Lavender Top Management SUCCESS BEYOND FINANCES

Transcription

1 Lavender Top Management Alfonso Ziccardi Ass.Lab.Operation Manager for AP/CP/Safety Officer New York Hospital Medical Center of Queens SUCCESS BEYOND FINANCES 1

2 . VISION Mission/ Vision To successfully develop and implement continuous innovative laboratory technologies, and consistently provide the highest quality patient care experience. Hematology Testing Breakdown NYHQ Descrete testing CBCD 42% CBC 45% PLT 0% HGB A1C Retic 5% 1% ESR HGB 3% 2% HH 0% HCT 2% 2

3 Sysmex XE vs. XN Technology RBC, PLT, Hgb WBC / BASO NRBC DIFF RET / PLT-O RBC, PLT, Hgb WNR WDF RET PLT-F NEW NEW NEW Copyright 2012 by Sysmex America, Inc. All rights reserved. Sysmex Foundational Technology RBC & Platelet DC Detection / Hydrodynamic Focusing Hemoglobin Absorbance / Sulfolyser Copyright 2012 by Sysmex America, Inc. All rights reserved. 3

4 Unique Clinical Utility Basic Channels RBC & PLT Impedance HGB Channel WNR Channel (WBC / BASO / NRBC) WDF Channel (6-part DIFF including IG) Body Fluid Channel (Including 2-part DIFF) Advanced Channels Platelet (PLT-F / IPF) Complete Reticulocyte Analysis (Retic / IRF / RET-He) Copyright 2012 by Sysmex America, Inc. All rights reserved. Clinical Utility Basic Channels NRBC Standard With Every XN-CBC IG Standard With Every XN-Diff Body Fluids With Diff Advanced Channels (Advanced Clinical Parameters- ACPs) Thrombopoiesis (IPF) Erythropoiesis (RET-He) 4

5 Fluorescent Flow Cytometry WNR channel WDF channel PLT-F channel RET channel WNR Channel NRBC BASO Granulocyte MONO LYMPH Fluorescent NRBC with every CBC No sample preparation Accurate WBC counts Virtually eliminates interference from: Lyse resistant RBCs Lipids Reports: WBC, BASO#, BASO%, NRBC#, NRBC% RBC Debris 5

6 WDF Channel Atypical LYMPH LYMPH ImmatureWBC MONO NEUT EO Enhanced Flagging Improved separation between lymphs and monos (SAFLAS) Auto- correction of lymphs when NRBC are present 6-part differential with reportable including IG% / # Improved efficiencies Rapid TAT Decreased technical intervention Reportable: NEUT#/%,LYMPH#/%,MONO#/ %,EO#/%,IG#/% Low WBC Analysis Mode WB (Whole Blood) mode LW (Low WBC) mode Dilution Rate : Analysis Volume : Whole Counts *2 : x µL 9,530 Dilution Rate : Analysis Volume : Whole Counts *2 : x µL 28,600 Analysis Time extended to 3 times the Whole Blood WBC count time Copyright 2012 by Sysmex America, Inc. All rights reserved. 6

7 Low WBC Analysis Mode Analysis time extended to 3 times WB WBC count time Better accuracy and precision on counts < 0.50 x 10 3 No Vote Outs Differential results on all counts Increased reportable differentials Copyright 2012 by Sysmex America, Inc. All rights reserved. PLT-F Channel PLT performance Impedance platelet analysis (size) has limitations in the identification and discrimination of platelets from interfering particles with the same size. Possible interferences RBC fragments counted as platelets: falsely high Microcytic RBCs counted as platelets: falsely high Large platelets counted as RBC: falsely low Copyright 2012 by Sysmex America, Inc. All rights reserved. 7

8 Binding sites of Fluorocell PLT Fluorocell PLT stains nucleic acid rich organelle Rough-surfaced endoplasmic reticulum (ribosomal RNA) Mitochondria (MtDNA) open tubule mitochondria α granule microtubule RBC RBC roughsurfaced endoplasmic reticulum deep dyeing granule glycogen granule Copyright 2012 by Sysmex America, Inc. All rights reserved. PLT-F separates platelets from RBC fragment by the differences in staining Platelet RBC Fragment Transmitted light CD41/CD61 positive = Platelets Staining by PLT-F dedicated reagent Platelets - Strong, especially within the cell RBC fragments - Weak, only cell membrane Copyright 2012 by Sysmex America, Inc. All rights reserved. CD61/PLT-F Transmitted light 8

9 PLT-F Channel RBC PLT IPF Second, reportable, method of platelet Extended count time for accuracy, especially in low platelet counts Fluorescent Dye specific for platelet organella Good comparison with CD41/CD61 Minimizes interference from RBC fragments, microcytic RBC s and WBC fragments Automated Action message and reflex action (XN rules) Generates reportable: PLT-F & IPF (Immature platelet fraction) RET Channel RBC PLT RET LFR MFR IRF HFR Improved operational efficiency Reduced Interference From: WBC WBCs Howell Jolley Bodies Parasites Sickle cells Monitor RBC development at the cellular level IRF for Retic production RET-He for iron incorporation in hemoglobin of the erythron Clinically relevant information for: Improved anemia screening and monitoring of iron therapy. Reportable parameters: Ret# / %, IRF, RET-He 9

10 Reticulocyte Channel Operational Efficiency Reduced Interference From: WBCs Howell Jolley Bodies Parasites Sickle cells Quick and automatic Monitor RBC development at the cellular level IRF for Retic production RET-He for iron incorporation in hemoglobin of the erythron Clinically relevant information for the management of anemia in conjunction with other available clinical information. Copyright 2012 by Sysmex America, Inc. All rights reserved. Body Fluid Analysis HF-BF LY-BF MN MO-BF NE-BF WDF Scattergram Cerebrospinal fluid (CSF) Pleural fluid Peritoneal fluid Synovial fluid PMN EO-BF Efficient process: No pre-analytical sample preparation Rapid Automatic background count Cost effective: No additional reagents Time savings testing Quality results: Fluorescent flow cytometry technology Reports cell count and 2 part differential Generates reportable: WBC & RBC count PMN & MN % / # TC# 10

11 Lavender Top Management with A1c Testing More Walk-Away Time Reduced maintenance: Once / daily Hands-free maintenance and QC Single aspiration pathway 11

12 Unique Concentrated Reagent System Inventory space saving Concentrated reagent system (standard with XN-9000) Decrease hands-on 100 changes to 1 change Positive identification: RFID technology Color coding from spout to software Concentrated Cellpack Enhanced Workflow 12

13 Comprehensive Data Review / Management All-in-One Testing Data Review- A1c 13

14 So What Have We Learned? Low WBC Better accuracy and precision on counts < 0.50 x 10 3 No Vote Outs Differential results on all counts Increased Reportable differentials PLT-F Fluorescent Dye specific for platelet organelle Extended count time (6 times) for accurate low platelet enumeration Good comparison with CD41/CD61 Automated Action message and reflex with on board rules Copyright 2012 by Sysmex America, Inc. All rights reserved. So What Have We Learned? Low WBC Better accuracy and precision on counts < 0.50 x 10 3 No Vote Outs Differential results on all counts Increased Reportable differentials PLT-F Fluorescent Dye specific for platelet organelle Extended count time (6 times) for accurate low platelet enumeration Good comparison with CD41/CD61 Automated Action message and reflex with on board rules Copyright 2012 by Sysmex America, Inc. All rights reserved. 14

15 XN Technology Hematology Technology of the Future Today ACP IG, RET He, IPF Copyright 2012 by Sysmex America, Inc. All rights reserved. Rules Set for Hematology and A1c Comprehensive Hematology Rules Database- Examples Test Rule Action Operator Instruction WBC ISLH Criteria If dimorphic population? (Instrument suspect FLAG) Sample Handling Critical Reflex Smear and Value cut- Hold ADIFF offs Review smear RBC HGB If WBC >20 and LOC = PEDs and age < 2 years (Instrument value, location & age) Laboratory Specific Criteria If HGB > 16.0 and Requestor = Smith and no previous result (Instrument value, doctor, previous result) Reflex smear and hold ADIFF Reflex Smear and HOLD all tests Re-run and call ward Delta rules Review smear and call Dr. Smith PLT If PLT ABN distribution and retic ordered and PLT < 80 Instrument Flags (Instrument flag, sample order and instrument value) Hold PLT Review smear and verify PLT count Rules based on previous results 15

16 Impacts we Have Realized Auto-verification (hematology and A1c) Paperless environment Capacity and opportunity to add new tests Reduce opportunities for error Standardized sample and data workflow Staff cross-training TAT improvements HBA1c on demand Compare rerun/reflex Use: Compare rerun/reflex & STAT rates Review auto / manual validation rates Benefits: Measure laboratory performance & efficiency Compare user productivity 16

17 Turnaround Statistics Report 17

18 Counts Statistic Report On-Demand Management Reports 18

19 Enhanced Workflow Complete Critical Alert Documentation Step 1 Step 2 Step 3 Result Review Enter Call to info in WAM Save and transmit to LIS 19

20 All-in-One Data Station Multi-application Sysmex WAM workstation: Review of exception results: CBC and A1c Smear review /diff station LIS access Our Lavender Top Management Configuration Bio-Rad VARIANT II TURBO Link- A1c TS-500- Automated sorting, re-routing and archiving SP 10 Smear prep 3 XN Hematology testing 20

21 Efficiencies Gained with Sysmex WAM Decrease data TAT: Typical heme and A1c Auto-validation rates of ~85% + Automatic identification of STAT exception samples Reduce non-productive tech time: Advanced hematology technology and comprehensive smear rules Standardize review and process across techs, shifts and lab Reduce waste and cost: Paperless environment = decreases costs around paper, printing, storage and destruction of printouts 2 years data storage for easy access LEAN Achievements Workflow improvements: One tube for CBC and A1c Single piece flow Data Review auto-verification Over 85% of CBC s Achieved >90% of A1c Reduction Testing and result TAT: CBC A1c Labor Savings/Resource Reallocation for new testing 21

22 Our Automated LEAN Work Cell before Our New Automated LEAN Work Cell 22

23 NEW LINE WITH DI-60 23

24 DI-60 /TERMINAL QUESTIONS 24