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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

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Published on: November 8, 2015

Process Optimization to Improve Immunosuppressant Drug Testing Turnaround Time.

Vilte E Barakauskas¹, Tiffany A Bradshaw², Lonnie D Smith³

¹From the Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, Canada Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.

American Journal of Clinical Pathology

|July 26, 2016

Summary

Improving immunosuppressant (ISP) drug testing processes significantly increased timely results for transplant patients. Process changes boosted reporting by 2:00 PM from 28% to a median of 76%.

Keywords:

Hospital laboratory Immunosuppressants Process improvement Process optimization Run chart Turnaround time Value stream map

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Area of Science:

Clinical Chemistry
Laboratory Medicine
Transplant Management

Background:

Effective management of transplant recipients relies on prompt immunosuppressant (ISP) drug level results.
Current laboratory processes may hinder timely reporting, impacting patient care.

Purpose of the Study:

To characterize the existing immunosuppressant (ISP) testing workflow.
To identify bottlenecks within the ISP testing process.
To implement improvements to meet required turnaround times for ISP drug level results.

Main Methods:

A value stream map was created using laboratory timestamps, direct observation, and staff interviews.
Process bottlenecks in the ISP testing workflow were identified.
Process changes were implemented to improve result reporting timeliness.

Main Results:

Baseline ISP testing reported only 28% of samples by 2:00 PM over seven weeks (n=272).
Key bottlenecks included analytical run scheduling, instrument delays, sample identification challenges, and specimen collection difficulties.
Post-implementation, a median of 76% of ISP samples were reported by 2:00 PM.

Conclusions:

Optimizing ISP sample collection and analysis processes enhances the laboratory's ability to meet physician-requested reporting deadlines.
Process improvements are crucial for timely immunosuppressant drug monitoring in transplant patients.