The document describes the implementation of a central specimen accessioning department at a VA medical laboratory. It outlines the vision, analysis conducted, improvement team assembled, and plan to set up an area for specimen drop-off, entry into the lab information system, processing, and delivery to departments. Metrics measured before and after implementation showed decreased turnaround times for MRSA samples and certain tests from the emergency room. The change was successful and later expanded to other shifts.

1. Jonathan Dryjowicz-Burek MLS(ASCP)
Medical Technologist

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

4. Methodology: VA-TAMMCS
 Vision
 Analysis
 Team
 Aim
 Map
 Measure
 Change
 Sustain/Spread
 http://www.paloalto.va.gov/docs/ImprovementGuide.
pdf

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

11. Pre Implementation Process Map

12. Post Implementation Process Map

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

21. Accessioning Processing
Specimen Drop Off

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

23. Questions?