Immunophenotyping team engage in improvement workshop with the aim to reduce turnaround times of Acute Myeloid Leukaemia test

The Immunophenotyping team, based at University Hospital Wales, provide and interpret clinically relevant information for the diagnosis, management, early detection and prevention of diseases such as Acute Myeloid Leukaemia (AML), through analysis of a laboratory investigation.

Immunophenotyping is a process that uses antibodies to identify cells based on the types of antigens or markers on the surface of the cells. This process is used in basic research and to help diagnose diseases, such as specific types of leukaemia and lymphoma.[1]

The team at UHW got in touch with Shaping Change’s Improvement and Implementation Team as they were looking to reduce test turnaround times for patients.

Why is it important?

The team are testing for life-threatening diseases on all ages. Several tests that came through whilst the workshop was taking place were that of a 30-year old woman and a young child, both of which were yet to receive their diagnosis.

What did the workshop involve?

Nick Tyson, Change Academy Lead and Kate Blower, Service Improvement Manager, delivered a two-day ‘Kaizen’ workshop to analyse, implement, test and standardise new processes with the aim to improve efficiency and enable clinicians to treat patients quickly and effectively.

The team have identified that parts of the process can be streamlined with the option for a mixture of reagents used in the testing process, rather than individually and manually combining reagents. A reagent is a compound or mixture used to detect the presence or absence of another substance. This poses a great time saving opportunity with environmental benefits from using less single-use plastic products.

In the workshop, other time-saving activities were identified such as manual administration tasks being automated and improved visual management of workflow within the lab to improve communication and flow within the workspace.

There are various constraints on the lab to consider being that it is a small team, they aren’t able to operate 24/7 and they are experiencing increased demands.

However, the question is - what could be done considering these constraints to reduce turnaround times? Is it out of their hands?

Over the course of two days spent in the laboratory, Nick and Kate engaged the team in facilitated discussions and used techniques such as process mapping, brainstorming and ease benefit analysis to bring focus to improvements that can impact the turnaround times for the AML test and supported the team to prioritise tasks for improvements.

Richard Thomas, Principle Clinical Scientist said, ‘It was very interesting to see our processes mapped out, identifying the bottlenecks and areas of this process where risks of mistakes are increased (manually pipetting individual antibodies etc). The introduction of antibody cocktails or multimixes is an area which has been identified previously as a technique to improve efficiency and mitigate some of the risks associated with omitting, and/or introducing the wrong reagent which could have a negative impact on a patient’s diagnosis and/or follow-up care.  The workshop highlighted the introduction of this technique would significantly reduce the processing time and risks for these assays, freeing up staff members to focus on the reporting side of the service which is important for a small specialised working team. It was interesting to hear that the I&I team encountered similar problems with reporting bottlenecks in other pathways within the health board.

The introduction of IT solutions (E.g. Kanban board, cloud based spreadsheets etc) are interesting developments that automate workflows and look to reduce the volume of printed paper within the laboratory. Getting our analysers networked will also increase the efficiency within the group, potentially allowing staff to perform aspects of the service from home if needed.’

What’s next?

In this case, as with many, it’s not a quick fix. In order to address the ongoing challenges and create realistic and sustainable improvements, Nick and Kate are providing on-going support such as assisting with improving complex data processes and training the team to utilise the new workflow management system. They will also return to the team to go through a process called 5S which aims to improve workplace organisation and standardisation, achieve and sustain a clear, clean, safe and organised workplace and ensure that it contains only what is needed, when it is needed, and where it is needed

[1] https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunophenotyping