Installing New Automation and Analyzers in a Confined Lab Space: Why Our Big Bang Approach Saved Implementation Time and Produced and Better TAT
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1 Installing New Automation and Analyzers in a Confined Lab Space: Why Our Big Bang Approach Saved Implementation Time and Produced and Better TAT ATHENA K. PETRIDES, PhD Medical Director for Pathology Informatics / Assistant Medical Director of Chemistry Brigham and Women s Hospital Assistant Professor of Pathology Harvard Medical School
2 Brigham and Women s Hospital 793-bed hospital Founding member of Partners Healthcare Network 16 members Brigham and Women s (BWH) Clinical Pathology 5000 specimens/day Multiple analyzing areas
3 BWH Clinical Pathology Labs Chemistry Special Chemistry Hematology Special Hematology Coagulation Special Coagulation Mass Spectrometry Serum Protein Electrophoresis Reproductive Endocrinology Clinical Immunology Client Services (Reference lab) Microbiology
4 General Chemistry Area (Jan 2017) Blood gas bench Pre-analytical system Chemistry Lines Problems: 1. Frequent downtimes due to instrument age 2. Shorten TAT, especially for ED 3. Make line coverage more efficient (breaks, off shifts) 4. Introduce pre-analytical automation to coagulation analyzing area 5. Heavy foot traffic in specimen process area
5 Future Configuration Pre-analytical system Coagulation Instruments Chemistry Lines
6 Foot Traffic - current Functions of pre-analytical system: 1. Centrifuge 2. Create aliquot tubes when appropriate 3. Sort tubes into sorting groups for easy distribution 4. Re-cap tubes for archiving 5. Delivers specimens to analyzers aliquoted into cups
7 Foot Traffic - future Functions of pre-analytical system: 1. Centrifuge 2. Create aliquot tubes when appropriate 3. Sort tubes into sorting groups for easy distribution 4. Re-cap tubes for archiving 5. Bi-directional track 6. Specimen temporary archiving 7. Delivers specimens to analyzers in primary tubes
8 Implementation Stages
9 Baseline Configuration Where will we validate new instruments? Do we have to validate again after moving to final location? How would it impact our timeline if we validated and replaced one line at a time? Can we go through major reconfiguration and construction in the lab without compromising services?
10 How did we make decisions? Teams Project Manager from BWH Project Manager from vendor Establish core workgroups General (all teams) Ops group (TDs, supervisors, Medical Directors of 3 areas and Director of Operations) Define workflows and ask for what is possible! Construction (engineering, electric, plumbing, furniture) IT (vendor and BWH)
11 Stage 1 6 months Decisions Ops group: validate all 3 lines simultaneously close to final location to avoid revalidation Construction: prep new electrical room, start LCO renovation Actions Stage 1A LCO renovation Move blood gas bench to make room for preanalytical module (MPA) Move MPA to make room for new lines
12 Stage 2 3 months MPA sill connected to chemistry lines Push coag instruments further west Install and begin validating and training all 3 lines of new chemistry instruments Required installation of a second water source Current filtration system could not handle both sets of instruments Hospital water was contaminated Required HVAC boost to control heat emitted from all the instruments
13 Stage 3 1 week Remove track to disconnect MPA from chemistry lines Unanticipated problems: Increase in TAT for routine testing manual step of taking specimens to analyzers Decided to use MPA for just aliquoting and recapping/archiving
14 Stage 4 2 weeks Live lines: Old 2 Old 1 New 1 Made sure that complete test menu is covered (all tests validated on all new lines) Remove Old 3 and move New 3
15 Stage 5 1 week Live lines: New 3 Old 1 New 1 Made sure that complete test menu is covered (all tests validated on all new lines) Remove Old 2 and move New 2
16 Stage 6 1 week Live lines: New 3 New 2 Made sure that complete test menu is covered (all tests validated on all new lines) Remove Old 1 and move New 1
17 Stage 7 1 week Live lines: New 3 New 2 New 1 Move Old pre-analytical module to make room for the new one Old pre-analytical system still live
18 Stage 8 8 weeks Validation of new preanalytical system (c8100) Routing to instruments Masking Aliquoting Sorting Priority status Temporary archiving Optimize on-board and physical workflows
19 Stage 9 4 weeks Connect Coagulation instruments Validate connection Validate routing Define downtime procedures Decided to do an upgrade of coag analyzers in the meantime delay
20 Stage 10 1 week Remove old pre-analytical system (MPA)
21 How did we do?
22 Timeline Kickoff meeting Go-live new chemistry lines Pre-analytical module & coag instrument connection golive Instrument delivery & construction initiation BWH voluntary retirement program
23 ED Troponin TAT Implementation Stages Implementation Midpoint: Pre-implementation: MPA & Lab Control Transformation & Post Implementation: Cobas Cobas 6000s Offline Cobas 8000s 8100 & Cobas th Percentile 1:03 0:58 0:48 Avg 0:45 0:44 0:37 Median 0:43 0:41 0:34 N
24 ED Creatinine TAT Implementation Stages Implementation Midpoint: Pre-implementation: MPA & Lab Control Transformation & Post Implementation: Cobas Cobas 6000s Offline Cobas 8000s 8100 & Cobas th Percentile 1:02 0:56 0:50 Avg 0:45 0:41 0:37 Median 0:42 0:39 0:34 N
25 Inpatient Creatinine TAT Implementation Stages Implementation Midpoint: Pre-implementation: MPA & Lab Control Transformation & Post Implementation: Cobas Cobas 6000s Offline Cobas 8000s 8100 & Cobas th Percentile 1:05 0:59 0:58 Avg 0:47 0:43 0:40 Median 0:45 0:40 0:37 N
26 Inpatient Ammonia TAT Implementation Stages Note: Ammonia specimens are manually spun and front-loaded onto the chemistry analyzers. They do not go on the preanalytical line. Implementation Midpoint: Pre-implementation: MPA & Lab Control Transformation & Post Implementation: Cobas Cobas 6000s Offline Cobas 8000s 8100 & Cobas th Percentile 1:06 1:28 1:02 Avg 0:48 0:58 0:42 Median 0:45 0:55 0:39 Min 0:31 0:26 0:25 N
27 LEAN = common sense 1. Focus on your customer In the clinical lab environment there are 2 customers: clinicians and lab personnel 2. Figure out how work actually gets done Map out existing workflows 3. Remove wasted steps and inefficiencies 4. Keep score Data analytics 5. Empower people operating the process Display data 6. Keep improving systematically Keep asking for feedback from customers
28 Special Thanks BWH team Deborah Elliott Dr. Petr Jarolim Dr. Stacy Melanson Ellen Goonan Margaret Lobo Gail Kinchla Trish Senna Kelly Williams All the staff! Roche team John Hildebrandt Rick Schonberg Michele Mitchell and team!
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