In May 2013, Princess Margaret hosted its 1st annual Goals and Objectives Retreat which was attended by almost 300 staff members, including representatives from LMP. During the retreat, the various units and departments set team goals for the upcoming year.
In October 2013, a Goal Reporting Day was held for teams to provide progress updates and learnings from their goals and members from LMP gave a presentation on “Understanding the Process and the Barriers of Timely Delivery of Specimens.”
Recently, the team was able to give a poster presentation of their goal at the 1st annual Princess Margaret Goal Reporting Poster Day that explained their goal and how it would improve patient care. The presentation addressed the following questions:
What did the team do to achieve the goal?
The team organized and participated in clinical working groups to ensure successful implementation of a variety of initiatives including; stem cell apheresis move to TGH; improved TAT of test results for urgent TFC patients and; improved blood transfusion communication via whiteboard notification. The team also -
- Worked collaboratively with all stakeholders to understand expectations and limitations
- Engaged staff for process improvement input
- Aligned clinic schedules with patient flow through blood collection centres, laboratory testing, transportation and treatment clinics
- Implemented a process of prioritization via use of visual flags
- Provided input in support of whiteboard improvement project
What was the outcome?
- Implementation of priority processes to facilitate optimization of treatment time for apheresis patients
- Improved TAT to facilitate treatment for urgent TFC patients
- Improved whiteboard communications (standard language, visual flags
Who was involved?
Dr. David Barth, Laurie Mason, Sally Balmer, Jay Hockley, Diana Booth, Fatima Cardoso, Gisele Thorpe, Maria Amenta and technicians in blood collection, including Patsy Raymond, and the team of technologists from hematology and blood transfusion.
What was the “Greatest Learning”?
The laboratory needs to be engaged to be able to understand the process because there is always a solution.
“What are you most proud of?”
The collaboration and engagement by all laboratory professionals was extraordinary. Everyone wanted to see the success of these initiatives because they could make the positive impact association with patient care.
Reflecting on the goal process, Maria Amenta thanked the team and explained that “thanks to input from Patsy Raymond, and the entire team of technicians in blood collection and the team of technologists working in hematology and blood transfusion, Transfusion Centre patients waiting to find out if they require blood products are now waiting less. Previously, results could’ve taken up to 60 min or longer, clinicians are now receiving results within 20 min and are able to make transfusion decisions that much sooner. Their commitment to improving patient care is what makes LMP succeed and excel in all areas of our laboratory.”
Ten Questions for LMP’s Jordan Ngo Tian He
What do you do here? I work in Flow cytometry. It is a technique used to analyze cells stained with antibody-labeled fluorochrome. This suspension passes through a laser and electronic signals are collected to describe the properties of each cell. It is now routinely used in the diagnosis of blood cancers.
Why did you get into Lab medicine? I have always been interested in medical science- why people get sick, cause of the disease, diagnostic test, treatment and prevention
How did you get started at UHN? I worked for few years in Hematology, Biochemistry and Flow cytometry in MDS Lab (now Lifelabs). Later, I got more interested in Flow cytometry and an opportunity came when UHN was looking to fill one full time job
How long have you worked here? A little over 3 years
What is your favorite part of the job? The work environment – it is dynamic and evolving and keeps me on the move physically and mentally
What is the most challenging part of your job? The most challenging part is the analysis of the flow cytometry data. A skilled MLT needs to recognize an abnormal pattern to be able to report the correct immunophenotype to the Pathologists
What value would you say you add to patient care? Being able to provide a rapid and accurate report for the Pathologists in order to identify the blood disease.
How would you say you support the LMP mission to advance lab medicine in its three foundational pillars: research, education and clinical service?
Research: I have been involved in many clinical trial testing of new markers that would someday provide a more specific and more sensitive tests to identify diseases and improve the treatment
Education: I have been sharing different case studies to my colleagues that would further enhance and update our knowledge. I have been also presenting to medical student how Flow lab operates to get them familiarize with the tests
Service: I have been participating in our lab team meetings about creating a better work flow processes and consequently, an improve lab services and a better turn-around time for reporting of the results
In LMP, we often talk about serving as “global leaders” – what do you do to serve as a global leader?
To be called a global leader, one needs to initiate a fresh new approach or ideas for improvement and to stay current with the latest development and technologies happening around the world. I keep myself updated with new advances in Flow cytometry by attending conferences, off-site trainings and reading online articles. I take the lead right in the lab by setting a good example of a competent, productive and efficient MLT for others to follow. For the Flow cytometry team as a whole, we take pride in becoming the first and only leader in employing the use of Flow cytometry – 2 lasers, 10-colour multi-parameter assays for the processing Leukemia, Lymphoma, Screen tube, PNH, and the new MRD panel.
As the medical director for the Coagulation Laboratory at UHN and Sunnybrook, Dr. Rita Selby is responsible for the routine and Special coagulation testing for each of our hospitals and sites as well as our partner hospitals (Lakeridge Health, Timmins and cluster, Sault Area hospital) and for referred-in testing from our contract clients (Lifelabs, Dynacare, & regional hospitals).
According to Dr. Selby, this unique collaboration “allows for regional sharing of coagulation expertise in quality control, quality assurance, standardization and utilization of coagulation tests and medical interpretation of specialized coagulation assays plus also serving as a regional resource for physicians and health care providers for advice on complicated coagulation issues”.
Recently The Pathology Report asked Dr. Selby about Bloody Easy: Coagulation Simplified, a handbook that she co-authored and edited along with experts across her field. Read our Q&A below, to learn more.
What is Bloody Easy: Coagulation Simplified?
Bloody Easy: Coagulation Simplified is a handbook that provides practical information on blood coagulation. It is designed to enhance the knowledge of all health care professionals (physicians, nurses, pharmacists and medical technologists) about the basics of blood coagulation and its application, from routine testing in the coagulation laboratory to anticoagulant drugs and the assessment and management of common bleeding disorders.
What was involved in putting together this issue?
I was the lead author and a working group of coagulation experts across Ontario contributed content and provided peer review. Dr. Yulia Lin (Sunnybrook) was also an editors. Lesley Black (Charge technologist in LMP) was one of the content developers. Hope Creative provided the design/layout of the material. Images and photographs were produced or reproduced by the media department at Sunnybrook Health Sciences Centre.
How is it distributed?
Bloody Easy: Coagulation Simplified was funded by the Ontario Regional Blood Coordinating Network (ORBCoN), a grant program supported through the Blood Programs Coordinating Office of the Ontario Ministry of Health and Long Term Care. Project management and distribution of the book is through ORBCoN. It can be ordered through the Transfusion Ontario website: www.transfusionontario.org. The book is free (shipping charges may apply) to health professionals, hospitals and educational institutions within Ontario. It can also be downloaded as a free pdf from the Transfusion Ontario website – www.transfusionontario.org .
“We’ve been innovative to provide a much better pathology service for our patients. We’re not going to stop there . . . our vision is that pathology really is the heart of a patient’s diagnosis.”
– Dr. Sylvia Asa
Recently, Dr. Sylvia Asa, Medical Director of UHN’s Laboratory Medicine Program (LMP), addressed the question, “How can we harness innovation to transform medical diagnostics?” at a TEDx event.
In her talk, Asa spoke about why her team is looking at new and innovative ways to ensure that:
- every patient has the right diagnosis
- clinicians understand their patients’ prognosis
- pathologists predict the right treatment for each patient
Learn how LMP’s industry-leading ‘system change’ is:
- creating new, more flexible staffing models of pathologists
- forging hospital partnerships that ensure equitable access to expertise
- implementing the latest disruptive technological game changers in the pathology industry.
The Laboratory Medicine Program, under Dr. Asa’s leadership, is revolutionizing the way pathology is practiced across Toronto, the province, country and ultimately, around the world. Watch the video to find out how.
Recently, the Immunopathology (IP) laboratory in LMP acquired some new immunohistochemistry stainers that are faster, more flexible and will improve turnaround time for our patients.
“We received our first new machine back in 2013,” said Pam McCartin, MLT. “They are absolute powerhouses in terms of what they can do with our specialized antibodies and a new immunodetection system in order to label specific antigens in our patient’s slides. But, it took some time to get these machines up and running. The vendor has a set of metrics that we need to hit. But, we have our own high standards, as well, and we worked hard in order to assure ourselves that the strainers can meet our goals.”
It can take days – weeks – months – of invested time and energy from the laboratory staff in order to qualify and validate the equipment first to make sure that they are up to snuff. Then the team has to optimize staining protocols for each antibody, and validate these against known patient materials, and then continue to validate prospectively in the routine clinical testing environment.
“The other machines, some of which we still have in operation during this transition, were workhorses of a previous technological generation,” said Laurie Mason, Manager, Pathology. “But, in LMP we have incredibly high volumes, very complex cases and we needed equipment that would keep up with the challenge required for greater sensitivity of testing and improved workflow. The team has done a tremendous job at getting this equipment up and running.
“It was no small feat of perseverance and skill, but they rose to the challenge admirably, with the medical leadership of Dr. Emina Torlakovic and Dr. Elizabeth Hyjek,” added Laurie. “And of significant note, this project was undertaken with the Lakeridge team who, as part of our standardization between partner sites, acquired the same instrument platform and been a terrific contributor to the alignment and validation process. Their help continues to be valuable, and ensures patient testing is performed to the same standard of care, regardless of where it is performed.”
With the new stainers there is no batching required, which means that there can be a continuous feed of slides into the machines.
“The new system uses over 200 different antibodies and probes,” said Barb Terrett, MLT. “You have to test them all. Everyone worked together – our vendors, medical director, the lab staff, management – to ensure that the everything was up to our high standard.”
The team isn’t done yet and doesn’t expect to complete the final installations under spring 2014, but the new stainers are already making a significant difference to the team.
“It’s faster and better for the patient. Everything we could ask for.” said Pam.
“But the work doesn’t end there,” said Laurie. “We are now in an RFP process with Lakeridge Health and Sunnybrook for a second level testing platform in immunopathology. Again aligning standard of care testing between all three sites. Now how cool is that?”
Written by Pauline Diker, Senior MLT, Client Services and POCT, Laboratory Medicine Program
This year, while celebrating the anniversary and legacy of the insulin discovery made by Drs. Frederick Banting and Charles Best at Toronto General Hospital, we reflect on how much has been achieved since then.
While the diabetic population at UHN represents the growing global Diabetes epidemic, the POCT glucose meter technology embraced at LMP offers clinicians the most advanced tools to better manage patient care.
The preparation phase for the meter replacement project was long and the implementation period was intensive.
‘Presently, there are more than 461,000 POCT glucose meter results that reside in EPR, as they should be’, proudly states Christine Cursio, POCT Manager.
Implementation began with each clinical unit identifying the best location for their glucose meters, followed by the installation and activation of network jacks. Shortly afterwards the POCT team delivered docking/charging stations.
LMP was instrumental in mapping the network settings so that the flow of the patient glucose results from this tiny meter flowed seamlessly into the EPR. Just to appreciate the volume of work performed, there were approximately over 250 of these docking stations installed throughout UHN inclusive of the sites at Toronto Rehab.
While installation activity was happening, intensive training of the RNs and Health Professions staff took place. Preparation for the hands-on training, the staff were required to complete the “Glucose Meter Overview” E-Learning module that contains ‘how to’ slides followed by test questions. Nova Biomedical representatives trained up to 80% of the staff.
The meter practical training ensured that the operators became skilled at the functionality of the device, how to execute the QC and access for the acceptability, how to order a patient test in EPR and run properly on the device.
The ‘Train the Trainer’ teaching model was utilized for the select Super Users, who in turn would train operators on a continuing basis.
During the implementation phase, the POCT team was a source of contact and reference for concerns and up to date information, and implementation in-person support was provided on the units.
‘Since the implementation of the new glucose meter, improvements have been made around practices for managing hypoglycemia’, proudly notes Lori Taylor Nursing Professional Practice Leader. “The single vendor platform allows for standardized education, and clinicians access to EPR results trending, previously buried in the paper documentation”.
In May 2013, “Diabetic Trending Report” was launched in EPR for TGH and TWH. The report collates all POCT glucose results alongside patient’s diabetic medication. One of the meaningful future applications of this new report is to trend all diabetic patients’ results against best clinical practice.
EQA is an essential part of the POCT analytical process allowing POCT MLT to assess meter/ user performance. During the most recent EQA survey, POCT MLTs performed QMPLS Survey and audits in each clinical area practicing POCT Glucose monitoring.
Again, we had an opportunity to connect with a lot of operators and it was another chance to observe analytical performance, listen to the feedbacks and fine tune some performance techniques.
As of today, we have two provincial proficiency testing surveys under our belts using Nova meter and the most recent QMP-LS response was very favorable and without any outliers.
With a bit of a learning curve, we at POCT are also becoming more proficient in our AegisPOC data management program. This helps us maintain the quality of the glucose meter program.
For example, operators that fail to perform two levels of QC during the first 6 months of training will be locked out of the meter; thus being unable to perform patient testing. To be activated again, they have to repeat the training program.
Reflecting on this project, the POCT Manager says that the highlight of the project was when Transplant Unit went live as our first clinical area to use a new meter and they embraced it with such enthusiasm, she knew that we will be “OK” and the rest of the project would progress.” Given what we achieved to date, I am very happy” says Chris.
In June 2013 TR sites also underwent implementation of the Nova meters, following similar path; completing the projects execution phase. We are glad to act as a resource having the expertise that we established and perfected few months earlier.
Whether it is continuing education, or trying something creative and outside of the box, some members of the Laboratory Medicine Program have taken the initiative and decided to further their own education and interests. Read the two interviews below and see if it might encourage you to try something new. It could be a new course related to work, an opportunity outside of the laboratory, or something else altogether.
You have to take the leap! But read to see how these to fared when they had the courage to jump:
Wes Morrison works as a Molecular Genetics Technologist in the Laboratory Medicine Program’s molecular laboratory. Recently he completed the Michener Institute’s Clinical Laboratory Quality Manager Graduate Certificate Program. We sat down with him to learn more about what motivated him to further his education, and what he says to those who are thinking about their own educational opportunities.
What is the Clinical Laboratory Quality Manager Graduate Certificate Program?
It is a course, offered through an accredited institution that addresses the 12 quality management essentials, that are the core of every licensed clinical laboratory. It is detailed and comprehensive and provides a terrific overview – and deep dive – into the type of quality system we employ here in LMP.
How did you hear about the certificate program?
I actually don’t remember. I am an alumni of Michener, so I may have received it through being part of their mailing list. We also have a terrific network here in LMP, including our management team, that always has an ear to the ground for these types of opportunities. I knew I wanted to further my education, so I was likely looking for opportunities everywhere.
What was involved in the program?
The program was correspondence based and took about 2 years to complete. It was a series of online modules, online discussions, readings and projects. The program was filled with mostly students in Ontario, but some from other areas, including students from the Caribbean.
What did you learn?
I already knew about Quality Management Systems, so the overall concept wasn’t new to me. But, it was basically an in depth looks at the reasoning behinds the forms and structure of the systems. I’ve been working within it for years, so I knew how it applied in a practical sense, but learning about the theory and being educated on the strategy behind why we do things in the laboratory was really the best part. I was able to bridge the two – the theory and the practical – and be able to see the whole picture, think about why we do things here, and see how we can grow and improve our own system.
What did you hope to gain from the experience?
I wanted to improve. I think we should all strive for constant improvement and since quality drives everything we do, I felt this was the best place to focus. I really value delivering quality every day, so I wanted to gain a better understanding and appreciation around how to do that in a Quality Management System.
What would you say to others looking to further their education?
Do it! We should always continue to improve ourselves. Don’t be complacent. There are a lot of resources out there, whether online or through post-secondary institutions. The Allied Health fund is a great option for some people too. Plus, there is a lot of support within LMP for this type of continuing education. It really is a perfect fit as it benefits the individual and the organization.
Sarah Liang, who also works as an MLT from Molecular Genetics, is taking a different path than Wes – she’s going to try pastry making! We talked to Sarah about what why she decided to try and learn something completely different than her chosen career.
What will you be learning?
I’m going to be heading to Paris as I’ve been accepted into a pastry-making program in Paris. I’ve always been interested in cooking and baking, so I’m looking to further those skills. I’ll be attending Ferrandi, the French School of Culinary Arts. It’s a ten-month intensive program that focuses on the fundamentals of pastry making.
How did you hear about the program?
I came across the school online and thought that it would be the perfect opportunity to realize my dreams of learning how to bake plus living abroad in Europe.
How did you approach your supervisors about it?
I first spoke with Bev, the charge tech in our area. She was very supportive of the idea and even helped write a reference letter. Once I was accepted into the program, I spoke with Laurie Mason, my manager. I told her about the program and what it meant for me. She was very excited and supportive of the idea, including granting a leave of absence, which I really appreciated.
What would you say to others looking to try something new?
I think everyone should try and explore ways to enrich their life. Cooking and baking is where I find enjoyment outside of work, so this was a great fit for me. I encourage everyone to find something that they are passionate about and try it out. We should live life to the fullest and never let fear stop us from doing we what love.