Improving Quality and Efficiency of Pap Test Processing: A Lean Approach
CW Michael, K Naik. University of Michigan Hospital, Ann Arbor, MI
Background: In this era of enormous economic pressures, maintaining cost effectiveness while improving quality and patient safety is a challenge. We utilized lean methods to examine our Pap test processing procedure with the goal of improving processing time (PT) and reducing accessioning and/or labeling errors.
Design: A team composed of 2 cytopreparatory staff, 1 cytotechnologist, medical director, supervisor and a lean coach was charged to evaluate our ThinPrep Pap test processing procedure. A value stream map (VSM) from in-lab specimen receipt to production of labeled slides was created and reviewed with the following objectives: 1) identify opportunities to reduce waste and errors 2) design a new VSM based on identified opportunities 3) implement the new VSM and 4) measure the impact. Implemented changes included: 1) single piece flow (SPF) during accessioning 2) minimizing processing batch size in the T3000 instrument and 3) elimination of redundant steps. Impact of changes was evaluated by measuring the following monitors pre- and post-implementation: 1) total PT 2) number of accessioning errors (discrepancies between information on the requisition and that entered into the LIS) encountered during the normal workflow as well as via random audits for a period of four weeks and 3) number of labeling errors at the clinical site that were missed at the accessioning step, but identified downstream.
Results: Pre-implementation data review revealed: 1) PT for 1140 samples ranged from 1-3 days with an average of 2 days, 2) 29 accessioning errors were detected by review of 384 (7.6%) requisitions, 3) 5 of the 23,600 Pap tests processed in 6 months had labeling errors (mismatch of patient identification between the requisition and vial or no/inadequate identifier on vial) that had gone undetected in the processing stage. Four were detected later during specimen processing but one reached the reporting stage. Post-implementation data revealed no undetected labeling errors to date and PT remained consistently at 1 day. Random audits for accessioning errors are in progress.
Conclusions: Implementation of SPF and minimizing batch size allows for higher quality and greater patient safety by maximizing up-front detection of labeling errors. Single piece flow improves efficiency by reduction of the number of times each sample is handled during the process and elimination of re-work due to errors detected down stream. When implemented with engaged, actively participating staff, lean can be successfully implemented in the Cytopathology laboratory to improve efficiency and quality.
Category: Quality Assurance
Monday, March 22, 2010 1:00 PM
Poster Session II # 213, Monday Afternoon