Table 1

Improvement cycles

PDSA cyclePlan/PredictionDoStudyActTime required
Baseline
(‘new normal’)		  KP1: mean TaT=3.8 days.
KP2: % of TaT≤5 days=78%.
PM1: % on next run=70%.
PM2: mean test→authorised=2.0 days.		 4 weeks
PDSA1Remove need for a clinical scientist to create paper B27/B57 worklist (manual transcription step) for Luminex setup.
Predictions:

  • Setup standardised.

  • More samples included on next Luminex run (PM1 increase)→reduce mean time between sample receipt and sample setup.

  • Can monitor repeats and track samples.

Create automated query to produce list of samples received the previous day, saved as Excel spreadsheet on shared server.
Sample list then make available first thing in morning to the lab technician setting up Luminex run.		PM1: 97%—success.
Only one instance of a sample not being set up on the next available run (figure 3).
KP1: 3.5 days.
KP2: 92%.
Unexpected: lose recording of assay information.		Worthwhile improvement.
Adopt as permanent change. (S shown to be reliably sustained over the subsequent 3 months: all samples added to next available Luminex run.)
Create new electronic master sample log.		3 weeks
PDSA2Separate analysis and checking of B27/B57 (quicker) from renal/stem cell samples (slower).
Prediction:

  • Reduce mean time between samples tested and authorised (PM2 decrease).

Introduce new parallel process.PM2:1.8 days—small reduction; but variation limits increased (bad).
No. of runs at different stages of analysis/checking increased: closer communication required between staff.
Sample volumes low (COVID impact): Luminex runs not at capacity, so splitting the run into renal/stem cell patients and B27/B57 not (currently) necessary and increases confusion.
KP1: 3.2 days.
KP2: 98%.		Not currently worthwhile: (withdrawn and park).
(Could be tested again when sample volumes increase after COVID impact.)		4 weeks
PDSA3Improve tracking of B27/B57 samples so analysis/checking/authorisation not missed in daily work planning.
Prediction:

  • Better prioritisation of workload: samples not overlooked→fewer breaches of TaT target.

Add B27/B57 tracking to existing electronic dashboard and ‘amber alerts’ system based on time in process so far (TiP).
Create automated query to generate ‘amber alert’ list of all B27/B57 samples booked in >2 days previously (TiP >2 days).
Email list to all clinical scientists first thing every morning.		KP1: 3.3 days (not material change), but variation lower (good).
KP2=100% all samples had TaT 2, 3 or 4 days: no samples breached TaT target.
TiP is a useful tool for workflow progress planning.		Successful: more capable process.
Adopt as permanent change, retain TiP.		4 weeks

  • KP, key performance; PM, process metric; TaT, turnaround time.