Clinical Safety & Effectiveness
Reducing TAT in the Clinical
Cytogenetics Laboratory- Phase 2
DATE
1
What do we do in the Clinical
Cytogenetics Laboratory?
• Cytogenetics is the
study of heredity and
variation by the methods
of both cytology and
genetics.
• Constitutional Studies:
– Inherited
• Acquired Studies:
– Changes that happen
after birth, which are
cancer related
What do we do in the Clinical
Cytogenetics Laboratory?
• Examine chromosomes
to identify abnormalities
• Abnormalities are
markers for diagnosis,
prognosis, and
treatment.
• Culture cells for days to
weeks before analysis
begins
Clinical Cytogenetics Laboratory Personnel
Lynne V. Abruzzo, MD., Ph.D.
Guohui (Gary) Lu, MD., FACMG
Chief Director, Section of Cytogenetics
Section of Cytogenetics
Denise Lovshe, BS. CG(ASCP)
Laboratory Manager
Elizabeth Harper
Supervisor
(Day) Team 4
Terry Van Fleet
Supervisor
(Night )Team 7
Cytogenetics
Technologists’ &
Technicians’
Cytogenetics
Technologists’
& Technicians’
Romona Francis
Protacio Martin
Aruna Uppal
Emerson Huang
Tomaro
McChriston
Rodney Thomas
Linda/Zeb/Lenore
Darryl Mitchell
Avelina Varilla
Lisa Honore
Supervisor
(Day) Team 2
Cytogenetics
Technologists’
Sarita Bakhru S
Sheba Philip
Ruba Nassar S
Christi Taft S
Kaher Sari
Jessica Reyes
Lian Zhao
Supervisor
(Day) Team 1
Melissa Robinson
Lawrence Frimpong
Patrick Cheong
Supervisor
Supervisor
Supervisor
(Evening) Team 3
(Day/Evening) Team
5
(Evening) Team 6
Cytogenetics
Technologists’
Cytogenetics
Technologists’
Danielle Saldi S
Robert Chang
Joanne ChengS
Bing Bai S
Taryn Gomez
Mercedes Lovell S
Yuan Yang S
Roshini Thomas S
Ken Futrell
Helia Forouzan
Smita Trivedi
Jennifer Stewart
Jennifer Yarman
S
Michael Liang
Anamaria Fals S
Ricardo
Fernandez
Cytogenetics
Technologists’
Cytogenetics
Technologists’
Shelley Miao S
Christina Coleman S
Lina Wu S
Binh Vo
Joey Pena
Shanita Bhakta S
Carol Tran
Su Yang S
Juan Flores
Minh Vu
Roland Delgado
Steven Sfamenos
Wenping Dai
Shelli Cardona
Administrative asst.
Senior Secretary
Vivian Guadarrama
6/30/2016
Lab technical asst.
Jing Bao
Workload
• ~22,215 specimens per year
– 98% hematologic malignancies
– 2% solid tumors
• Conventional karyotypic analysis
– ~50% of tests
– 3 hours per case (after specimen culture & processing)
• FISH (Fluorescence In Situ Hybridization)
– ~50% of tests (~100 different probes)
– 1.5 hours per case (after specimen culture &
processing)
The Team
– Martha Johnson-Hamilton Pathology and
Laboratory Medicine
Quality Technologist
– Denise Lovshe
Cytogenetics Laboratory
Manager
– Elizabeth Harper
Cytogenetics Supervisor
– Soo Ha Cheong
Cytogenetics Supervisor
– Sarita Bakhru
Sr. Cytogenetics
Technologist
– Lisa Honore’
Cytogenetics Supervisor
6
What We Are Trying to
Accomplish?
AIM STATEMENT
The aim of this project is to reduce the
TAT for resulting neoplastic bone marrow
specimens submitted for Cytogenetics
analysis to 21 calendar days for 90% of
specimens by June 2011.
7
Background
The Cytogenetics Laboratory and Lab Quality
Improvement group wanted to improve on its
2008 CS&E Project (Phase 1) which had 85%
of its neoplastic bone marrow specimens
completed within a 21 day period.
Strategic Alignment:
We will continue to increase the quality, safety
and value of our clinical care.
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Baseline Data:
Percent Completed Within 21
Days
Previous Project
Results
9
Baseline Data:
Order to Verify TAT
Previous Project
Results
10
Cytogenetics Process Map
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Fishbone Diagram
Major Identified Issues
• Overwhelmed Cytogenetics Technologists
• Manual Slide Analysis
• Decrease in Efficiency
• Delay in the transcription of cases
• Increase in the workload
• Space Limitations
Implemented Solutions
•No Patient Left Behind (Jan 2009)
Implemented Solutions
• Banding Process Change (May 2009)
• Hired Full Time Secretary (Sept 2009)
• Genetix Slide Loader (GSL)
(March 2010)
Implemented Solutions
• Cross Trained Cytogenetics
Technologists (Mar 2010)
• Changed the sample media (Sept 2010)
• Changed the staffing hours (Jan 2011)
• Acquired space for the Breast pathologists to
sign out remotely (Jan 2011)
TAT Results- Order to Verify
21% Improvement
TAT Results: Percent Completed
within 21 Days
13% Improvement
Return on Investment
Hard Savings:
•Annualized margin increase of $547,200
•Jan 2008 - Apr 2010 vs. May 2010 - Jun 2011
• The lab began keeping over 61% of the cases that
they were previously sending out to a reference lab.
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# of Send Outs by Stages
Fewer Test being
sent out per month
Next Steps…
•
Go paperless with the updated version of our
Cerner computer system. (Dec 2011)
•
Interface the GSL analyzer with the updated
Cerner system. (Dec 2011)
•
Train the Lab Technicians to do more tasks
Lessons Learned
• Careful planning pays off
• Change Management is not as simple as it
sounds
• You can’t communicate too much!
• Data-driven decisions work
• Collaboration improves buy-in
• Input & feedback from stakeholders are
important
•Automation can create capacity
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Thank you!