Reducing Troponin

Test Turnaround Meiqiao Wang, Maab Khalil,

Latoya Rone
Time at Essential
Flow Hospital
“You are not paid to work hard. In fact, you are not paid for
effort at all. You are paid for results. It’s not what you do;
it’s what you get done.”
-Larry Winget
Essential Flow Emergency Room

• “Four-step improvement turnaround

process first implemented in urban
teaching hospital with an annual
volume of 115,000 visits.”
• ER Check-in Result Time=141mins
• Resulting in batching and poor workflow
Reducing Troponin Test Turnaround
Jan 2019 - December 2019
This project demonstrates how to reduce the troponin test turnaround time in Emergency Room(ER).
Goal Statement Status

Reduce 80 percent of troponin test turnaround time from Team current status: Control Phase
180 minutes to less than 60 minutes by December 2019.

Team Measurement
Sponsor: Richard Yochum
↑ Bad
Process Owner: Emergency Department

Project Lead, Green, Black Belt: Maab Khalil, Latoya Rone, ↓Good
Meiqiao Wang

Team: ED Nurses, Lab Technicians, Physicians

Scope

In Scope: Walk-in Patients, Patient chief complaint is chest pain

Out of Scope: Patients arrive by ambulance, Patient chief
complaint other than chest pain
Customer
ED/Chest Pain Patient
Reducing Troponin Test Turnaround
Critical Success Factors

In Scope Out of Scope

• Patient rooms outside of ED
• ED • Complaint made prior to
• Complaint made during check-in arrival
Critical Success Factors Boundaries/Non-Negotiables

• Continuous, effective communication • No new employees

• Clear roles and responsibilities
 Cause and Effect
CAUSE
Management Man Method

No doctor present
Bad communication between staff

No standard work by Receptionist too busy to order test Batching results

leadership.

EFFECT
No time stamp displayed, Blood collection delay
Non-updated system;
measures how long stamp Delay=44min
Patient status unknown Lab collection kit
should stay in basket Printer in lab not not ready
(checking point) working
Measurement Machine Material
Examples of Disorganization
Essential Flow Six Sigma
 Current
State Value
Stream

Total Check-in- Result time = 141 min

NVA = 9o NVA%= 64.54 %
VA = 51 VA% = 36.17 %
 Why should troponin turnaround time under
60 mins?
• Care coordination
• Patient safety
• Patient outcomes
• Early detection of Acute Coronary Syndrome (Boelstler,2015)
• Possible decrease the ED length of stay
 Troponin T- Turnaround
Time Frequency
91.73% of the work didn’t
completed under 60 mins
• Only 8.27% of the troponin T-
turnaround time were performed
under 60 mins
• Defects rate is 91.73%
• Data from July 2017 to September
2017, 713 patients with troponin
test were included in the analysis
Troponin T- Turnaround Time
• Average time for troponin test is 97
minutes
• First quartile is 72, which indicates that
majority of the TAT are over 60
minutes.
• Many outliners with long troponin
order time still exists.
 Troponin Milestones (n=713)
3rd Quarter 2017

TAT prior to PI Median

TAT Metrics (Min) Target (Min) Defect Rate
Door-to-order(Min) 12 15 38.90%
Order to Collect (Min) 17 10 71.91%
Received-to-result(Min) 51 35 93%
Door-to-result (Min) 85 60 91.73%
TAT= turnaround time; PI= process improvement
Future Value
Stream
NVA
VA

Total Check-in-Result Time = 65 min

NVA = 10 min NVA %= 15.4 %
VA = 55 min VA%= 84.6%
 Conclusion
• Objective
• reduce 80% turnaround time, 180mins to less than 60mins
• Improvement strategies
• Three person nurse team: doctor, nurse, lab technician
• Improvement on patient location updates/tracker
• Avoid batching
• Sustainability
• Create control chart which provide maintenance and
improvement measurements. (Control phase)
• Provides a response plan for any fluctuation in process/design
Thank You
References

• Boelstler, A. M., Rowland, R., Theoret, J., Takla, R. B., Szpunar, S., Patel, S.
P., . . . Pena, M. E. (2015). Decreasing troponin turnaround time in the
emergency department using the central laboratory: A process
improvement study. Clinical Biochemistry,48(4-5), 308-312.
doi:10.1016/j.clinbiochem.2014.10.014