2005 IQLM Conference

1. 2005 IQLM Conference IQLM Network:Meeting Goals –Meeting Needs Michael A Noble MD FRCPC Networks Committee April 29, 2005

2. Presentation Objectives • Stating the goals of the network committee • Characterizing the IQLM-Network project • A Snap-shot View of Quality Management in America’s Hospital Clinical Laboratories • Conclusions • Acknowledgements • IQLM Network –Next Steps

3. Defining Network Objectives (2003) • Identify a partner • Develop laboratory networks • Complete pilot study to determine potential of web based formatted survey • Collect information on laboratory quality practice and services • Determine respondents willing to participate in ongoing survey • Track trends in a volunteer group of laboratories • Develop process to obtain information on quality

4. Meeting the Objectives • In the first meeting of the Networks Committee (Atlanta 2003), three organizations offered to consider developing a project. • Following discussion, it was agreed that the Clinical Laboratory Management Association was in the best position to develop the initial pilot project.

5. Developing the Pilot Project • A CLMA study with assistance and support of the IQLM Networks Committee. Define the subject Develop the survey questionnaire design Pre-test and validate the questionnaire with two independent subgroups Advertise the questionnaire Let the questionnaire Capture and analyze the data Prepare for presentation

6. Survey Objectives To collect information on quality management activities in clinical laboratories Note that survey information was the product of two data formats: • Pre-defined specific answers • Invited open format comment

7. Survey Respondents • Targeted to U.S. hospital-based laboratories, including integrated delivery systems, university hospitals, government hospitals and independent labs owned by hospitals. • One respondent per institution – Most senior manager invited to participate; given option to delegate to most appropriate person

8. Survey Response • Distribution pool 2,301 • Response pool 572 – 25%

9. Respondent Demographics

10. Respondent Demographics

11. Respondent Demographics

12. Survey Response • Over 25% of eligible CLMA members responded to the survey. • The respondents represent a nationwide sample and distribution of laboratories that correlate closely with the distribution of CLMA member laboratories.

13. We consider this survey a success. Partnership Information Gathering Instrument Snap-shot of Quality Activities

14. A Snap-shot View of Quality Management in America’s Hospital Clinical Laboratories Julie Gayken, MT (ASCP) Administrative Director of Laboratory Services Regions Hospital – St. Paul, Minnesota Chair – CLMA Quality Advisory Council Member – IQLM Networks Work Group CLMA Quality Management Pilot Survey November 2004

15. Presentation Objectives • Quality pilot survey objectives • Summary of pilot survey results • Conclusion from pilot survey results

16. Quality Pilot Survey Objectives • Collect information on quality management activities • Identify types of events that lead to investigations and process used • Determine indicators being used today and rank usage (poster) • Determine steps used in patient ID process as example for benchmarking (poster) • Gather list of safety/quality initiatives that have resulted in error reduction (poster) • Determine topics for future surveys and benchmarking (poster) • Gather list of individuals for a future targeted network

17. Collect Information on Quality Management Activities

18. What Parts of Quality Management are Largely Implemented?

19. What Parts of Quality Management are Largely Implemented? (Top 5)

20. 0 10 20 30 40 50 Quality indicators 44 Suppliers of essential products and services 36 14 Guidelines for physicians for testing Institutional rules for routine test 10 Rules that limit esoteric test 5 What Parts of Quality Management are Largely Implemented? (Last 5)

21. Quality Management ActivitiesKey Findings • Most components recommended by guidelines are implemented to some degree • Lowest implementation percentage for test utilization components: • Develop clinical guidelines for physician use on appropriate testing • Institutional rules for frequency of tests

22. Quality Management Assessments

23. Which Components of Quality Assessment Do You Conduct?

24. Analysis of Quality Assessment Components

25. Analysis of Quality Assessment Components

26. Analysis of Quality Assessment Components

27. Quality Assessment Key Findings • >70% conduct, code and trend quality reports and surveys • <65% have guidelines that dictate when intervention (i.e. contact or change) is needed

28. Identify Types of Events that Lead to In-Depth Investigations and Processes Used

29. Which Laboratory Events Lead to Full (In-depth) Investigations?

30. How are Full Adverse EventInvestigations Performed?

31. How are Full Adverse EventInvestigations Performed?

32. How are Full Adverse EventInvestigations Performed?

33. How are Full Adverse EventInvestigations Performed?

34. Adverse Events – In-Depth InvestigationsKey Findings • 53% state risk management director leads review • Reviews conducted on lab, patient, nursing, physician information • 92% use root cause analysis process • 14% do not use a structured process for review and corrective action

35. Which Laboratory Events Lead to Full (In-depth) Investigations?

36. What Steps are Used in Investigations?

37. In-depth Investigations Key Findings Incident Reports, Physician Complaints, Patient Complaints, Employee Reports • Laboratories utilize the same processes for investigating various quality reports and complaints • <60% of labs use root cause analysis for investigation

38. Determine Indicators Being Used Today and Rank Usage

39. Indicators Tracked

40. Most Common Indicators Tracked

41. Least CommonIndicators Tracked

42. Indicators TrackedKey Findings • All 30 total testing process indicators are being tracked to some degree • The top 5 indicators most commonly tracked are required by regulation or patient safety goals • The 5 indicators least tracked are in the areas of appropriateness of testing for best care • Pre-analytic and post-analytic indicators monitored less than analytic • Less than 35% monitor order and use of testing for best care • Less than 10% monitor result interpretation by clinician or patient

43. Determine Steps Used in Patient Identification Process as Example for Benchmarking

44. What Features Would You Like in a New Patient Identification System?

45. Patient Identification Systems Key Findings • Most labs use two unique identifiers – patient name and medical record number • 50% of labs currently have the ability to print labels at the site of collection • >80% would like future ID systems to include hand held devices that • Read bar coded ID bands • Could be used for blood administration

46. Gather List of Safety/Quality Initiatives that Have Resulted in Error Reduction

47. Open Ended Question • What is the most significant initiative your laboratory implemented in the last three (3) years that effectively reduced laboratory errors or improved patient safety? Total # of Responses – 557

48. Most Significant Initiatives Other 18% Process/ System Redesign Patient/ Specimen Identification 7% 50% 12% Quality Improvement/ Management System 13% Information Systems/ Laboratory Information Systems

49. Significant Initiatives Key Findings • 50% of initiatives emphasize accurate patient and specimen identification • The use of technology at 13% is either an untapped safety tool or many hospital laboratories have already implemented necessary technology for safety improvement • The response of 12% indicating that their most significant event was implementing new or improved quality management systems demonstrates an evolving quality management environment • Process/system design at 7% demonstrates that hospital laboratories are starting to look for error reduction by addressing process and system issues

50. Determine Topics for Future Surveys and Benchmarks