Lean-Six Sigma Medical Laboratories Begin to Innovate in Ways That Add Value to Physicians, Payers, and Patients

With record attendance of 300 Lean-Six Sigma experts, this week’s conference was a high-energy event that provided medical lab professionals and pathologists with case studies of how to improve lab operations and contribute to better patient care

DATELINE: NEW ORLEANS—Yesterday was the conclusion of the 10th Annual Lab Quality Confab, which showcased innovators in clinical laboratories and anatomic pathology groups. Attendees traveled here from six different countries.

One new trend that emerged from this year’s presentations is that progressive medical labs are beginning to direct their Lean-Six Sigma, and process improvement efforts toward projects designed to add value to client physicians and hospitals. These projects include added-value features of benefit to patients and health insurers.

How Clinical Laboratories Are Succeeding with Lean Projects

This is a shift from prior years. At earlier Lab Quality Confabs, most speakers were describing how their labs were using Lean and quality management methods to improve workflow within their labs, increase the productivity of automation and staff, reduce errors, and cut costs. This was an “inside-the-lab” mindset.

That was not the case here in New Orleans this week. Yes, there were plenty of sessions where workflow redesign, productivity improvement, and cost reduction were discussed. But, at the same time, a significant number of labs doing presentations were describing projects that took the lab team outside of their laboratory to engage with physicians and nurses specifically to help them use clinical laboratory test data in ways that would improve patient care, reduce length-of-stay for hospital patients, and trigger worthwhile reductions of the cost of care. This is an “outside-the-lab” mindset.

One example shows how these progressive clinical laboratories are successfully collaborating with physicians to improve patient care and help clinicians better leverage the value of lab test results.

Northwell Health’s Medical Laboratory Team Tackles Acute Kidney Injury

At Northwell Health in Lake Success, New York, the clinical lab team initiated a pilot project in one of Northwell’s community hospitals. The goal was to improve the diagnosis and treatment of acute kidney injury (AKI). This project and how it contributed to improve patient care was described in two different sessions.

In his presentation about the strategic thinking of the laboratory division of Northwell Health, James M. Crawford, MD, PhD, Executive Director and Senior Vice President of Laboratory Services at Northwell, provided a summary of the project. The following day, Tarush Kothari, MD, MPH, Physician Informaticist & Assistant Professor of Pathology and Laboratory Medicine, presented a detailed case study of the AKI pilot project, including why AKI became an issue of concern, how the AKI project was implemented, and the impressive outcomes in patient care that resulted.

Clinical Laboratory Asked for Help by Hospital’s CMO

The opportunity for the clinical laboratory to deliver more value started with a request by the chief medical officer (CMO) of Forest Hills Hospital (FHH). “It was in July 2013 when the CMO at FHH approached the laboratory leadership,” recalled Kothari. “The problem was that radio contrast-induced AKI was occurring at FHH.

“Data showed that there were at least three cases of AKI per day,” he continued. “This was contributing approximately two excess days in length-of-stay. The CMO’s question for us was simple: ‘Can the laboratory do anything to prevent or mitigate this?’

“We saw the opportunity for our lab to collaborate in a more proactive and engaged way,” stated Kothari. “Our team researched the published studies and identified the relevant and accepted clinical pathways for acute kidney injury. After all the involved parties agreed on the protocols that would be used at 250-bed FHH, the necessary changes were made to the EHR [Electronic Health Record] and other software systems. A system of lab-generated alerts based on the results of creatinine tests was established.

Use of Creatinine Testing Generated Daily Alerts about Potential AKI

“We expected to see between five and 10 AKI alerts at Forest Hills Hospital,” he noted. “What actually resulted was about 40 alerts per day. This corresponded to 20 patients per day at risk for AKI. It also represented an 8% incidence rate in this busy community hospital.”

During 2013, data was collected from the baseline period and hospital staff were trained in the protocols for acute kidney injury. The study period took place for six months during 2014.

Medical Laboratory Contributes to Better Patient Outcomes

Kothari presented the following list of improvements associated with a better use of creatinine testing in support of AKI:

• The system-wide AKI capture rate has increased from 7.4% (in July 2014) to 12.9% (in July 2015) since the daily lab AKI reporting and education program for physicians began.

• Average revenue increase per diagnosis-related group (DRG) with secondary diagnosis of AKI is $700.

• Secondary diagnosis of AKI/month in 2014 (avg.) = 615 cases.

• Secondary diagnosis of AKI/month in 2015 (avg.) = 930 cases.

• Increase in secondary diagnosis of AKI from 2014 to 2015 = 315 cases.

• Increased in reimbursement/month because of secondary diagnosis of AKI = 315 x 700 = $220,500.

• Increase system reimbursement for 2015 = $220,500 x 12 = $2.65 million.

The lab team at Northwell Health further identified some of the challenges associated with the AKI program. Three of the lessons learned included:

• Lack of access to administrative data which can be readily linked to laboratory data;

• It remains very difficult to calculate total cost-of-care and therefore the effect of laboratory intervention; and

• Laboratory data is not linked to other data sets such as pharmacy and claims data.

This quick summary of the comments made by Crawford, and the full presentation delivered by Kothari, does not do justice to the full range of benefits that resulted because of a collaborative project with physicians to improve the diagnosis and treatment of acute kidney injury. The clinical laboratory team at Northwell Health intends to submit a paper describing this project for publication in a peer-reviewed journal.

Important Lab Industry First for Lab Quality Confab This Year

Lab Quality Confab 2016 delivered another distinctive first for the medical laboratory industry. Among the other sessions that took place at this year’s Confab was a one-hour panel discussion about labs’ compliance with Clinical Laboratory Improvement Amendments (CLIA) requirements. The panelists represented the four organizations that have deeming authority to certify clinical laboratories under the CLIA 1988 legislation, including the:

• American Association for Laboratory Accreditation;

• COLA;

•College of American Pathologists (CAP); and

• The Joint Commission.

Panelists acknowledged that this was the first time that all four of the accrediting bodies had sat together at a lab industry meeting. They presented the top 10 deficiencies that are found during inspection of labs. They also discussed the range of changes for 2017 that are expected from the Centers for Medicare & Medicaid Services  (CMS) relative to clinical laboratory certification and compliance.

These examples demonstrate the valuable information presented by the lab industry’s most accomplished experts and innovators in Lean, Six Sigma, and process management. A full set of audio recording are available for those readers of Dark Daily who were unable to attend the conference in New Orleans this week and would like to access this information and share it within their laboratories. Contact the offices of The Dark Report at 800-560-6363 for details and to order.

 

Your Dark Daily Editor,

Robert L. Michel

 
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