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[1573] Using Lean Methods To Reduce Errors, Improve Efficiency, and Reduce Costs in an Anatomic Pathology Lab

SS Raab, DM Grzybicki, JL Condel, DM Jukic. University of Pittsburgh, Pittsburgh, PA

Background: In industry, Lean methods have been shown to improve quality, reduce inefficiency, and decrease costs. Although Lean methods have been applied with some success in the clinical lab, there has been little study of Lean methods in anatomic pathology labs.
Design: We implemented a Lean learning line in the histology component of an anatomic pathology lab. After a 3 year period, we measured the metrics of efficiency (turn around time (TAT)), production to staffing ratio, and errors pre and post implementation. We initiated a tracking system that measured 24 separate quality/error metrics (e.g., loss of tissue, poor quality stain). We performed over 200 documented line experiments affecting quality and/or error. Each experiment was scored on a 1 to 5 basis (5 being high) for the mean impact (degree of error reduction), success (sustainability and degree of affect on targeted measure), and complexity (scale of intervention). We estimated the degree of error reduction by performing root cause analysis of errors at each step in the histology process and assessing how each initiative affected these errors. Costs were assessed by measuring Medicare technical fees, based on CPT codes, and distributed across the different technical lab components (e.g., gross room, histology, etc.).
Results: Although the volume of work increased by 73%, the TAT within the histology component decreased by 42%. The production to staffing ratio, as measured by the specimens of work per day divided by the number of workers, increased from 8.2 to 10.3 (increase of 26%), reflecting an increase in productivity. The increased volume resulted in increased revenue of $125,000 per year attributable solely to the histology lab productivity. Prior to implementation, very few errors were reported and error reporting increased by over 3000%, as the culture of the lab changed from one of fear to ownership. The mean impact, success, and complexity of each experiment was 2.4, 2.7, and 2.5, respectively, although 32%, 26%, and 20%, respectively, had scores greater than 4. We estimated that these experiments reduced the frequency of error by approximately 45%. Error reduction initiatives improved specimen quality and interpretability and drastically reduced the probability of specimen switches.
Conclusions: The Lean learning line markedly improved efficiency, decreased errors, improved quality, and decreased costs.
Category: Quality Assurance

Tuesday, March 27, 2007

Poster # 190, Tuesday Afternoon