Making a Positive Impact on Patient Care: A Case Study of Children’s National Medical Center Clinical Laboratory

Making a Positive Impact on Patient Care: ACase Study of Children’s National MedicalCenter Clinical LaboratoryPresented by: Joseph M. Campos, PhD, D(ABMM), F(AAM)Children’s National Medical Center, Washington, DC

Your Presenter Today Joseph M. Campos, Ph.D., D(ABMM), F(AAM) Children’s National Medical Center, Washington, DC• Obtained AB (1968), MA (1970), and PhD (1976) in Bacteriology from the University of California, Berkeley.• Served as Director of the Microbiology Laboratory at both Children’s Hospital of Philadelphia (1978-1985) and at Children’s National Medical Center (1985- present). He is also Director of the Molecular Diagnostics Laboratory and Director of Laboratory Informatics at Children’s National Medical Center.• Tenured Professor of Pediatrics, Pathology, and Microbiology/Immunology/Tropical Medicine at George Washington University Medical Center and is board-certified by the American Board of Medical Microbiology.• Currently is serving his fourth year in the elected position of Secretary of the American Society for Microbiology. © 2010 Guidon Performance Solutions, LLC. All rights reserved. 2

What We’ll Cover Today• Healthcare and Laboratory Testing Using Lean• 5 Lean Principles that Apply to the Laboratory• Case Studies – Microbiology Laboratory Workload and Staffing Data – Microbiology Incoming “Work Cell” – Automated Culture Plate Inoculation• Microbiology Testing – Traditional vs. Lean Approach• Summary © 2010 Guidon Performance Solutions, LLC. All rights reserved. 3

Healthcare and Lean• Lean principles can be applied to Start activities that have a defined series of steps during preparation of products Step 1• Healthcare and laboratory testing in particular are ideal targets for Lean• Presently the waste in the Yes Decision Step Y1 healthcare system of the U.S. alone is monumental amounting to $850 No billion per year• A Lean overhaul of the hospital Step N1 Step Y2 laboratory can eliminate wasteful activity and inactivity, reduce costs, improve patient outcomes, and Step 3 provide for safer healthcare encounters Finish © 2010 Guidon Performance Solutions, LLC. All rights reserved. 4

Laboratory Testing and Lean• The main objective of a Lean laboratory reorganization is to deliver the highest quality test results, at the lowest cost, within the shortest time frame, while improving physician/patient satisfaction• The deliverables of a successful Lean laboratory reorganization are: – Improved operational performance – Standardized processes – Fewer errors during testing – Better employee morale – Increased patient/employee safety © 2010 Guidon Performance Solutions, LLC. All rights reserved. 5

Five Lean Principles that Apply to the Laboratory1. Value: Strive to increase the value of testing from the physician/patient perspective2. Value Stream: Define the steps of testing processes and eliminate wasteful activities and inactivities3. Flow: Make each testing process flow as consistently as possible4. Pull: Maintain a “just-in-time” inventory of supplies5. Continuous Improvement: Seek perfection by constantly reviewing the steps of the testing processes © 2010 Guidon Performance Solutions, LLC. All rights reserved. 6

Implementation of Lean at CNMC• Microbiology Laboratory workload and staffing data were pre- submitted to Guidon Performance Solutions• A 3.5 day laboratory assessment was conducted on-site by Guidon• The focus was on the blood culture and urine culture value streams• Recommendations were made regarding maximal use of available staff, opportunities for automation, and more efficient utilization of laboratory space © 2010 Guidon Performance Solutions, LLC. All rights reserved. 7

Microbiology Testing – The Traditional ApproachDay Zero 0000 – 1600 1600 – 2400 New specimens are examined New specimens are examined microscopically and inoculated to microscopically and inoculated to culture media culture mediaDay One 0800 – 1600 0800 – 1600 Culture media are examined for growth Culture media are reincubated to allow and identification/antimicrobial more time for organisms to grow susceptibility tests are set upDay Two 0800 – 1600 0800 – 1600 Identification/antimicrobial Culture media are examined for growth susceptibility test results are reviewed and identification/antimicrobial and released to the physician susceptibility tests are set upDay Three 0800 – 1600 Identification/antimicrobial susceptibility test results are reviewed and released to the physician © 2010 Guidon Performance Solutions, LLC. All rights reserved. 8

Microbiology Testing – The Lean ApproachDay Zero 0000 – 2400 New specimens are examined microscopically and inoculated to culture media16 Hours 0000 – 2400 Culture media are examined for growthLater and identification/antimicrobial susceptibility tests are set up18-24 Hours 0000 – 2400 Identification/antimicrobialLater susceptibility test results are reviewed and released to the physician © 2010 Guidon Performance Solutions, LLC. All rights reserved. 9

Traditional Versus Lean Microbiology Testing• In the traditional testing scenario, work is performed when the laboratory staff is ready – organisms wait for the staff to be available on the next day shift• In the Lean testing scenario, work is performed when the organisms are ready – staff is always available to begin work on positive cultures• In the traditional testing scenario, final results of positive cultures are available in 40-64 hours• In the Lean testing scenario, final results of positive cultures are available in 34-40 hours © 2010 Guidon Performance Solutions, LLC. All rights reserved. 10

Other Lean Microbiology Improvements• Creation of “work cells” to minimize unnecessary movement and motion• More frequent deliveries of culture media and reagents to lessen inventory storage requirements and deterioration of labile materials• Automation of mindless repetitive steps to eliminate human error and free up staff for brain- intensive activities• Use of information technology to standardize culture workups – reducing inefficiency and mistakes © 2010 Guidon Performance Solutions, LLC. All rights reserved. 11

Microbiology Incoming “Work Cell”(A) (B) • Photo A – Specimen processing hood, continuously monitored blood culture instruments, and Gram staining sink in the left foreground • Photo B – Automated culture media inoculator and incubators © 2010 Guidon Performance Solutions, LLC. All rights reserved. 12

Automated Culture Plate Inoculation Manual Automated Manual Automated• The goal of a microbiology culture is to furnish well-isolated colonies for additional testing• The photos above illustrate how much better the automated culture medium inoculator does than a human• In this example, identification and antimicrobial susceptibility results would be available at least 18 hours sooner from the media inoculated with the automated instrument © 2010 Guidon Performance Solutions, LLC. All rights reserved. 13

Summary• While still in progress, the Lean-based reorganization of our Microbiology Laboratory has already eliminated a great deal of wasted time and effort• The changes to our laboratory are being achieved without increasing our space nor the number of our staff• Most importantly, the clinical utility of our test results are being improved because they Mission are less prone to human error Accomplished! and are available on a more timely basis © 2010 Guidon Performance Solutions, LLC. All rights reserved. 14

Thank You Guidon Performance Solutions 866-986-4414 or 480-986-4414 contact@guidonps.com www.GuidonPS.com © 2010 Guidon Performance Solutions, LLC. All rights reserved. 16© 2008 Guidon Performance Solutions, LLC. All rights reserved. Guidon Performance Solutions is a licensee of LeanSigma®, a service mark of TBM Consulting Group.

Making a Positive Impact on Patient Care: A Case Study of Children’s National Medical Center Clinical Laboratory

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Making a Positive Impact on Patient Care: A Case Study of Children’s National Medical Center Clinical Laboratory Presentation Transcript