Edward W Randell1, Garry Short2, Natasha Lee3, Allison Beresford3, Margaret Spencer2, Marina Kennell3, Zoë Moores3, David Parry4. 1. Discipline of Laboratory Medicine, Eastern Health Authority, 300 Prince Philip Dr., St. John's, NL A1B 3V6, Canada; Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Dr., St. John's, NL A1B 3V6, Canada. Electronic address: ed.randell@easternhealth.ca. 2. Western Health Authority, 1 Brookfield Ave., Corner Brook, NL A2H 6J7, Canada. 3. Discipline of Laboratory Medicine, Eastern Health Authority, 300 Prince Philip Dr., St. John's, NL A1B 3V6, Canada. 4. Discipline of Laboratory Medicine, Eastern Health Authority, 300 Prince Philip Dr., St. John's, NL A1B 3V6, Canada; Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Dr., St. John's, NL A1B 3V6, Canada.
Abstract
OBJECTIVE: This study examines effectiveness of a project to enhance an autoverification (AV) system through application of Six Sigma (DMAIC) process improvement strategies. DESIGN AND METHODS: Similar AV systems set up at three sites underwent examination and modification to produce improved systems while monitoring proportions of samples autoverified, the time required for manual review and verification, sample processing time, and examining characteristics of tests not autoverified. This information was used to identify areas for improvement and monitor the impact of changes. RESULTS: Use of reference range based criteria had the greatest impact on the proportion of tests autoverified. To improve AV process, reference range based criteria was replaced with extreme value limits based on a 99.5% test result interval, delta check criteria were broadened, and new specimen consistency rules were implemented. Decision guidance tools were also developed to assist staff using the AV system. The mean proportion of tests and samples autoverified improved from <62% for samples and <80% for tests, to >90% for samples and >95% for tests across all three sites. The new AV system significantly decreased turn-around time and total sample review time (to about a third), however, time spent for manual review of held samples almost tripled. There was no evidence of compromise to the quality of testing process and <1% of samples held for exceeding delta check or extreme limits required corrective action. CONCLUSIONS: The Six Sigma (DMAIC) process improvement methodology was successfully applied to AV systems resulting in an increase in overall test and sample AV by >90%, improved turn-around time, reduced time for manual verification, and with no obvious compromise to quality or error detection.
OBJECTIVE: This study examines effectiveness of a project to enhance an autoverification (AV) system through application of Six Sigma (DMAIC) process improvement strategies. DESIGN AND METHODS: Similar AV systems set up at three sites underwent examination and modification to produce improved systems while monitoring proportions of samples autoverified, the time required for manual review and verification, sample processing time, and examining characteristics of tests not autoverified. This information was used to identify areas for improvement and monitor the impact of changes. RESULTS: Use of reference range based criteria had the greatest impact on the proportion of tests autoverified. To improve AV process, reference range based criteria was replaced with extreme value limits based on a 99.5% test result interval, delta check criteria were broadened, and new specimen consistency rules were implemented. Decision guidance tools were also developed to assist staff using the AV system. The mean proportion of tests and samples autoverified improved from <62% for samples and <80% for tests, to >90% for samples and >95% for tests across all three sites. The new AV system significantly decreased turn-around time and total sample review time (to about a third), however, time spent for manual review of held samples almost tripled. There was no evidence of compromise to the quality of testing process and <1% of samples held for exceeding delta check or extreme limits required corrective action. CONCLUSIONS: The Six Sigma (DMAIC) process improvement methodology was successfully applied to AV systems resulting in an increase in overall test and sample AV by >90%, improved turn-around time, reduced time for manual verification, and with no obvious compromise to quality or error detection.
Authors: Rachel D Starks; Anna E Merrill; Scott R Davis; Dena R Voss; Pamela J Goldsmith; Bonnie S Brown; Jeff Kulhavy; Matthew D Krasowski Journal: J Pathol Inform Date: 2021-04-07
Authors: Edward W Randell; Garry Short; Natasha Lee; Allison Beresford; Margaret Spencer; Marina Kennell; Zoë Moores; David Parry Journal: Data Brief Date: 2018-05-03