LabNotes - Volume 18, No. 1, 2008

Case Study: Decreased Turnaround for Urinalysis

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