1 ADVANCE for Executive Insight

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clinical lab efficiency FIG. 2 - OUTREACH program: volume of tests & revenue Test Volume: Reported Results 3400 3200 3000 2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 $2,642,724 $4,468,418 Year 5 Year 6 Year 7 Year 8 Based on Medicare Fee Schedule performs centralized, real-time monitoring of all instruments operating in the lab. The middleware system also performs autovalidation, eliminating the need for manual processes and the errors associated with it, by insuring that all test results pass through the same vigorous algorithmic process before being released. Among the most important features is the critical values notification, which alerts lab operators to outliers. Critical values are an important patient safety indicator, as they represent a potentially life-threatening pathophysiologic state that requires immediate intervention. If the sample needs to be rerun, this happens automatically as middleware rules trigger the test order and TLA carries out the processing. The lab operator can then notify the physician. In 2010, St. Mary’s laboratories enrolled in a CAP Q-track survey (Quality Assurance Benchmarking by CAP) on critical values reporting and we were rated on the top 5% with a reporting rate of 100%. 5 This means that all critical values were transmitted to the physicians within one hour for inpatients and outpatients. The study was carried over one year and 96 hospitals participated. TAT Improvements Also Improve Care In the post-analytic phase, we’ve focused on improving turnaround times (TATs) and enhancing communication, particularly with the emergency department, where prompt, predictable data reporting is especially critical. In 2008, the cost of avoidable medical errors to the U.S. healthcare system was estimated at nearly $20 billion, 6 and diagnostic errors were cited in as many as one-half of all malpractice claims involving emergency room care. 7 At St. Mary’s, the clinical lab has actively worked with ER and oncology clinicians to better understand their requirements. As a result of our automation system and ongoing communication through regular meetings, lab turnaround times (TATs) have improved by more than 50%, and delivery time variability has been drastically reduced. We measured TAT for stat chemistry tests, and results were delivered 90% of the time in 33 minutes or less. Better processing efficiency improved physician satisfaction levels, and greater collaboration with the lab in patient care delivery. Sustained Returns for Modest Investments Financially, investments to create St. Marys’ TLA environment have been very modest, and with very favorable ROI. Over a sixyear period, NPV was $1.54 million and IRR was 35%, with a payback period of approximately three years. The useful life of the automation system was estimated at 10+ years; St. Marys’ automation system is in its 14th year. There has also been a 60% growth in our lab outreach business, which generates additional revenues by providing laboratory services beyond our hospital. Implementing TLA and Lean processes have eliminated the vast majority of errors associated with the analytical phase of lab operations, enabling us to now focus on the pre-analytic phase, where the highest incidence of errors have been well documented to occur. 8 To date, a thorough process review (Lean approach) of blood collection has been completed, and an ongoing training program for phlebotomists and nurses is already in place. We are now looking at the feasibility to implement, hospitalwide, a barcoded wrist band for patients coupled with hand-held devices for patient identification. Conserving a small portion of the returns realized from our TLA investment and reinvesting it to reduce pre-analytic errors is a sound move that will yield considerable returns over the longer term in improved patient care, reduction of medical errors, and decreased cost care. As a hospital CFO as well as former lab director, I have seen the operational, financial and patient care benefits realized from investing in clinical lab operations. The advantages of implementing Lean processes and a TLA environment have quickly paid for the system and yielded even greater longer-term returns, and I believe other hospitals can experience similar favorable outcomes when executives give this sometimes small but always critical department the attention and investment support to accomplish these goals. These results may not be typical, as laboratory requirements differ. References 1. Boowe J. 2003 2. Lewin Group 2008 3. US Institutes of Medicine, To Err is Human Executive Brief, Nov 1999 4. Lewin Group 2008 5. CAP – QPROBES - 2010 6. Hospital Finance News, Aug. 9, 2010 7. Dark Daily Newsletter, Sept. 7, 2011 8. Plebani – 2006 34 ADVANCE for Executive Insight
FAST TIMES IN CHINA: We helped one core laboratory expand capacity as they raced to meet the demands of a growing patient population. Abbott Diagnostics offers up timely solutions to challenging problems. Together, let’s see what we can do for your institution. One Chinese hospital was expanding from 3000 beds to 4000 in very rapid fashion. And they knew pretty soon they’d have to expand again. That’s why Abbott Diagnostics was asked to help increase their core laboratory capacity to meet ballooning demand today and, simultaneously, position them for continued growth tomorrow. By providing integrated assay systems with a well-defi ned workfl ow, as well as training for the staff, we were able to offer responsive turnaround time while managing a signifi cant increase of tests per day. At Abbott Diagnostics we go beyond tests and instruments. We’ll partner with you to develop a solution that fi ts your institution. VISIT ABBOTTDIAGNOSTICS.COM. Put science on your side. is a trademark of Abbott Laboratories in various jurisdictions. ©2012 Abbott Laboratories MS_11_41068/v1 ADVANCE for Executive Insight 35
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