HIV Testing in Newborns at Rush Hospital

Work System Analysis

1. Nurse in Neonatal Care draws blood sample from newborn patient who has HIV positive mother.

2. Nurse sends sample to lab processing center.3. Lab processing center technician forwards blood sample to

microbiology lab 4. Microbiology lab technician identifies the numbered sample

as a HIV sample and sends it on to the retrovirology lab. 5. Retrovirology lab technician enters patient number

information into hospital database.6. Lab technician performs HIV ELISA screening test when

samples meet the capacity of test tray to perform one test, otherwise samples must be preformed within one week.

7. Lab Technician enters patients HIV results into hospital database by patient number.

8. Lab Technician calls the contact Doctor that HIV results are available.

9. Doctor retrieves HIV test results from fax machine and in forms Patients’ Guardian of HIV test Result.

As Is Work System

Work System Contains unnecessary hand-offs

Contains too many participants Customers have unrealistic expectations Undocumented technology

Important Problems

MetricsAspect of performance

Metric (specific measure of performance in this situation)

Current value of metric

Realistic desired value of metric

Error Rate % of false positive HIV tests

.01% 0%

Consistency % of all decisions that followed all proper procedures confused

95% 99.5% (better training of employees)

Participants # of participants required to test and give results of samples

7 5

Speed Time from blood draw to HIV test Results

1 week 3 days

Cost Current value of work to test samples (confused)

Decrease number of participants Bypass extra departments Utilize new technology, database

To Be Work System

Change customer expectations Verify that nurses draw enough blood Introduce more training for lab technicians Use labels with bar codes Bypass extra departments and go directly to

retrovirology department Give doctors access to test result database

Recommendations