Genetic Markers of Cancer – A Molecular Oncology Laboratory Adjusts to Changing Demands of Integrated Hospitals, Medical Centers and Outreach Services
Milena Cankovic, Lisa Whiteley, Joanne Beher, Dhananjay A Chitale. Henry Ford Hospital, Detroit, MI
Background: Molecular oncology testing is exponentially increasing to aid in diagnosis and targeted therapy. In complex, budget limited health systems molecular labs are under pressure to cut costs. To align with our system's goal of integration and consolidation we aimed to re-examine and streamline already existing work processes and pathways to reduce waste due to lack of understanding, miscommunication, missing information, and miss delivered specimens. The ultimate goal is to provide timely and seamless service to our customers with zero defects.
Design: Following the specimen trail we focussed efforts on 1) Increasing clinician awareness of test availability and specimen requirements (lectures, consultation, information brochures, internet resources); 2) Educating nursing, laboratory, administrative personnel by a) clearly defined standard processes (value stream maps, written instructions, internet links); b) monitoring different sites for test requisition completeness and specimen acceptability; 3) Establishing contact with leadership at off site locations; 4) Expanding already existing processes to include remote locations (TAT monitoring; provision of special blood collection tubes); 5) Reinforcing lab's commitment to superior customer service and LEAN practices (refresher training).
Results: Clinician awareness was shown by increased utilization of our test menu with appropriate test selection (e.g. vIII EGFR vs EGFR exon 19/21 mutation), and reduced phone call/E-mail questions. There was 80% decrease in missing information (ICD9 codes, clinical information). Process flow maps facilitated tissue selection (tumor in block, little/no necrosis) making >90% of specimens acceptable for testing. LEAN practices reduced delay in processing from 31% to 5% in the past 2.5 years even when specimens needed to arrive from different sites and through different pathways. Although volumes increased by about 20% per year our TATs remained constant at 2 to 3 business days (vs the industry standard of 7-14 days).
Conclusions: Correct test ordering and timely specimen delivery often necessitate collaboration with individuals separated by geography, leadership structure, and educational levels. By taking initiative, our laboratory has ensured that latest developments in molecular oncologic testing quickly translate into benefits to cancer patients. By eliminating non-value added waste we have been able to maintain record short turn around times even with increasing testing volumes and new hospitals and medical centers being integrated into our health system.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 280, Monday Afternoon