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LabNotes - Volume 18, No. 1, 2008

Case Study: Decreased Turnaround for Urinalysis

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	From the Editor
	FEATURE: Error-prooofing the Laboratory
	Case Study: Decreased Turnaround for Urinalysis
	Product News: Introducing BD Vacutainer® Urine Foley Catheter Kit
	BD Vacutainer Urine Products Family
	New BD Vacutainer® Tube Guide Wall Chart
	Webinar: Decipering Coding's Role in Reporting Never Events
	BD Vacutainer® Brand and Trademark
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Lean Sigma Urinalysis Solutions Results in 0.5 FTE capacity gain, 25% Decrease in Turnaround Time, 28% Improvement in Specimen Quality, and 4.1% Reduction in Total Cost-in-Use

Conemaugh Memorial Medical Center is a nationally recognized facility for cardiac, orthopedic, neonatal intensive care and home healthcare programs. The Center's focus on total quality management has driven continuous improvement efforts for the laboratory. A comprehensive urinalysis solution was implemented that consisted of workflow and process enhancement initiatives, incorporation of automation, and a closed urine collection system.

The Challenges

In a typical day, the laboratory manages more than 145 urinalysis tests and about 70 cultures from their outpatient clinics, nursing floors, and physician offices. Opportunities for improvement in several aspects of the testing process were identified:

Efficiently managing increase in urinalysis workload
Inability of the existing testing processes and workflow to handle specimen demand (particularly during peak hours)
Improve turnaround time for specimens from the Emergency Department (67% of urinalysis workload)
Decrease number of false positive urine cultures
Improve Receive to Verify times (Laboratory ranked in the 9th percentile versus a similar peer group)
Decrease staff movement when obtaining urine cultures
Prepare for CMS' upcoming reimbursement changes due to be implemented in October 2008

The Solution

A joint effort between BD, Iris, and the Medical Center was designed to maximize the testing efficiency and workflow in the laboratory. This endeavor incorporated Lean Sigma process improvement services, installation of an Iris Diagnostic iQ® 200 ELITE™ Urinalysis Workcell (automation), and the BD Vacutainer® Urine Collection System (closed system). The process included:

Identifying segments of the process that demonstrated inadequate performance as well as those that warranted a detailed examination
Assessing productivity based on hands-on operator time using cycle time measurements
Measuring one of the fundamental goals of Lean process improvement'reduction in the length of time from order to delivery
Quantifying defects (e.g., leaking specimens, outliers) as a means of eliminating waste
Training Urinalysis Department staff on Lean principles (e.g., single piece flow, standardization of processes)
Replacing existing manual microscopy and urine chemistry equipment with a complete automation system; relocate equipment for more convenient access to the point of specimen entry to the laboratory
Implementing a closed urine collection system to safely transport urine, decrease false positives, and eliminate re-testing

The Result

The laboratory experienced significant qualitative and quantitative progress including:

Ability to handle total urinalysis workload'at any time of the day or night'without delay.
Overall turnaround time decreased by 26% in all areas; with ED turnaround times decreased by 21%.
Reduced inquiries from nursing staff on specimen status and recalls'possible labor savings of $100,000 per year.
Technical staff requirement decreased by 50%, translating into a productivity and capacity gain of 0.5 FTE, allowing redeployment of staff to perform other functions.
As a result of the Lean layout and automated urinalysis, staff movement was reduced by 61%.
Lower proportion of outliers'specimens with turnaround time above 2 hours dramatically decreased in the ED and inpatient locations.
Improvement in specimen quality with a 28% decrease in poor quality urine culture specimens ' mixed growth.
4.1% reduction in total cost-in-use for urinalysis and urine culture processes (which are related to the initial urine collection process).

Data on file at BD. Results may vary by customer. Iris, Iris Logo, iQ and ELITE are trademarks of Iris International, Inc.

For questions regarding our Blood, Urine collection, or other sample collection products and services please contact us.

This publication is a service to the customers and friends of BD, and is designed only to provide general information. It is not intended to be comprehensive or provide any legal or medical advice.