2. Accessioning
The process of accepting all orders or group of tests on
a specimen into the Laboratory information system
(LIS) Vista.
Example
White’s Café and Pastry Shop
R/CH 0527 455
R/HE 0527 1083
3. The Opportunity
Failure to launch
History of unsuccessful Efforts
Employees hired for Specimen processing in our Send Out Dept.
Chemistry staff is doing the work
Medical technologists doing medical technician work.
Deficient Specimen Accessioning
MRSA, app. 280 specimens/week
Microbiology; blood cultures, C.diff
Procedure
None
On the job training
Drop off location
Middle of the lab
Laboratory renovation project
Window of opportunity
5. 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.
6. Analysis
Benchmarking against “best practices”
VA West Roxbury Chemistry
Work Flow
Specimen processing
Norwood Hospital Site Visit 12/18/2014
Q and A
Compared a similar hospital size/volume with a Central
Accessioning Department.
7. Improvement Team
Sheryl Dinisco- Laboratory Manager, mentor, meetings, project
outlines, deadlines
Jonathan Dryjowicz-Burek-Medical Technologist, owner
Jennifer Stelmach-Medical Technologist, logistics , specimen
processing expert
Mary 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
8. 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
9. Aim
From 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.
10. Map/Measure
Map: Old Sample Flow vs. New Sample Flow
Measure-
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
13. Primary Metric:
Average MRSA agar Accessioning Delay
18.6
11.58(-37.2%)
14.38(-22.7%)
14.65(-21.2%)
10.11(-45.6%)
0
2
4
6
8
10
12
14
16
18
20
hours
Week
Average MRSA Delay
avg. delay in hours
(percent change)
Implemented
14. Secondary Metric:
Average complete blood count turn around time
per week
12.73
14.51
16.46
12.44
14.31
12.6
0
2
4
6
8
10
12
14
16
18
Feb. 2-6 Feb. 9-13 Feb. 16-20 Mar. 2-6 Mar. 9-13 Mar. 16-20
Minutes
Week
Avg. CBC TAT/week
Avg TAT post
avg tat pre CA
15. Secondary Metric:
Average glucose turn around time per
week
30.15
26.68
30
25.87
27.98
32.01
0
5
10
15
20
25
30
35
Feb. 2-6 Feb. 9-13 Feb. 16-20 Mar. 2-6 Mar. 9-13 Mar. 16-20
Minutes
Week
Avg. Glucose TAT/Week
Avg tat
avg tat pre CA
16. 0
10
20
30
40
50
60
70
80
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 53
Minutes
Specimen Number
Glucose Turn around Time from Emergency Department
TAT
AVG TAT
17. Secondary Metric:
MRSA Prev. Used Order Numbers
13
8
13
5
14
22
31
18
17
35
24
0
5
10
15
20
25
30
35
40
OCT NOV DEC JAN FEB MARCH APRIL MAY JUNE JULY AUG
Number
Month
Prev. Used Order #'s
Prev. Used Order #'s
18. Change PDSA
• Notify Staff and
begin process
• Reinforce the
changes, adapt
procedure to
include the
changes.
• Frozen Section
Hand Delivery
• OR specimens
signed
• C.diff accessioning
• Current
state
Act Plan
DoStudy
• Delegate to
nightshift
supervisor.
• Afternoon shift is
deficient in
accessioning
• Night shift has
adopted
•Spread MRSA
Accessioning to
afternoon/night
shift
• Reinforce
accessioning
process with
afternoon
shift
Act Plan
DoStudy
19. Sustain/Spread
Sustain:
All employees trained and competent.
Procedure
Resources
JDOS- home page>documents>manuals>laboratory
Desk references
Leadership on board
Continuous monitoring
Spread
Apply accessioning criteria to afternoon/overnight shifts.
MRSA
Blood cultures
20. 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
22. Thank you!!!!
Janet Ferguson
Thomas Lilly
Sheryl Dinisco
Mary Pitts
Jennifer Stalmech
Linda Farney
Brenda Masciovecchio
Theresa Wedekind
Susan Bennett
Jackie Rosario
Dave McElwee
Dianne Fitzsimmons
Bob Boc
Jodi Poliferno
Norwood Hospital
Patricia Watson
The Lead Program
West Roxbury Clinical
laboratory
Ashley Kelly
Tufts Medical Center
