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Using Lean to Improve the Turn Around Time for Stat Crossmatches. Clinical Laboratory Blood Bank Lean Committee Pat Bradford, Laurie Gillard, Colleen Jarosz, Barb Mitchell, Cindy Pritchett, Beth Rossett, Joann Urani. Confidential: For Quality Improvement Purposes Only. Defining the Problem .

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using lean to improve the turn around time for stat crossmatches

Using Lean to Improve the Turn Around Time for Stat Crossmatches

Clinical Laboratory Blood Bank Lean Committee

Pat Bradford, Laurie Gillard, Colleen Jarosz, Barb Mitchell, Cindy Pritchett, Beth Rossett, Joann Urani

Confidential: For Quality Improvement Purposes Only

defining the problem
Defining the Problem
  • During a mock JCAHO inspection, a tracer audit was performed for an urgent blood transfusion
  • The audit revealed a delay between the time the blood was ordered and the time it was available

Confidential: For Quality Improvement Purposes Only

analysis of the problem
Analysis of the Problem
  • To determine if this event was isolated, audits were performed on two separate occasions
  • Random sample of 44 STAT crossmatch orders were audited
    • Average TAT was 76 minutes
  • The acceptable TAT for stat tests is within 60 minutes

Confidential: For Quality Improvement Purposes Only

this audit demonstrates the variation of time required to crossmatch blood
This audit demonstrates the variation of time required to crossmatch blood

Confidential: For Quality Improvement Purposes Only

layout considerations
Layout Considerations
  • Use “spaghetti diagram” to determine people, material, and information flow
  • Concentrate on elimination of waste
  • Create layout with cross-functional team
  • Ergonomics, safety, point of use, material handling
  • Use 5S for improving layout (sort, set in order, shine, standardize, sustain)

Confidential: For Quality Improvement Purposes Only

what process improvements need to be made
What Process Improvements Need to Be Made
  • Define the standardized work processes and write the SOPs
  • Purchase additional equipment to facilitate efficiency (new instrumentation, continue to develop visual cues for inventory replenishment)
  • Move the irradiator to a more central location

Confidential: For Quality Improvement Purposes Only

blood bank lean accomplishments thus far
Blood Bank Lean Accomplishments Thus Far
  • Relocation of centrifuges closer to work areas
  • Irradiation of stock red cells to be available on demand
  • Developed visual cues: Organize specimens according to type and urgency of work using labeled racks
  • Purchased high speed centrifuges
  • Re-auditing the stat crossmatch TAT demonstrated an improved time of 62 minutes
  • Overall, reduced process variation in performing crossmatch testing

Confidential: For Quality Improvement Purposes Only

slide10

Pre-Lean 90th percentile of stat crossmatches had a TAT of 119 minutes. After the partial implementation the 90th percentile was 105 minutes. The average Stat crossmatch TAT has improved from 76 minutes pre-Lean to 66 minutes after the partial implementation of the changes identified by the Lean committee.

Confidential: For Quality Improvement Purposes Only

next steps long term
Next Steps- Long Term
  • Submitted a project planning request to evaluate the Blood Bank area for improved workflow
  • Create areas for specific tasks (blood component preparation and testing)
  • Purchase new testing analyzers
  • The post-Lean audit showed a reduced TAT, however the average time did not meet our laboratory requirements of having the TAT of 60 or less.
  • Stay tuned for new developments!

Confidential: For Quality Improvement Purposes Only