
at LIS
faster, more consistent
Costs • Load individual tubes into
turnaround
& centrifuge
• Centrifuge Samples
TAT • Unload each tube from
centrifuge
• Split samples for separate
9 Steps
workstation
• Distribute samples to each
workstation • Samples manually logged
• Visualize Serum Indices into laboratory
• Check QC • Verification of Collection
5 Steps
• Load sample tube on wheel at LIS
• Results validated and • Load racks into centrifuge
verified at LIS • Centrifuge samples
• Samples Stored • Unload racks from • Samples placed into inlet
3 Steps
• Delta Checking centrifuge station
• Program tests not validated • Place racks on analyzer • Place racks on analyzer
• Rerun tests not validated • Rerun tests not validated • Rerun test not validated • Samples placed into inlet
• Identify samples for reflex • Identify samples for reflex • Reflex Testing station
testing testing automatically • Review by exception
• Reflex Testing • Reflex Testing • Samples stored • Samples stored

Current Lab System-Based Discrete Connected

Process Automation Automation Automation

Productivity Increases
 Steps Automated
in the Diagnostic Laboratory

Post-Analytical Pre-Analytical
prepare order
collect sample
transport to lab
Sample retrieval
accession sample
store samples

dispose of waste centrifuge

post-sort decap tubes

transmit test results pre-sort/aliquot

technical validation transport to analyzer

Analytical
 Solutions to Streamline the Process
EDTA Pre-Analytics Track
tubes Informatics Tube Storage & Retrieval

X X X X X X X
Sort
Receive Sample Label
into lab Load Unload Aliquot Sort
tubes Decap aliquot
centrifuge centrifuge
tubes

X
Load in
Input Queue Pre-Analytics (100% of tubes / >50% of labor) Walk to
analyzers

X Post-Analytics (100% of tubes / 8% of labor)

Load
analyzers

X X X X X X X X
Walk Verify/
Store Archive Recap Unload Rerun Locate Verify
to storage Manage
racks tubes tubes analyzers exceptions exceptions at LIS
area exceptions

X X X X XX X Find
tube
Load on
analyzer
Verify at
LIS
Unload
analyzer

Exceptions (10% of tubes)

Recap
tube
Archive
tubes
Store
racks
 Understanding your Processes

Process Mapping
• Analyze your processes
• Identify opportunities
• Eliminate waste
 Metrics for Success
• Testing • TAT
• Test/Tube • Tube Arrival
12,000
Volume
Stated
Estimated Annual IA Volume by Order/Assay

35%
California Hospital Medical Center
Tests per Tube Distribution
Jan. 3 through 10, 2005 60
California Hospital Medical Center
Total Samples by Hour - Thursday, Jan 6, 2005
318 Routine, 238 STAT
30.00
Analysis
Histogram of Sample TAT: Order to Result Verified
USL 60.00

33%
10,244
STAT Routine Mean 76.21 Cp -0.16
Extrapolated Routine Median Cpk

53
62.89 -0.16
10,000
30% STAT 50
Pp -0.11

48
25.00

8,475

27%
Ppk -0.11

46
Number of Orders per Year

Cpm 0.15
8,000
7,150

Stdev 48.24
25%
40 20.00 Max 255.59

21%

Number of Samples
Min 25.16

36
20%
Zbench

34
6,000 -0.34

Number
20% CpkU

Frequency
-0.16
4,420

15.00
4,160

30

32
13
3,692

3,700

27
15%
3,484

ZTarget 0.22

26
51
4,000
3,075

25

25
%Defects

45
15% 0.59

23
23
2,525

2,450
2,350

2,274
%Expected 0.63

21

21
10.00

19
19
1,716

DPMO

8
20 586206.90

9
1,392

30

7
1,196
1,200

2,000

17
17

17
Expected

10
631608.88

7
10%

15
936

8%
825

676

12
VANCORDM 0 572

8
468

7%
450

468
357
364

9
5.00

1 12
275

306

300

7%
260
208

156

156
160

156

6%

6%
104

104
100
52

52
52

52

10
41

23

11

7
0

13
0 10

20
15
4%
4%

18
2 8
5%

17
4%
HEPFPNL
FREET3
CARBAM

HBSAB

HBSAG

HCYST-ARUP

RUBG-NHMC
BNP

CKMB

PSA

TROPONIN
FT4

HCGQL

16

16
HCGQN

MYOGLOBIN

TSH
T3

T4
CK

VANCOT
VANCOP
FOLATE

3%
3%

3%

14

14
3%

2%

13
5
2%

5 05
2%

2%

8
11
2%

2%

11

10
0.00

2%
1%
1%
1%
1%

1%

1%

9
1%

1%

8
1%
1%

1%

0%
0%
0%

0%
0%

0%
0%
0%
0%

0%

6
0%
-3.647656257 25.156249993 53.960156243 82.764062493 111.567968743 140.371874993 169.175781243 197.979687493 226.783593743 255.587499993

4
3
2

2
0% 0 to to to to to to to to to to
25.156249993 53.960156243 82.764062493 111.567968743 140.371874993 169.175781243 197.979687493 226.783593743 255.587499993 284.391406243
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Order/Assay Number of Tests per Tube Hour of Day Minutes

• Capacity • TAT Analysis • Efficiency

Planning
ACCELERATOR ACCELERATOR
ARCHITECT® c8000™ Throughput Utilization Automated Processing System
Chemistry Sample TAT by Hour of Day

100%
At Risk 60

At Target Routine CC TAT Summary

STAT
Target Routine STAT
50 Mean 36.0 29.4
80%
St. Dev. 3.6 2.9
Percent of Total Capacity

40

60%
TAT (min)

30
44%

40%
31%

30%
29%

20
26%
14%

13%

20%
13%

10
11%
10%

8%
6%
6%

4%
2%

2%

2%
2%

2%
1%

1%

1%
0%
0%

0% 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0:00 3:00 6:00 9:00 12:00 15:00 18:00 21:00 0:00

Hour of Day Arrival Time

Core Lab
Regional Labs
Satellite Labs
 The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 ADVIA® Automation

The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 ADVIA® Automation

The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
 ADVIA® Automation Solution User
Outcomes

Reporting errors The FUTURE of

Clinical Laboratory Me dicine
60%
reduction
in error

Farooq Ghani, M.D.,Ph.D

Director, Bayer HealthCare
Tarrytown, New York
2004 2006 2007 2008
Individual results may vary.
 Process Efficiency

Tubes (thousands) %
5 100
The FUTURE of
4 Clinical
$1,600
savings
75 Laboratory Me dicine
3 98%
50 reduction
2
25
1 Farooq Ghani, M.D.,Ph.D
Director, Bayer HealthCare
Tarrytown, New York
Primary tubes Aliquots
Source: ACM
Individual results may vary.
 Technology Adoption Life Cycle

100

75

50

25

0
 The FUTURE of
Clinical Laboratory Me dicine

Farooq Ghani, M.D.,Ph.D

Director,
Thank YouBayer HealthCare
Tarrytown, New York