Detroit Medical Center Laboratory Automation, Instrumentation & - - PowerPoint PPT Presentation

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Laboratory Automation, Instrumentation & Autoverification: Methods for Maximizing Quality & Efficiency

William Neeley, MD, FCAP, DABCC

Medical Director Detroit Medical Center University Laboratories Detroit, Michigan

Detroit Medical Center

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Lab Automation, Instrumentation & Autoverification

• Good news—improved instrumentation
• Wide selection of lab automation systems
• Challenge is to select the one that most

closely meets your particular needs

• Lab automation alone will not produce

efficiency

• Autoverification—dramatically improving

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Detroit Medical Center

Huron Valley Hospital Harper & Hutzel Hospitals Children's Hospital Sinai-Grace Hospital Orthopedic Hospital University Health Center & Core Laboratory Detroit Receiving Hospital Rehabilitation Institute

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Interesting Statistics

• 8 Hospitals and 1 Institute
• 1,800 Licensed Beds
• 3,000 Affiliated Physicians
• 11,100 Full-Time Equivalents

Detroit Medical Center

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Detroit Medical Center

General Lab Information

• Over 12 million billable tests/year
• 48% of volume is outreach
• < 0.8 % of testing sent to outside labs
• Core Laboratory
• Routine & STAT testing
• Specialized testing
• Outreach testing

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Detroit Medical Center

Strategies & Objectives

• Develop a clear vision
• Visit automation sites—apply common sense
• Ask if the benefits are worth the cost
• Unify methodology across entire system
• Apply lean principles & clean up sample flow
• Reduce manual handling & transport of samples

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Detroit Medical Center

Strategies & Objectives

• Consolidate tests from multiple areas
• Instruments should function well with and

without automation

• Instruments should enhance automation
• Automation should handle STATs
• Support our 29-minute ER initiative

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Strategies & Objectives

• Autoverification— essential & not an option
• 1st Generation Autoverification
• 2nd Generation Middleware
• 3rd Generation Autoverification

Detroit Medical Center

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Detroit Medical Center

Centrifugation

• Automation or manual?
• Worth the cost? ($80K-$120K each)
• Is automated or manual centrifugation faster?
• To re-centrifuge or not re-centrifuge?
• Results of our study

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Detroit Medical Center

General Criteria for Selecting Instrumentation for Lab Automation

• Long term calibration stability
• Highly stable electrolytes
• System handles a wide variety of tubes—

depends on particular environment

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Detroit Medical Center

General Criteria for Selecting Instrumentation

• Chemical and instrument stability reduces total

number of controls

• Low maintenance (saves labor)
• Maintenance costs inversely related to reliability

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Detroit Medical Center

General Criteria for Selecting Instrumentation

• Minimize consumables—watch for hidden costs
• Disposable tips are very important for

automation—no cross contamination

• Measure indices—bilirubin, hemoglobin &

lipemia

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Detroit Medical Center

Criteria for Selecting Instrumentation for Lab Automation Systems

• Clot detection
• Low repeat rate—minimizes cost
• Highly reliable results over wide dynamic

ranges

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Detroit Medical Center

Criteria for Selecting both Instrumentation & Lab Automation Systems

• Direct tube sampling from

automated conveyor system

• Extremely important for

attaining highest efficiency

• Point-In-Space Sampling

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Detroit Medical Center

Criteria for Selecting both Instrumentation & Lab Automation Systems

• Maximize the number of

different tube sizes that can be used with automation

• Very important for attaining

high efficiency, especially in competitive outreach market

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Detroit Medical Center

Criteria for Selecting Both Instrumentation & Lab Automation Systems

• Short draws are a major

source of inefficiency, ~20% samples

• Critical to handle short

draws with minimal labor

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Detroit Medical Center

Criteria for Selecting Instrumentation for Lab Automation Systems

• Small tubes in pediatrics

10 x 65 mm

• Critical to handle most pediatric

samples with automation

• Major pediatric hospital in

Michigan

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Detroit Medical Center

Sample Aliquoting

• Front or back of automate track?
• Is an automated aliquoter worth $350K?
• Are STATS done faster or slower with robotic

aliquoter?

• More or fewer incidents of QNS?
• Does direct tube sampling plus aliquoting at

end of automation line provide higher efficiency?

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Detroit Medical Center

Robotic Storage

• Robot to remove samples from track & place

them in storage rack

• Robot can remove tube from storage & place

back on conveyor for re-testing or add-on tests

• Refrigerated storage areas are good but $$$

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Detroit Medical Center

Earliest Systems Before Autoverification

Home grown but powerful (1992) Clearly demonstrated basic principles Allowed complex algorithms using many different parameters Clearly notified tech as to nature of problem as well as lab policy for correction

History of Autoverification

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Detroit Medical Center

History of Autoverification

1st Generation Autoverification

• A disappointment but a start
• Not enthusiastically supported by LIS
• Limited to simple testing to see if a result is

within a specified range

• Complex algorithms
• Major labor savings

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Detroit Medical Center

2nd Generation Autoverification

• “Middleware” created to fill a void
• Positioned between instrument & LIS
• Allows complicated algorithms or rules
• Can examine many results simultaneously

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Detroit Medical Center

• Philosophy—Provide the user with tools to develop

algorithms or rules of their own choosing based on medical experience that can be uniformly applied to each and every result.

• Utilize all information that is available to evaluate results

before they are released.

• Utilize information from EMR such as CC, HPI, family

history, medications, etc.

3rd Generation of Autoverification

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Detroit Medical Center

Autoverification Statistics

• Automated general chemistry
• 87 % outreach
• 83 % outreach and inpatients (combined)
• Automated hematology
• 93 %
• Coagulation
• 81 %

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Detroit Medical Center

Daily Workload Automated Chemistry

Tue 05/15/2007 17 86 104 114 57 46 51 48 36 141 107 143 240 277 207 209 202 274 176 218 229 146 42 76 50 100 150 200 250 300 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM 12:00 AM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM

Tubes per Hour Time of Day

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Detroit Medical Center

DAILY WORKLOAD

500 1000 1500 2000 2500 3000 3500

M T W T F S S M T W T F S S

DAYS OF WEEK TUBES 2004 2006

Automated Chemistry

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Detroit Medical Center

Over a 5-year period the labor savings is $9,290,988 Chemistry Savings to Bottom Line

1500000 1550000 1600000 1650000 1700000 1750000 1800000 1850000 1900000 1950000 2000000 1 2 3 4 5

Savings $$ Years

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Detroit Medical Center

Summary

• Significant improvements in service, quality, &

efficiency can be obtained by appropriate choices & integration of Lab Automation, Instrumentation, & Autoverification

• The fewer times a sample is touched the higher

the efficiency, fewer errors & lower costs

• Questions: wneeley@dmc.org

Phone:313-966-0005

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Detroit Medical Center

Thank you