The positive impact of new laboratory technology developments cannot be overstated. Yet, the technological explosion of the last half-century has had questionable effects as well, one of which is the ongoing separation between a skilled laboratory staff member and the actual mechanics of a test. Great skill and acumen is still required to operate and maintain advanced diagnostic instruments, but by removing the practitioner from the actual steps of the task, certain detrimental variables, such as waste, become less obvious.
As hospitals coalesce and health systems grow, it can be a daunting task to maintain operational efficiency and rein in waste. At Adventist Health, in Roseville, California, we are fortunate to work with Beckman Coulter Diagnostics on DxONE, a new software product that provides granular insight into lab operations to maximize efficiency and mitigate waste. As a beta site for this product, we began running a DxONE pilot in June 2016, and since that time, its impact has been noticeable.
Identify Waste Per Analyte
We are at a point now where process change is initiated by the introduction of new technology, and often, laboratorians are told a shiny new device is going to do all of the work for them in producing a test result. But as laboratory scientists have become further removed from the step-by-step processes of diagnostic testing, the production of waste has ballooned. By identifying the amount of waste produced, per-analyte, DxONE aims to refine processes and drive out waste.
In our role as a beta site for DxONE, we tasked a group of our laboratorians with implementing the system into their workflows and utilizing it for a lengthy period of time. While we are still functioning as a beta site, we have been actively utilizing the data generated through the system since the beginning of 2017.
DxONE is a Web-based data analytics tool deployed to 15 hospital labs in our system and each of those labs opted-in their specific analytes, per-analyte, and per piece of specific testing equipment. By integrating that information with our ProService Analytics connection with Beckman, we are able to generate reports on equipment and analyte usage by individual equipment, and by month, week, day, and shift.
In the beginning of 2017, after using DxONE for 6 months, we had collected sufficient data to set outcome goals and reaction plans. At the beginning of February, the directors of the pilot labs presented action plans based upon the information gleaned from this tool over the previous 6 months. We were pleased that given the detailed insight into individual testing processes from the onset, several labs had already made significant changes to their operations based upon early data.
As part of the ongoing beta testing, a lab director focus group convenes every two weeks to discuss the impact of DxONE on operations. The group compares methods, identifies best practices, details desired changes, and reviews test utilization and waste information for 15 laboratory sites. This allows lab directors to benchmark themselves against other labs in the system and produces healthy competition in the drive to improve efficiency.
Reagent efficiency for our DxC analyzers was reported at 70.6% in the fourth quarter of 2016, followed by a report of 84% in the first quarter of 2017 (the most recent quarter report, Q2, also held at 84%), demonstrating sustained improvement. This gained efficiency in reagent usage resulted in a 4% decrease in the number of cartridges used from Q4, 2016 to Q1 and Q2, 2017, while sample volume exhibited an increase of 34% in the same time period. These improvements, demonstrated from just 11 of the 15 total hospitals, translate to an estimated annualized cost savings of $114,000, despite the substantial increase in sample volume.
DxONE allows lab management to view testing operations at any stage in the process. With the ability to review test volumes by analyte, or by the hour of the day, we can positively affect everything from supplies ordering to shift staffing. The question then becomes: Can all diagnostic waste be eliminated? As we all know, perfection is unattainable, but as a stretch goal, we placed waste reduction at 95%. With the help of DxONE, we hope to achieve this goal.
John Ferguson, BS, MBA, is the system director of laboratory and imaging services at Adventist Health based in Roseville, California.
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