Volume 4, Issue 1 (Winter-Spring 2021)                   Mod Med Lab J 2021, 4(1): 1-4 | Back to browse issues page

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Huq Ronny F, Almadani M, Fallon J, Adem P. Lean six sigma process improvement in specimen receiving to improve stat chemistry turnaround times. Mod Med Lab J. 2021; 4 (1) :1-4
URL: http://modernmedlab.com/article-1-92-en.html
Abstract:   (377 Views)
Objective: As a consequence of stat turnaround times (TATs) chronically exceeding 60 minutes, our laboratory was facing pressure to divert limited resources toward the implementation of an emergency department satellite laboratory. Peer-reviewed literature in clinical laboratory quality assurance and improvement indicates that between 60-70% of errors occur at the pre-analytical level.  Thus, we sought to improve overall TATs by focusing on reducing pre-analytical lag times. Lean six sigma process improvement owes its origins to industry, and may be universally applied in healthcare settings to improve outcomes. We report the application of Lean six sigma process improvement tools in the clinical laboratory specimen accession and processing area of a busy tertiary care center to improve chemistry stat TATs. 
Methods: The prospective before-and-after redesign encompassed a detailed evaluation of existing system, assessment of established monitors and historical data, formulation and implementation of a plan, and post-move data collection and analysis. Allocation of laboratory space was based on Lean six sigma quality improvement methods. Test TAT and volumes were obtained from the LIS.  Spaghetti diagrams were utilized to assess workflow in the existing space and in layout planning for the new space. An assessment of the pre-analytical steps in the receiving and processing area, in tandem with pre and post move Pareto chart data enabled the calculation of the reduction of defects per million opportunities that could be ascribed to this effort.
Results: 12 months mean ED CMP TATs before the move was 44.4 minutes with 90% of results reported in 60 minutes or less; after the move this improved to a mean of 37.1 minutes with 90% of results reported in 49 minutes or less. 12-month ED troponin mean TAT was 49.5 minutes with 83% of results reported in 60 minutes or less; after the move this improved to mean TAT of 43.4 minutes with 90% of results reported in 55 minutes or less.  Given seven touch points per result, this project enabled a 75% reduction in defects per million opportunities.
Conclusions: Lean-six sigma tools facilitated the identification and elimination of inefficiencies in specimen receiving to enable sustained improvements in TATs. Thus, defining and measuring problems, planning, taking necessary steps and implementing them are effective techniques to improve throughput in preanalytical specimen handling.  The one-time expenses associated with the moves were minimal, and the cost-avoidance of satellite laboratory oversight and operation is substantial.  Lean six sigma techniques can be applied in a cost-effective manner to minimize preanalytical wastes and improve patient care.
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Type of Study: Original | Subject: Laboratory Sciences

1. Mohammed Saleh ZM, Mohammed Saleh F. A Review Article of the Reduce Errors in Medical Laboratories: Glob J Health Sci. 2015 Jan; 7(1): 46–51. [DOI:10.5539/gjhs.v7n1p46]
2. Hawkins R. Managing the Pre- and Post-analytical Phases of the Total Testing Process: Ann Lab Med. 2012 Jan; 32(1): 5–16. [DOI:10.3343/alm.2012.32.1.5]
3. Najat D. Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan.: PLoS One. 2017; 12(1): e0170211. [DOI:10.1371/journal.pone.0170211]
4. Atay A, Demir L, Cuhadar S, Saglam G, Unal H, Aksun S, et al. Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors: Biochem Med (Zagreb). 2014 Oct 15; 24(3):376-82. [DOI:10.11613/BM.2014.040]
5. Ialongo C, Bernardini S. Long story short: an introduction to the short-term and long term Six Sigma quality and its importance in laboratory medicine for the management of extra-analytical processes. Clin Chem Lab Med. 2018 Oct 25; 56(11):1838-1845. [DOI:10.1515/cclm-2018-0310]
6. Morón-Castañeda LH, Useche-Bernal A, Morales-Reyes OL, Mojica-Figueroa IL, Palacios-Carlos A, Ardila-Gómez CE, et al. Impact of Lean methodology to improve care processes and levels of satisfaction in patient care in a clinical laboratory. Rev Calid Asist. Nov-Dec 2015; 30(6):289-96. [DOI:10.1016/j.cali.2015.09.001]
7. Clark D. Quality improvement in basic histotechnology: the lean approach. Virchows Arch. 2016 Jan; 468(1):5-17. [DOI:10.1007/s00428-015-1838-0]
8. Samuel L, Novak-Weekley S. The Role of the Clinical Laboratory in the Future of Health Care: Lean Microbiology: J Clin Microbiol. 2014 Jun; 52(6): 1812–1817. [DOI:10.1128/JCM.00099-14]
9. Shawn Mitchell P, Mandrekar JN, Yao JDC. Adoption of Lean Principles in a High-Volume Molecular Diagnostic Microbiology Laboratory: J Clin Microbiol. 2014 Jul; 52(7): 2689–2693. [DOI:10.1128/JCM.00430-14]
10. Blick KE. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance. Am J Clin Pathol. 2013 Aug; 140(2):193-202. [DOI:10.1309/AJCPNUTIPQTRRG0D]
11. Raab SS, Grzybicki DM, Condel JL, Stewart WR, Turcsanyi BD, Mahood LK, Becich MJ. Effect of Lean method implementation in the histopathology section of an anatomical pathology laboratory: J Clin Pathol. 2008 Nov; 61(11):1193-9. [DOI:10.1136/jcp.2007.051326]
12. Napoles L, Quintana M. Developing a lean culture in the laboratory: Clin Leadersh Manag Rev. 2006 Jul 25; 20(4):E4. [PubMed]
13. Rutledge J, Xu M, Simpson J. Application of the Toyota Production System improves core laboratory operations: Am J Clin Pathol. 2010. Jan; 133(1):24-31 [DOI:10.1309/AJCPD1MSTIVZI0PZ]
14. Inal TC, Goruroglu Ozturk O, Kibar F, Cetiner S, Matyar S, Daglioglu G, et al. Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times. J Clin Lab Anal. 2018 Jan; 32(1): e22180. [DOI:10.1002/jcla.22180]

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