Lean Six Sigma Speeds Testing for Hospital Emergency Rooms

More and more healthcare organizations are adopting Lean Six Sigma methodologies to help cut costs and improve patient services. No where is this more true than in hospital laboratories. HCA’s Integrated Regional Laboratories (IRL) manages the clinical laboratory operations of its East Florida Division hospitals and has been applying Lean Six Sigma to improve its operations for more than four years. IRL has seen marked improvement in its ability to deliver prompt and reliable laboratory services both to its HCA hospitals and to physician and institutional clients in the community it serves in South Florida.

Speedy Test Results through the Use of Lean Six Sigma

A key focus of IRL’s Lean Six Sigma initiative is to optimize laboratory services to our hospital emergency rooms where the ability to turnaround results on tests is so obviously critical. Speed in processing these tests can literally help save lives. As in other similar applications of Lean Six Sigma at IRL, using Lean Six Sigma to lean the laboratory process in order to reduce turnaround time can provide a huge payoff both in service to our patients and reduced costs. In a similar case, the Department of Pathology at Iowa University reported that they used the Lean methodology to reduce their median preanalytic processing time (the time used to prepare specimens for testing) from 29 to 19 minutes and achieved and maintained a goal of 80 percent of chemistry tests processed in less than one hour.1

The Lean Six Sigma Project

This is a case study of one of the Lean Six Sigma projects that has contributed to the improved turnaround time (TAT) in emergency room services that the IRL laboratory delivers. Lean Six Sigma Green Belt, Janice Pini, IRL’s Westside Hospital laboratory QA/Point of Care Coordinator, led this project, which delivered more than a 29 percent overall reduction in TAT for four critical laboratory tests.

The ER TAT project at Westside Regional Medical Center started with the Define stage of the Lean Six Sigma methodology. The average ER Turnaround Times of 39.0 minutes from the time the specimen was received in the laboratory until the tests were finalized had implications for a serious impact on the quality of healthcare. With new regulations for both stroke and cardiac patients the Turnaround Times had to be reduced to 30.0 minutes from receipt to verify. The four laboratory tests analyzed were Potassium, Troponin, Hemoglobin and Partial Thromboplastin Time (PTT). By entering into the Measure Phase, the Lean Six Sigma team collected data to see where improvements could be made. The Lean Six Sigma team discovered the layout of the laboratory was one of the most important factors in shortening the TAT. Departments were combined and analyzers moved to allow for a continuous flow. An area that was not utilized was cleaned of debris and the team moved both the Coagulation and Urinalysis equipment into the available space. This change allowed for the Hematology, Coagulation and Urinalysis departments to flow freely in a conjoined area. New Coagulation and Chemistry Stat centrifuges were purchased thus cutting the centrifuge time from 10 minutes to three minutes. This alone proved to make a tremendous difference in our PTTs.

Control Phase of the Lean Six Sigma Methodology

In the Control Phase the average Turnaround Time for all four tests post testing is 27.6 minutes from Receipt to Verify (when results of testing are available to the physician). This is a time savings of 11.4 minutes. The following chart will show the percent improvement by test from received to verify.

Test Q2 2007 Q2 2008 Percentage Change
HGB 20.0 13.0 35.0
PTT 39.0 34.7 11.0
K 48.3 31.8 34.2
TROPI 59.0 41.6 29.5
ALL 39.0 27.6 29.2

We have learned that the Techs awareness of ER turnaround times is also a major factor in keeping the times within our goal. The Techs have the ability to print their own turnaround times and this helps them to monitor outliers. All lengthy turnaround times must be explained in writing to the Laboratory Director. This allows for the Techs to be more cognizant of their work. The benefits of employee morale when they see their accomplishments are an overwhelming feeling of success.

Lean Six Sigma Keeps the Focus on Striving for Perfection

The results of this ER TAT project are typical of the results experienced at IRL’s HCA hospitals where two other projects have been targeted at improving ER TAT. At the IRL Core Lab a project is underway to reduce the AM TAT work which is the routine work that IRL’s hospital labs send to be tested at the Core Lab. Hospital based physicians are looking for the results of those tests by 7:30 in the morning when they make their rounds with their hospitalized patients. IRL is setting aggressive goals to meet the physicians’ requirement for these early results.

Lean Six Sigma is all about striving for perfection. HCA physicians and patients expect IRL to deliver perfect results every time and on time. They will accept nothing less and any thing less risks patient safety and limits the physician’s ability to heal the patient. Lean Six Sigma keeps IRL focused on its goal of perfection.

1. Improving Preanalytic Processes Using the Principles of Lean Production (Toyota Production System), Persoon Thomas J., Zaleski Sue, and Frerichs Janice, American Journal of Clinical Pathology 2006; 125: 16-25.