Douglas, S

Laffan, M

Littlewood, R

Haematologica

English

Spiral - Imperial College Digital Repository

Summary/Conclusions: In conclusion, the psychometric properties of theGreek version of TranQoL confirmed that it is valid, reliable and responsive tochange. The TranQoL can be incorporated into future studies of thalassemiamajor in Greek patients.E1455BIG DATA ANALYTICS & PATHOLOGY SERVICES IN NHS: ACHIEVINGSTEP CHANGES IN CAPACITYM Laffan1, S Douglas2, R Littlewood2,*1Haematology, imperial college london, 2Applied, Applied Strategic, London,United KingdomBackground: A major hospital Trust in London provides healthcare for a largepopulation across Medicine, Surgery, Obstetrics and other specialties. Threelaboratories are on sites using automated, high capacity analysers to providepathology services much of which requires rapid turnaround. The major chal-lenge for laboratories in this situation is centred on the high throughput testscomprising full blood count, assessment of renal/ liver function, and coagulation.To date these services have not been subjected to detailed analysis of demand,efficiency of use of analyser capacity and efficiency of physician requesting.Aims: First to determine the factors limiting the turnaround times for routinetesting throughout periods of varying demand and those factors limiting theoptimum use of existing analyser resources. Second, to identify requestingpractices that are inefficient or which drive the changes in demand.Methods: A database consisting 20M data points from 1M pathology testrequests, recorded over 1 year was provided including details of requester andsite of request with way points defining the passage of the sample from requesttime through to test reporting. This allowed a map of volume and activity overtime and test turnaround times identifying bottlenecks and changes in efficiency.Parameters showing healthcare professional ordering of tests, location ofpatient and laboratory site were also provided and analysed.Results: Initial descriptive analysis showed 1 particular laboratory had difficultiesachieving its potential capacity utilization rate and target turnaround times. Bot-tlenecks were clearly identified at sample entry into the laboratory and at vali-dation of results. These resulted in build-up of samples and delays in reportingthat were staggered in time: thus although the peak in TAT occurs at 4pm theextra capacity was required prior to this, revealing a negative, delayed impactof test arrival on test turnaround time. This has obvious implications for laboratorymanagement. The fastest 10% of FBC tests were reported in 0.2hr and 80% in1.5 hrs but the slowest 10% varied from 2-120 hours. Of 200,000 testsprocessed per year at one lab, 47% were ordered by clinical division Medicine,34% Surgery & Cancer / Clinical Haematology, 15% Women and Children. Med-icine was the leading requester at all 3 sites. Of 2,000 physicians, 87% orderfewer than 500 tests per year. Some intensive requesting practices are probablymasked by the use of common requesting codes. 61% of patients have only 1to 2 tests per year, the proportion of patients having 100 tests per year beingless than 1%. However at one site >1% of patients had >50 tests per year, iden-tifying an intensively monitored population. Measurement of true machine capac-ity highlighted a large gap between current performance and maximum potentialindicating that better sample profiling and management could produce savings.The maximum capacity for FBC was 420 tests per hour but the average per-formance was 60/hr and the peak rate of reporting only 95/hr.Summary/Conclusions: Big data analytics and process mapping identified 2rate-limiting steps to performance inherent in current test system: test receivedat lab and validation of results. Close analysis of such a large dataset indicateshow we can optimise the laboratory processes and improve utilisation of currentinstalled capacity in NHS pathology services.E1456THE EFFECTIVENESS OF CLINICAL TRIAGE: CLOSING THE AUDIT LOOPL Vanhinsbergh*, F ChowdhuryHaematology, NHS, London, United KingdomBackground: In 2014-2015 there were 85 million outpatient clinic attendancesin NHS hospitals across the UK with a cost to secondary care exceeding £15billion. 25.9 million (30 percent) of these were first appointments. In 2014 weaudited a 6 month period of haematology outpatient clinic referrals and estab-lished the effectiveness of clinical triage in filtering inappropriate referrals. Weestablished that 74% of all new patient referrals were from primary care in2014. Of the rejected referrals 96% were from primary care. Aims: In 2015, we implemented audit guided interventions, consisting of struc-tured consultant led primary care teaching sessions across the North WestLondon region. These sessions were specifically designed to educate andguide primary care physicians regarding haematological symptoms and bloodparameters requiring secondary care input. The intervention was made withthe aim of both capturing potential haematological malignancies at an earlystage and also reducing inappropriate referrals. The proposed secondary out-come of this intervention was cost efficiency saving and improvement in region-al haematology care.Methods: Data was collected retrospectively from a local clinic referral databasecontaining information on all new patient referrals including demographics, refer-ral reason and triage outcome. We compared data from a four month period(June to September) in 2014 with the same four month period a year later in2015.Results: Our data shows a 31 percent increase in monthly referrals in 2015.The mean monthly referral number increased from 169 in 2014 to 244 in 2015.Despite this we saw a reduction in the percentage of inappropriate referrals tothe service. In 2014 a monthly mean of 22 percent of referrals were rejectedwith feedback provided to the referring clinician. In 2015 the rejected referralrate was reduced by 6 percent to a monthly mean of just 16 percent for thesame time of year period. 37% of referrals were for clotting/ thrombosis, 23%potential haematological malignancy including 2 week waits and the remaining40% general haematology.Summary/Conclusions: Our data support the ongoing use of consultant ledclinical triage and primary care education in order to reduce the significant costburden of new patient clinics whilst remaining safe for patient care.E1457USE OF COMBINED ORAL ADMINISTRATION OF ANALGESIA ANDANXIOLYSIS FOR PAIN ASSOCIATED WITH BONE MARROW ASPIRATIONAND BIOPSYA Gravetti, C Cerchione*, A Casoria, N Pugliese, L Marano, F De Gregorio,M Di Perna, M Picardi, V Martinelli, F PaneHematology, Ematologia e Trapianto/AU Federico II, Napoli, ItalyBackground: Bone marrow aspiration and biopsy (BMB) is central to the diag-nosis and management of many haematological disorders and is a safe pro-cedure associated with low morbidity and mortality. For adults, the infiltrationof local anesthesia at the biopsy site has been used as the principal form ofanalgesia for BMBA. Unfortunately pain relief is often incomplete especiallyduring aspiration of the bone marrow. In addition, pain is likely to contribute tothe anxiety the patient may already be experiencing.Aims: In this study we assessed an oral administration of analgesia (fentanil-ACTIQ) and anxiolysis (midazolam). 107 consecutive ambulatory adult patientsreferred for bone marrow examination were enrolled. Informed consent for theprocedure was obtained from all patients.Methods: All patients received local anaesthesia (LA) with 10 mL of injected2% lignocaine, but 52 patients received LA alone (group A) and 55 patients LAplus 5 mg midazolam (oral administration) and 200 mcg of Fentanyl trans-mucoso (group B), 30 min before the procedure. The pain level was assessedwith the Numeric Rating Scale which distinguishes ten levels of pain, from 0 to10 in five times of procedure (baseline, start LA T1, aspiration T2a, biopsy T2b,five minutes after the end of the procedure T3). At the end, all were given aquestionnaire about efficacy, satisfaction, comfort with three levels (1/low-2/medium-3/high).Results: This medium values were found: at time T1 the medium level of painwas 0.87 for the group A vs 0.88 of group B, at time T2a 3,63 group A vs 3,54group B, at time T2b 4,63 group A vs 4 group B (p<0,05), time T3 0,41 groupA vs 0,16 group B (p<0.05). In addition 21 Patients, who have already under-gone the procedure without sedoanalgesia, saw to prefer the new medication. Summary/Conclusions: Our preliminary results seem interesting becauseunderline the different subjective perception of pain in the two groups and espe-cially show a main level of satisfaction and comfortable in our patients under-gone medication with sedoanalgesia and a lower level of anxiety in view of apossible repeat of examination.E1458THE IMPACT OF AL AMYLOIDOSIS ON ABSENTEEISM, REDUCEDPRODUCTIVITY, AND JOB LOSSS Guthrie1,*, MK White2, KL Mccausland2, M Bayliss21Prothena Biosciences Inc, South San Francisco, CA, 2Optum, Lincoln, RI,United StatesBackground: Debilitating chronic conditions and their treatments often nega-tively impact patient’s ability to work, resulting in absenteeism, reduced pro-ductivity, and job loss. Light-chain (AL) amyloidosis is a rare disease in whichmisfolded light chains are deposited in tissues, which may lead to organ failure,disability, and death. Current treatments are known to affect patients’ function-ing and well-being, but there is little evidence to date on the impact of AL amy-loidosis on patients’ ability to work.Aims: To describe the impact of AL amyloidosis on patients’ work using datafrom qualitative and quantitative research.Methods: Data for these analyses were collected from two phases of a broadresearch program on the experience of patients with AL amyloidosis. First,qualitative in-depth individual telephone interviews were conducted with 10patients. Results are presented from coded interview transcripts that were ana-lyzed using a grounded theory approach to identify themes. Second, a quan-titative online survey including a battery of patient-reported outcome measures602 | haematologica | 2016; 101(s1)21st Congress of the European Hematology Association

Big data analytics & pathology services in NHS: achieving step changes in capacity

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Big data analytics & pathology services in NHS: achieving step changes in capacity

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