35. Low Normal High
WBC x 109/L
Ruby (n = 175) 2.51 (3.9%) 8.07 (2.6%) 10.67 (2.5%)
Sapphire (n = 146) 2.62 (3.9) 8.19 (2.3%) 10.87 (2.6%)
Hb x g/dL 6.45 (2.2%) 14.02 (2.0%) 18.77 (2.1%)
Platelets x 109/L 85.9 (6.7%) 197.7 (6.1%) 397.9 (4.8%)
36. 4. Reticulocytes
• Ruby reticulocyte method uses the thiazine dye New
Methylene Blue N.
• Assay performed in the WOC channel.
• Sample preparation is performed manually. 20ul blood
dispensed into a tube of Cell-Dyn reticulocyte reagent.
• Staining of reticulum is complete within 15 mins.
Stained sample is aspirated in the open mode.
• Reticulocytes are reported (%R).
• Absolute reticulocyte count calculated if RBC
concentration is entered.
Less than 5 requests per day
37. > 6 sigma is world-class; < 3.4 defects / million episodes
Ruby IQC RBC WBC Hb Platelet
Low 4.2 6.2 6.8 3.4
Normal 4.6 9.3 8.4 6.4
High 5.4 7.0 7.4 9.9
Sigma metric = (TEa – Bias) / cv > 4 -- 2 x 2 controls / day
-- one 2.5 s QC rule
TEa (total error allowable)
53. Divider Title 4
How ?
3. Post-Analytics
- critical lab values
- autoverification
Result Availability
- local printing
- intranet (lab)
- electronic medical record (EMR)
58. Continuing QA Validation
• Staff will regularly scroll through the data
manager (10%) for potential discrepancy
in results, note ID no., & sign document for
review by senior staff.
• Senior QA Co-ordinator will review and file
the documents.
60. Middleware – Impact of Autoverification
Mean: 9 – 12 min
90th centile: 21-28 min
45 min TAT: 98.5 – 99.1%
61. Autoverification occurs in “middleware” server
90% of results autoverified
Faster turnaround time
Increased capacity
62. Where Abbott Instrument Manager fits in
Laboratory Hospital
Information Information
System System
Ethernet
Additional Instrument
Instrument ManagerTM
ManagerTM Workstation
Workstation
No limitations
for added
workstations…
No limitations for
added
instrumentation…
63. Middleware – Instrument Manager
Improve satisfaction and reduce costs by decreasing human
errors and enabling quicker diagnosis
View all sample information
Centralized Information Select a sample to view
patient and test data
Quick, accurate diagnosis
Improve consistency
Reduce training time View patient
information
Automated Tasks
Centralized, intelligent verification
Manage
Decrease human errors test results
Standardize routine tasks (release, order
re-runs, etc.)
Simplified Quality
Increase quality control
Share data with QC software Adaptable Workspaces
Utilize moving averages Customize windows, color code and filter data as needed
63
64. Redundancy Features
Back-Up
LIS Backup
– Automatically print chartable reports
to ER and ICU printers during
downtime
– Print LIS downtime labels
automatically or on demand
– Complete audit trail for full
traceability
Database backup
– Enables active mirror of Instrument
ManagerTM database
– Real time, continuous data backup
– Minimal downtime to failover
65. • Platelets > Hb > WBC
• Start by releasing ALL normal results + NO flags
Then ALL no hold backs + NO flags
66. Differentials
• WBC & RBC morphology flags
• Rules to decide manual differential or slide review
67.
68.
69. Location Apr2006 Jan2007 Feb2008 Mar2008
Wards 35’ 29’ 20’ 18’
SICU 27-40’ 36’ 21’ 19’
MICU 31-44’ 32’ 21’ 19’
Clinics 25’ 23’ 20’ 17’
ER 22-25’ 22’ 20’ 18’
Mean: 9 – 12 min
90th centile: 21-28 min
45 min TAT: 98.5 – 99.1%
70. Results Availability
Printing @ source Web Query
- LIS
- EMR (electronic
medical record)
71.
72.
73.
74. Bonus - Remote Diagnostics
Maximum equipment uptime
Benefits
Fix it before it breaks
Faster response time
Engineers arrive with
the right parts
Monitor Instrument
Events and Alarms
Early error detection
Remote troubleshooting
Proactive on-site visit
74
78. PROCESS
Eliminate Waste
- over-production
- waiting
- unnecessary transport
- over/incorrect processing
- defects
- unused employee creativity
Right Process - - > Right Results
Continuous Process Flow
No over-production (what he wants, when he wants,
in the amount he wants)
Level out workload
Right quality first time
Standardized task
Visual control – no problems hidden
Use reliable, tested technology