Central AccessioningJonathan Dryjowicz-Burek MLS(ASCP)

Medical Technologist

AccessioningThe process of accepting all orders or group

of tests on a specimen into the Laboratory information system (LIS) Vista.

ExampleWhite’s Café and Pastry Shop

R/CH 0527 455R/HE 0527 1083

The Opportunity Failure to launch

History of unsuccessful EffortsEmployees hired for Specimen processing in our Send Out Dept.

Chemistry staff is doing the workMedical technologists doing medical technician work.

Deficient Specimen AccessioningMRSA, app. 280 specimens/week Microbiology; blood cultures, C.diff

Procedure NoneOn the job training

Drop off location Middle of the lab

Laboratory renovation projectWindow of opportunity

Methodology: VA-TAMMCSVisionAnalysisTeamAimMapMeasureChangeSustain/Spreadhttp://www.paloalto.va.gov/docs/Improvement

Guide.pdf

Vision Vision- Implement Central Accessioning

at the VA West Roxbury Laboratory

An Area at the entrance of the West Roxbury Clinical Laboratory where specimens get dropped off, entered in the LIS, processed, and delivered to the appropriate department for analysis.

AnalysisBenchmarking against “best practices”

VA West Roxbury Chemistry Work Flow Specimen processing

Norwood Hospital Site Visit 12/18/2014Q and A Compared a similar hospital size/volume with a

Central Accessioning Department.

Improvement Team Sheryl Dinisco- Laboratory Manager, mentor, meetings, project

outlines, deadlinesJonathan Dryjowicz-Burek-Medical Technologist, ownerJennifer Stelmach-Medical Technologist, logistics , specimen

processing expertMary Pitts- Send-out supervisor, key for coordination with

staffing, scheduling, training.Linda Farney- Medical technologist, chemistry supervisor,

coordinator, specimen processing and limitations, context expert.Theresa Wedekind- Details , context expert.Susan Bennett-Medical technologist, QA manager ,

documentation, limitations, training, data, competencies. Jackie Rosario- LIM, data collection

The Plan Project Charter: 12/18/15 Define Scope 1/1/15

The central accessioning department will be implemented on February 1, 2015. It will operate during the day shift on weekdays All specimens including Hematology, Chemistry, Immunology, MRSA, blood culture

bottles, and send out tests will be accessioned and processed. Document QA issues

Set up work station and sample process 1/30/15 Centrifuges Aliquot tubes Sample racks

Write Procedure Implement: 2/2/2015 Collect data 1/2015-4/2015 Train Staff

3 weeks/employee Competencies

AimFrom 2/1 to 4/1 decrease time from specimen

collection to laboratory arrival by 15% using the MRSA agar. TAT for STAT Glucose and CBC from the

Emergency Room as an Analytical metric.Previously used order numbers as the Patient

center care metric.

Map/MeasureMap: Old Sample Flow vs. New Sample FlowMeasure-

Primary metric: MRSA Delay

The amount of time between specimen collection to accessioning. Pre-analytical metric

Secondary Metric CBC/Glucose TAT from ER

TAT from accession to result Analytical metric

Previously used order numbers Patient centered care metric = unnecessary collection Secondary outcome

Pre Implementation Process Map

Post Implementation Process Map

Primary Metric:Average MRSA agar Accessioning Delay

Jan. 12-16

Feb. 2-6

Feb. 16-20

March 2-6

March 16-20

0

4

8

12

16

20 18.6

11.58(-37.2%)

14.38(-22.7%)14.65(-21.2%)

10.11(-45.6%)

Average MRSA Delay

avg. delay in hours (percent change)

Week

hour

s

Implemented

Secondary Metric:Average complete blood count turn around time per week

Feb. 2-6 Feb. 9-13 Feb. 16-20 Mar. 2-6 Mar. 9-13 Mar. 16-200

2

4

6

8

10

12

14

16

18

12.73

14.51

16.46

12.44

14.31

12.6

Avg. CBC TAT/week

Avg TAT postavg tat pre CA

Week

Min

utes

Secondary Metric:Average glucose turn around time per week

Feb. 2-6 Feb. 9-13 Feb. 16-20 Mar. 2-6 Mar. 9-13 Mar. 16-200

5

10

15

20

25

30

35

30.15

26.68

30

25.8727.98

32.01

Avg. Glucose TAT/Week

Avg tatavg tat pre CA

Week

Min

utes

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 530

10

20

30

40

50

60

70

80

Glucose Turn around Time from Emergency Department

TATAVG TAT

Specimen Number

Min

utes

Secondary Metric:MRSA Prev. Used Order Numbers

OCT NOV DEC JAN FEB MARCH APRIL MAY JUNE JULY AUG0

5

10

15

20

25

30

35

40

13

8

13

5

14

22

31

18 17

35

24

Prev. Used Order #'s

Prev. Used Order #'s

Month

Num

ber

Change PDSA• Current

state

• Frozen Section Hand Delivery

• OR specimens signed

• C.diff accessioning

• Notify Staff and begin process

• Reinforce the changes, adapt procedure to include the changes.

Act Plan

DoStudy

• Reinforce accessioning process with afternoon shift

• Spread MRSA Accessioning to afternoon/night shift

• Delegate to nightshift supervisor.

• Afternoon shift is deficient in accessioning

• Night shift has adopted

Act Plan

DoStudy

Sustain/SpreadSustain:

All employees trained and competent.ProcedureResources

JDOS- home page>documents>manuals>laboratory Desk references

Leadership on boardContinuous monitoring

SpreadApply accessioning criteria to afternoon/overnight shifts.MRSA Blood cultures

Leadership Competencies Leading people

Commitment to employees and VA. Empowers others Build high-performing teams

Building Coalitions Developed networks and builds alliances Collaborates with stakeholders to better achieve objectives Find common ground with a wide range of stakeholders to better serve veterans.

Leading Change Champions Innovation Communicates vision and drives change

Global Perspective Understands and integrates stakeholder perspectives and takes action to improve

the deliver of benefits and services to veterans. Business Acumen

Applies forward thinking human capital management principles Employs technology effectively

Accessioning Processing

Specimen Drop Off

Thank you !!!!Janet Ferguson Thomas LillySheryl Dinisco Mary PittsJennifer StalmechLinda FarneyBrenda MasciovecchioTheresa WedekindSusan BennettJackie RosarioDave McElwee

Dianne FitzsimmonsBob BocJodi PolifernoNorwood HospitalPatricia WatsonThe Lead ProgramWest Roxbury Clinical

laboratoryAshley KellyTufts Medical Center

Questions?