Pathology News

Improvement Projects Highlighted During Quality Month

By Elizabeth Walker | 5 November

Each October, Michigan Medicine celebrates the efforts that faculty and staff make in order to improve the quality and safety of patient care across the institution. With its commitment to collaboration and innovation, the Department of Pathology is always well represented at the annual Quality Month event. This year was no exception.

The October 18th event featured a poster session, break-out sessions, and talks. It began with the panel Engaging Patients in Quality Improvement, moderated by Dr. Steven J. Bernstein and featuring the departments of cardiology and pathology. Patient members, Michele Mitchell, and Dennis Serras, of the Department of Pathology’s Patient and Families Advisory Council (PFAC), shared their stories, along with Vice Chair of Clinical Affairs and Quality, Dr. Jeffrey Myers. “Participating in the Quality Panel was so rewarding!” Mitchell said. “I so enjoyed sharing specifics as to how the Pathology PFAC has used the patient voice to impact real work.”

The event’s posters highlighted teams and projects that have used the Plan-Do-Check-Act (PDCA) cycle throughout the year. The PDCA cycle is a four-step model for carrying out positive change. It consists of recognizing an area for improvement, planning an experiment to test a change, reviewing the results and identifying what was learned, and then taking action based on the study. The PDCA cycle is intended to be never-ending, for continuous improvement.

The Quality Month projects must demonstrate:

  • at least one PDCA cycle of improvement
  • a clear relationship between root causes and countermeasures
  • measurable assessment of the outcomes of experiments
  • connections between improvement objectives and organizational goals of optimizing quality and safety in patient care, leading in value creation, enhancing the patient experience, developing our employees, improving financial performance, and improving diversity and inclusion

Members of The Department of Pathology worked on projects featured in nine of the event’s eighty-four posters. Additionally, a poster from the Department of Social Work by Lisbeth Harcourt, LMSW and Erin Loomer, an MSW student intern, featured The Traumatic Death Outreach Program which benefits patient families of U-M’s Washtenaw County Medical Examiner’s Office which is part of the division of anatomic pathology.

The Quality Month Poster Review Team selects exemplar finalists and an exemplar winner. The poster, Reducing Inappropriate Laboratory Ordering for Heparin-Induced Thrombocytopenia (HIT), a multi-disciplinary project including pathology’s special coagulation technologists and Drs. Scott Owens, Lee Schroeder, and Steven Pipe, and staff members Jeff Lott, Usha Kota, Linda Johnson, and Lindsay Szczepanski, was one of four exemplar finalists.

Heparin is commonly prescribed for hospitalized patients but it can cause a potential for HIT. Using PF4 ELISA (protein four antibody enzyme-linked immunosorbent assay) and serotonin release assays (SRA) testing can help predict a patient’s likelihood of developing HIT. However, hematologists and hospitalists had concerns over the appropriateness of testing and wanted to measure compliance to standards to reduce inappropriate use. It was found that only 44% of the tests ordered were clinically useful. A change was made to hold SRA orders until PF4 ELISA are back and only order SRA testing if required. The project resulted in a 75.6% reduction in the use of (SRA) testing across the hospital system.

The event’s exemplar winner was for the poster Optimizing Clinic Efficiency by Developing a Novel Bandage Wrapping Device. This project reduced the time spent rolling bandages enough to save five full weeks of staff time at just one MedSport clinic.

Pathology posters included:

Efficient Staffing of Satellite Labs (Recognized for impressive outcomes.)

Team Members:

  • Usha Kota, MT(ASCP)
  • Lee Schroeder, MD, PhD
  • Tom Morrow
  • Marty Lawlor
  • Mary Jane Liu, MY(ASCP)
  • Kristy Wendt, MT (ASCP)
  • Priti Patel, MT(ASCP)
  • A group of all-volunteer rotational technologists and hematology lab staff.

Strategic Development of Two Fully Automated Arkray Aution Hybrid AU-4050 Urinalysis Analyzers (Recognized for impressive outcomes.)

Team Members:

  • Kristy Wendt, MT (ASCP)
  • Jerry Davis, MT (ASCP), MPH
  • Rajan Dewar, MD, PhD
  • Usha Kota, MT (ASCP)
  • Mary Jane Liu, MT (ASCP)
  • Vicki Pierzynski, MT (ASCP)
  • Cel Gallardo, MT (ASCP)

Giving Innovance a Chance (Recognized for great use of technology.)

Team Members:

  • Morgan Stuart, MT
  • Linda Johnson, MT (SH)
  • Steven Pipe, MD
  • JoAnne McCarthy, Siemens
  • Coagulation Technologists

High Sensitivity Troponin T: Implementing a New Test in the Chemistry Lab (Recognized for great use of technology to improve care, efficiency, and money.)

Team Members:

  • Don Giacherio, PhD
  • Eric Vasbinder, MT (ASCP)
  • Kate Ferguson, MLS (ASCP)
  • Amy Rosendaul, MLS (ASCP)
  • Catherine White, MS, MLS (ASCP)

Tandem Dye Antibody Breakdown Detection in new 10 Color Flow Cytometry Panels (Recognized for a great background section that clearly articulated the importance of solving this problem.)

 Team Members:

  • Jaclyn Epple, MLS (ASCP)
  • Julie Bensinger, MT (ASCP)
  • Dan Boyer, MD, PhD
  • Special thanks to the technologists in the flow cytometry lab
  • Multidisciplinary posters with team members from pathology included:

 

Emergency Department Implementation of a High-Sensitivity Troponin T Assay within a Chest Pain Evaluation Pathway (Recognized for great problem statement and great use of a multi-disciplinary team.)

     Team members:

  • Cardiovascular Medicine: Hitinder Gurm, MD; Geoff Barnes, MD; Jim Froehlich, MD; Vallerie McLaughlin, MD; Robert Keast; Todd Kolias, MD; Kristi Bradsher
  • Emergency Department: Steve Kronick, MD; Dave Somand, MD; Fred Korley, MD; Steve Maxwell; Jennifer Holmes; Amy Hardy; Lisa Hartwell; Andrew Adan, MD; Alexander Beyer, MD; Debbie Burrum; Renee Havey; John Fairchild
  • Hospitalist Medicine: Scott Flanders, MD; Chris Petrilli, MD; David Paje, MD: Adam Zahr, MD; Garth Strohbehn, MD: Robert Chang, MD
  • General Medicine/Primary Care: Maria Han, MD; Rob Ernst, MD; Raymond Yeow, MD
  • Pathology: Don Giacherio, PhD; David Manthei, MD; Sue Stern
  • Radiology: Ella Kazerooni, MD; Cheryl Kucharski; Smita Patel, MD; Penni Toney; Sarah Metzger
  • HITS and Quality Analytics: Linda Bashaw (Internal Medicine), Jim Hiner, Karen Karolle-Caton
  • M-PROVE: James Henderson, PhD; Ashley Snyder, Emily Dibble
  • MiChart: Stephanie Brooks, Rodger Lupton, & Cybill Starr
  • Internal Medicine Project Support: Matt Johnson & Katie Schwalm

 

Reducing Inappropriate Laboratory Ordering for Heparin-Induced Thrombocytopenia (HIT) (Recognized as Exemplar Finalist.)

       Team Members:

  • Internal Medicine: Chris Petrilli, MD; Lauren Heidemann, MD
  • Hematology: Alice Cusick, MD
  • HITS/Quality and Innovation: Linda Bashaw
  • Quality and Innovation: Matt Johnson; Katie Schwalm
  • Pathology: Scott Owens, MD; Lee Schroeder, MD, PhD; Jeff Lott; Usha Kota; Steven Pipe, MD; Linda Johnson; Lindsay Szczepanski; Special Coagulation Technologists
  • HITS: Cybill Starr

 

 Impacting Antimicrobial Stewardship: With a Timely, Reliable POC Flu Test (Recognized for robust PDCA cycle with impressive outcomes.)

     Team members:

  • Pathology Point-of-Care Team: Karen Barron; Scott MacLellan; Amy Rosendaul; Lee Schroeder, MD, PhD; Andrew Szczembara; Denise Twarkowski; Nick Wesener

 

 Identifying Patients at Risk for Hereditary Cancers (Recognized for great use of a multidisciplinary team with impressive use of technology.)

    Team Members:

  • Internal Medicine: Sofia Merajver, MD, PhD; Kara Milliron, MS, CGC
  • Pathology: David Keren, MD; Lee Schroeder, MD, PhD; Lynn McCain, MHSA, PMP; Amanda Cook

 

Our teams in the Department of Pathology are continuously looking at process improvements that will positively enhance the patient experience, optimize quality and safety, develop employees, lead to value creation, and improve financial performance and diversity and inclusion. We look forward to celebrating this year’s improvements at next year’s Quality Month event.

 
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