Detroit Medical Center Laboratory Automation, Instrumentation & Autoverification: Methods for Maximizing Quality & Efficiency William Neeley, MD, FCAP, DABCC Medical Director Detroit Medical Center University Laboratories Detroit, Michigan 1
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 2
Detroit Medical Center Children's Hospital Harper & Hutzel Hospitals Huron Valley Hospital Detroit Receiving University Health Center & Hospital Core Laboratory Orthopedic Hospital Sinai-Grace Hospital 3 Rehabilitation Institute
Detroit Medical Center Interesting Statistics • 8 Hospitals and 1 Institute • 1,800 Licensed Beds • 3,000 Affiliated Physicians • 11,100 Full-Time Equivalents 4
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 5 • Outreach testing
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 6
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 7
Detroit Medical Center Strategies & Objectives • Autoverification— essential & not an option • 1 st Generation Autoverification • 2 nd Generation Middleware • 3 rd Generation Autoverification 8
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 9
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 10
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 11
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 12
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 13
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 14
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 15
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 16
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 17
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 18 efficiency?
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 $$$ 19
Detroit Medical Center History of Autoverification 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 20
Detroit Medical Center History of Autoverification 1 st 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 21 • Major labor savings
Detroit Medical Center 2 nd Generation Autoverification • “Middleware” created to fill a void • Positioned between instrument & LIS • Allows complicated algorithms or rules • Can examine many results simultaneously 22
Detroit Medical Center 3 rd Generation of Autoverification • 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. 23
Detroit Medical Center Autoverification Statistics • Automated general chemistry - 87 % outreach - 83 % outreach and inpatients (combined) • Automated hematology - 93 % • Coagulation - 81 % 24
Detroit Medical Center Daily Workload Automated Chemistry Tue 05/15/2007 300 277 274 250 240 229 Tubes per Hour 218 209 207 202 200 176 146 143 150 141 114 107 104 100 86 76 57 51 48 46 42 50 36 17 0 7:00 8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 5:00 6:00 AM AM AM AM AM PM PM PM PM PM PM PM PM PM PM PM PM AM AM AM AM AM AM AM 25 Time of Day
Detroit Medical Center DAILY WORKLOAD Automated Chemistry 3500 3000 2500 TUBES 2000 2004 1500 2006 1000 500 0 M T W T F S S M T W T F S S DAYS OF WEEK 26
Detroit Medical Center Chemistry Savings to Bottom Line 2000000 1950000 1900000 Savings $$ 1850000 1800000 1750000 1700000 1650000 1600000 1550000 1500000 1 2 3 4 5 Years Over a 5-year period the labor savings is $9,290,988 27
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 28
Detroit Medical Center Thank you 29
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