Using Keele data to demonstrate
efficiency and effectiveness
Jim Allison
Background
 SCBMDN has to engage with the
Keele benchmarking process.
 Improve the consistency of the data
returned by Scottish labs
 Seek to influence the introduction of
new questions within the Keele
database
 Enable greater use of this data to
plan service delivery
Background :
Background :
National Pathology Benchmarking
Service at Keele University
 Performance management tool.
 Peer comparison of key indicators.
 Internal comparison of year on year performance.
 Separate data collection and benchmark reports are
offered for Clinical Biochemistry, Haematology/Blood
Transfusion, Histopathology/Cytology, Immunology and
Microbiology/Virology.
Background :
Keele Benchmarking – difficult and
time consuming process.







Questionnaires sent out electronically during April 2012.
Completed questionnaires returned to Keele in June
Data checking exercise undertaken.
Data is processed at Keele, and a specialist panel - made up
of clinicians from the relevant discipline - meet to discuss
the data.
Panel write a commentary on the findings, providing
interpretation of the data which is included in the final
report.
Generic report produced in December for each participant,
plus a separate analysis tool enabling you to drill down into
the data further and create their own charts and tables.
In January, participants are invited to a user group meeting,
where the findings of the report are discussed, and the
participants get the opportunity to influence future
development of the programme
Keele and the SCBMDN
1. What information /markers of
efficiency and effectiveness Keele
provides the SCBMDN.
2. Identify areas of inconsistency.
3. Recent interactions of the SCBMDN
with Keele.
4. What the SCBMDN might do with
Keele in the future.
Keele Information:
 Workload
 Staffing
 Finance
 Efficiency & productivity
 Quality & effectiveness
Engagement with Keele:
SCBMDN questionnaire (Sept 2011); 8 out of
15 Health Boards responded.
Efficiency and Productivity
 Cost per test and request
 Requests and Tests per WTE
Effectiveness
 A&E turnaround times
 Other ideas
Keele Information:
Keele Information:
Biochemistry is a
local lab for local
people.
There’s no need
for benchmarking
here!!!
Keele Information:
Test Workload per 1000 Population
Health Board
Children
Adults
Total
Ayrshire & Arran
63,210
299,850
363,060
Borders
19,840
92,050
111,890
Dumfries &
Galloway
24,430
122,190
146,620
Fife
64,610
293,160
357,770
Forth Valley
53,670
232,770
286,440
Grampian
95,620
441,550
537,170
Greater Glasgow &
Clyde
207,670
975,050
1,182,720
Highland
53,010
250,970
303,980
Lanarkshire
105,580
451,900
557,480
Lothian
140,450
676,880
817,330
Orkney
3,380
16,560
19,940
Shetland
4,220
17,940
22,160
Tayside
67,750
325,070
392,820
Western Isles
4,440
21,510
25,950
Keele Information:
Workload: Like for Like U&E?
Serum Creatinine Workload per 1000 Population
Creatinine
500
400
300
200
Lab / Region
NHS
Tayside
NHS
Lothian
WG
St John's
RIE
NHS
Lanarkshire
NHS
Highland
NHS GGC
Aberdeen
Forth Valey
Fife
0
Borders
100
Ayrshire &
Arran
Cereat Req /1000 pop
600
Keele Information:
Workload: Like for Like TFTs?
TSH & FT4 workload per 1000 Population
Tests Per 1,000 GP Population: T4 (Free)
300
Tests Per 1,000 GP Population: TSH
200
150
100
Region
NHS Tayside
NHS Lothian
NHS
Lanarkshire
NHS Highland
NHSGGC
NHS Grampian
NHS Forth
Valley
NHS Fife
0
NHS Borders
50
NHS Ayrshire &
Arran
Req / 1000 Pop
250
Keele Information:
Workload: Like for Like Lipids?
Chol, Trig & HDL Workload Per 1000 Pop
Triglyceride
Cholesterol
HDL (+D-LDL)
300
200
150
100
Region
NHS Tayside
NHS Lothian
NHS
Lanarkshire
NHS
Highland
NHS GGC
Aberdeen
Fife
Borders
0
Forth Valley
50
Ayrshire &
Arran
Req /1000 Pop
250
Keele Information:
Workload: Like for Like HbA1c?
HbA1c and Micro Alb Workload per
1000 Population
100
Albumin/Microalbumin (urine)
90
HbA1c
70
60
50
40
30
20
Region
NHS Tayside
NHS Lothian
NHS
Lanarkshire
NHS Highland
Aberdeen
Forth Valley
Fife
Borders
0
NHS GGC
10
Ayrshire &
Arran
Req /1000 Pop
80
Keele Information:
Staffing
All
Teaching
Non
Teaching
Total Medical Staff
(including Trainees)
-14.76%
-13.63%
-19.39%
Total WTE Biomedical
Scientists
-3.47%
-4.48%
-1.78%
WTE MLA / Support Workers
-3.05%
-1.29%
-6.23%
Total WTE Clinical Scientists
-12.24%
-10.73%
-15.99%
% Change 2010-2011
Lab / Region
Western Isles
70
Tayside
80
Western
General
90
St John's
Hospital
100
RIE
RHSC
NHS
Lanarkshire
Highland
South
Glasgow
North
Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
Ayrshire and
Arran
Numbers of Staff
Keele Information:
Staffing
Lab Staff AfC band 4 and Below + Band 5 and Above
Total Staff: AfC Band 4 and
Below
Total Staff: AfC Band 5 and
Above
60
50
40
30
20
10
0
0
Lab / Region
Western Isles
Tayside
Western General
3
St John's Hospital
RIE
RHSC
NHS Lanarkshire
Highland
South Glasgow
North Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
Ayrshire and Arran
pay cost/ test (£)
Keele Information:
Finance
Total Pay Cost Per Test
3.5
Total Pay Cost Per Test
2.5
2
1.5
1
0.5
0
Lab / Region
Western Isles
Tayside
Western
General
0.8
St John's
Hospital
RIE
NHS
Lanarkshire
Highland
South
Glasgow
North Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
Ayrshire and
Arran
pay cost/ test (£)
Keele Information:
Finance
Total Pay Cost Per Test
0.9
Total Pay Cost Per Test
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Lab / Region
Western Isles
Tayside
Western
General
0.7
St John's
Hospital
RIE
NHS
Lanarkshire
Highland
South
Glasgow
North
Glasgow
Clyde
Aberdeen
Forth Valley
Fife
Borders
Ayrshire and
Arran
pay cost/ test (£)
Keele Information:
Finance
Total Pay Cost Per Test
0.8
Total Pay Cost Per Test
0.6
0.5
0.4
0.3
0.2
0.1
Keele Information:
Finance
Biomedical Scientists Out of Hours Payments (Including Trainees)
£1,200,000
Biomedical Scientists Out of
Hours Payments (Including
Trainees)
£1,000,000
£600,000
£400,000
£200,000
Lab / Region
Western Isles
Tayside
Western General
St John's Hospital
RIE
RHSC
NHS Lanarkshire
Highland
South Glasgow
North Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
£0
Ayrshire and Arran
Cost (£)
£800,000
Keele Information:
Efficiency and Productivity
i)
Efficiency – Cost per test and cost
per request.
ii) Productivity - Number of tests per
WTE.
Keele Information:
Cost per Request
PMS says ….
No!
Lab /Region
Western Isles
Tayside
WG
4.5
St John's
RIE
RHSC
Lanarkshire
Raigmore
Oban
Caithness
Belford
South Glasgow
North Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
Ayrshire and Arran
Cost (£)
Keele Information:
Efficiency
Total Pay and Non Pay Cost per Test
Total Pay Cost Per Test
Total Non Pay Cost Per Test
4
Grand Total
3.5
3
2.5
2
1.5
1
0.5
0
Keele Information:
Efficiency
Total Pay and Non Pay Cost per Test
Total Pay Cost Per Test
Total Non Pay Cost Per Test
1.2
Grand Total
0.8
0.6
0.4
0.2
Lab /Region
Tayside
WG
St John's
RIE
Lanarkshire
South Glasgow
North Glasgow
Clyde
Aberdeen
Forth Valley
Fife
Borders
0
Ayrshire and Arran
Cost (£)
1
Lab/Region
Western Isles
Tayside
Western General
200000
180000
160000
140000
120000
100000
80000
60000
40000
20000
0
St John's
RIE
RHSC
Lanarkshire
Oban
South Glasgow
North Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
Ayrshire and Arran
Tests /Total WTE
Keele Information:
Productivity
Tests Per Total WTE Staff
Tests Per Total WTE Staff
Keele Information:
Productivity
Tests Per Total WTE Staff
180000
160000
Tests Per Total WTE Staff
120000
100000
80000
60000
40000
20000
Lab/Region
Tayside
West Gen
St John's
RIE
Lanarkshire
South
Glasgow
North Glasgow
Clyde
Aberdeen
Forth Valley
Fife
Borders
0
Ayrshire and
Arran
Tests/WTE
140000
Keele Information:
Efficiency and Productivity
These workload variations do not impact
significantly on Keele efficiency and
productivity figures.
Tot Tests
Tot Expend
Total
WTE
Cost /
Test
Tests /
WTE
Average Lab
5,000,000
£3,500,000
48
£0.70
104,166
Plus extra 80,000 FT4,
50,000Trigs and
30,000HbA1C
5,160,000
£3,540, 000
48
£0.69
107,291
Keele Information:
Quality & Effectiveness
 Accreditation status
 A&E TATs
Keele Information:
Effectiveness
Keele - U&E TAT for A&E
 What is the target TAT for U&E
requests from A&E?
 What proportion of A&E requests for
U&E are reported within this target?
0
Lab Location
Western Isles
Tayside
WG
St John's
RIE
RHSC
Lanarkshire
Raigmore
Oban
Caithness
Belford
South Glasgow
North Glasgow
Clyde
Elgin
Aberdeen
Forth Valley
Fife
Borders
U&E Target TAT for A&E
140
120
100
70
80
60
60
50
40
40
30
20
20
10
0
% Within Target
Ayrshire & Arran
TAT (Min)
Keele Information:
U&E TAT for A&E
Target TAT for U&E
% of requests reported within this target
100
90
80
Keele Information:
Future Inclusion of RCPath KPIs
KPI: A&E blood sciences turn-around-times
 Baseline: Percentage of core investigations, i.e. renal
function, liver function tests and full blood counts
from A&E completed within 1 hour of receipt,
including out of hours
 Challenge: 85% by Apr 2012 increasing to 90% by
Apr 2014. The standard will move to 1 hour from
sample collection by April 2015.
 SCBMDN: Agreement to adopt this RCPath KPI.
Keele Information:
Effectiveness
 Vetting Work Referred to Outside Laboratories
 Identifying Duplicate Requests and Standard Rejection
Procedure
 Providing Requestors with Key Performance Indicators
 Participation in Training Events for Requestors and
Utilisation of Order Comms for Education
 Disease/Symptom-specific Profiles, Requestor/Gradespecific Testing, Clinical Pathway Development
 Processes to Improve the Efficiency and Quality of
Service
 Does your clinical biochemistry laboratory have a
formal risk management policy ?
Quality and Effectiveness
SCBMDN engagement with
Keele
Engagement with Keele:
SCBMDN New Questions in Keele

Availability of clinical advice.

Repertoire of tests available on an emergency basis?

Communication of critical results; timeliness and number/
frequency.

Number of urgent/emergency requests processed in last
year?

What percentage of reports contain interpretative
comments?

Number of complaints /critical incidents
SCBMDN & KEELE
Availability of Clinical Advice
Q2-5-1
Which member(s) of staff provide clinical interpretative
advice?
UA
When does this service operate?
Is this 24 hours
per day,
365(6)
days per
year?
If no please state start and
finish time (please use
the format HH:MM)
Start time
Finish time
Q2-5-2
Monday to Friday
UA
09:00
17:00
Q2-5-3
Saturday
UA
09:00
17:00
Q2-5-4
Sunday
UA
09:00
17:00
Q2-5-5
Public Holiday
UA
09:00
17:00
SCBMDN & KEELE
Plasma/Serum/Blood
Test Name
Column 1
Total Tests Inhouse
Column 2
Number of
Tests
Performed for
Primary Care
Column 3
Column 4
Tests Referred
Out (change to
'yes' only if you
refer the test
out)
Is Test Provided
as an
Emergency
(change to 'yes'
only if available
24/7, 365)
1,25 Hydroxy Vitamin D
UA
No
No
11-Deoxycortisol
UA
No
No
17 Hydroxy Progesterone
UA
No
No
25 Hydroxy Vitamin D
UA
No
No
ACTH
UA
No
No
Adrenaline
UA
No
No
Albumin
UA
No
No
Alcohol (Ethanol)
UA
No
No
UA
Ongoing Dialogue with Keele
 Getting more out of the existing
questionnaire
 Incorporating further markers of
effectiveness
 Invitation to David Holland to attend
SCBMDN meeting later this year.
END
Example of Improvement in Clinical
Effectiveness of Laboratory Service
 NHSG Primary Care – ongoing problem with spurious
hyperkalaemia due to long transportation times.
 Jan 2010, <20% of SST samples from primary care
spun at source.
 Centrifugation of SST tubes in primary care practices
introduced in July 2010.
 Jan 2011, 95% of SST samples from primary care
spun at source
Clinical Effectiveness
Retrospective audit conducted to review
the impact on patient care of introduction of
centrifugation in primary care:
a) Pre-GP centrifugation Jan – June
2010
b) Post-GP centrifugation Jan – June
2011
Classification of follow-up of
hyperkalaemia




Appropriate admission: Genuine hyperkalaemia in a GP
sample resulting in admission to acute medical receiving
where the hyperkalaemia has been confirmed
Appropriate GP follow-up: Genuine hyperkalaemia in a
GP sample resulting in a repeat sample from the GP where
the hyperkalaemia has been confirmed
Inappropriate admission: Pseudohyperkalaemia in a GP
sample due to delay in sample centrifugation resulting in
admission to acute medical receiving where the follow-up
serum potassium is within the reference interval
Inappropriate GP follow-up: Pseudohyperkalaemia in a
GP sample due to delay in centrifugation resulting in a
repeat sample from the GP where the follow-up serum
potassium is within the reference interval
Effectiveness of follow-up of
primary care patients with
hyperkalaemia
 Sample centrifugation in primary care locations
in NHSG has proven to be an excellent
example in improving the clinical effectiveness
of an existing laboratory investigations,
whereby the same test deployed now secures a
greater health gain for patients from the
available resource.