Mission Statement

The Program provides a community of cooperation and education to enhance the sharing of
resources to improve quality and maximize the efforts of Regional Laboratory Services in
providing a high level of service to our member hospitals and communities.

Values

Integrity

We act honestly, ethically and impartially at all times.

Professionalism

We encourage self-improvement and aim for scientific excellence.

Quality Assurance

We ensure that all our work is carried out in accordance with recognized standards.

Teamwork

We recognize the participation, initiative and cooperation of all the laboratories as being essential to our success.

Client Focus

We strive to recognize and anticipate the needs of clients by working openly and cooperatively to meet those expectations.

Board of Directors

Robert Wilson – Atikokan General Hospital
Wade Petranik – Dryden Regional Health Centre
Mark Balcaen – Lake of the Woods District Hospital
Janice Mullin - Red Lake Margaret Cochenour Memorial Hospital
Wayne Woods – Riverside Health Care Facilities, Inc.
Roger Walker - Sioux Lookout Meno-Ya-Win Health Centre

Regional Office

Kenora-Rainy River Regional Laboratory Program, Inc.
P.O. Box 3003
Dryden, ON    P8N 2Z6
Phone:  807-223-8264      Fax:  807-223-7342

Chief Operating Officer: Wade Petranik
Laboratory Director: Dr. J. Kerry MacDonald
Regional Laboratory Consultant: Anna Robinson
Program Assistant: Marilyn Rustan

Organizational Chart

(See Appendix A)

Executive Summary

A hospital’s commitment to patient-centered care is based on the belief that the perspective of the patient is what matters most. Collaboratively this Program reaches across the region and beyond to share best practices and contribute to that perspective. It is our commitment to understand and meet the needs of clients we serve.

In 2007, the KRR RLP focused on current services with targeted initiatives. Regionally 1.4 million tests were performed so having informed users of our services became the key of the Program’s initiatives. Educational programs, guideline development and implementation, utilization audits, and on site presentations were developed to provide guidance to physicians and technical staff on appropriate test selection and interpretation.

In an increasingly complex regulatory environment we must remain cognizant of the need to improve efficiency and cut costs while also maintaining compliance. Replacement of particular analyzers in 2006/2007 should realize some savings due to the reduction of maintenance, QC testing and staff time to perform these duties.

As an on-going commitment to improve human resource strategies the Region has entered into an agreement with Cambrian and Confederation College to provide clinical placements in Laboratory Medicine. The first MLA student intake from this combined College format is scheduled for January 2009.

It is to the great credit not only of the Program’s founders but also those people who have worked through the years to make this Program provincially known and respected. The Board, clinical, technical and support team continue to integrate all aspects of our Quality Management Program, designed specifically to achieve our goals. Policies, processes and procedures integral to the quality of our services are identified, developed, validated, implemented and reviewed for improvement in accordance with current standards of practice and the requirements of regulatory agencies. We remain highly ambitious and committed to build on our quality improvement strategy in the years ahead.

All laboratories in KRRRLP continue to participate in internal and external assessment processes to ensure testing services meet the requirements of it’s customers, the Ministry of Health and Long-Term Care Laboratory Licensing Branch, and accrediting regulatory agencies such as QMP-LS.

Detailed Description of Activities

Equipment / Test Menus

Through a series of RFP’s developed by the Program the laboratories have been successful at:

• Identifying a suitable coagulation analyzer for purchase
• Identifying a suitable glucose meter for point of care use
• Purchasing a Laboratory Information System (LOWH)

When one considers that a majority of diagnostic and treatment decisions are based on laboratory tests, it is easy to see the crucial role laboratory medicine plays in patient care in our hospitals. Last year the region performed 1,245,000 laboratory tests, which are consistent with past years. Menus continue to be streamlined however to make room for newer and more appropriate tests. It is expected that BNP testing will be added to the menu to assess congestive heart failure. In addition a strategy will be developed for its effective use.

Education

The Program organizes continuing medical and technical education in a variety of forums: conferences, teleconferences, workshops, presentations and lectures. It is committed to helping the medical and technical personnel be the best they can be. By 2008 it will be the only regional Program to host an annual Conference in Ontario outside of a provincial initiative.

Details of this year’s Symposium are outlined in Appendix B.

This year the Program continued in it’s educational commitment by producing a series of newsletters for physicians and technologists to provide authoritative information, advice and instruction on the utility of specific laboratory tests.  Appendix C.

The Laboratory Director continues to provide onsite education to a variety of health care providers. The presentations included topics such as heart failure.

Onsite Visits

In addition to monthly or bi-monthly teleconference meetings with the Laboratory Managers, onsite visits have occurred in the region by the Laboratory Director and/or the Laboratory Consultant, 3 times.  Appendix D.

The Laboratory Managers also meet with the Laboratory Director and Program Consultant bi-annually for 2-day sessions to deal with strategic planning, new initiatives and complex projects.  These meetings provide guidance to the Laboratories in order to meet the clinical needs and established goals in each facility.

A regional Microbiology Committee was resurrected to help technologists working in this discipline to connect with their peers and discuss related issues. This has led to quality improvements to individual operations and the regional manual.

Recruitment

The Program is committed to the training of students pursuing a career as laboratory technologists. Staff members at LOWH worked closely with Cambrian College by helping to train students in their clinical year. The Pathologists also provided training to a fifth year Pathology resident.

The Program is pleased to announce that another agreement has been reached with Cambrian College to provide practical experience to Medical Laboratory students in their clinical year. Four facilities in the KRRRLP (including LOWH) have agreed to work collaboratively to provide students with the training needed to transition them into their career path hopefully in this Region.

EQA Challenges

The Quality Management System-Laboratory Services provides an external quality control program specifically designed for Ontario laboratories. Its goal is to provide a confidential assessment by which a laboratory can compare its internal test results to those of other laboratories.

Samples are sent to participants two to four times per year, and participants analyze the samples and return their results in a specified time period. Data is pooled and statistically analyzed by QMPLS, and a confidential, individualized report along with Committee Comments is returned to each participant.

The survey results includes an assessment of error based on the clinical significance of discordant findings.  Lesser errors are assessed for results that exceed the established acceptable limits and significant errors for results that, in addition, have the potential to cause mistreatment or misdiagnosis.  QMP-LS corresponds with the participating laboratories  regarding the discordant findings, requesting feedback on the cause of the result and implementation of corrective action.

Broadsheets are frequently provided as an additional reference to the discipline specific surveys. These are developed by academic specialists to provide best practice guidelines.

A Regional review of EQA challenges has revealed improvement in performance when compared to last year. Appendix E.

This year there were 28 letters of non-conformance received:

Non-conformances:

Clerical- transcription, test code change – 3

Technical -misinterpretation of results, calculation errors, QC limits sample mix-up, random error – 13

Materials – defective reagents/unsupported reagents, mishandling QMP-LS samples – 6

Inability of staff to apply knowledge to situation, failure to follow SOP, missing SOP – 3

Equipment function – 3

Organizational Factors- communication, training – 0

∗No Action required- Letters of inquiry, notification of best practice (excluded as a non-conformance) – 7

Corrective actions for the most part included re-education and training of staff, writing/updating procedures, and contacting manufacturers regarding problems with materials or analytical performance.

Goals for 2007:

Goals for 2008:

• Training video for POCT. Promote additional POCT.
• RFP – Hematology analyzer and blood culture incubator
• Assess QA at a regional level to establish regional benchmarks.
• Meet with LHINs to promote the Program and market management skills.
• Arrange workshops in communication, adult training
• Prepare Program Administrative Manual

Appendix A

Organizational Chart

Appendix B

Annual Fall Symposium
2007

Summary

The 16th Annual Fall Symposium was held September 18, 19 & 20, 2007 at Totem Resorts in Sioux Narrows, Ontario.

36 delegates, 30 of whom were from our own region, attended this year’s Symposium.  Delegates included technologists and technicians as well as one Laboratory Director.  The breakdown of delegates from our region include:

• Atikokan General Hospital:   2
• Dryden Regional Health Centre:    2
• Lake of the Woods District Hospital:   11  (Includes Laboratory Director)
• Red Lake MC Memorial Hospital:   2
• Riverside Health Care Facilities:  7
• Sioux Lookout Meno-Ya-Win Health Centre: 4
• KRR RLP 2

The educational format consisted of 8 guest speakers who provided presentations relating to laboratory management and medicine.  The exhibition itself included 16 Booths with 24 vendors.

Michael Bayer provided a workshop titled “Unraveling the Laboratory Customer Labyrinth: How to Achieve World Class Customer Satisfaction. He also performed as a magician at the after-Dinner Entertainment on the Wednesday evening.

The Financial Report, as follows:

The Program will have to give serious consideration on how it will provide the Symposium in future years. This year saw the merger of 3 medical companies, therefore reducing operating capital.  Cash flow was further compounded with the absence of 5 other vendors for numerous reasons.  These organizations are typically present.  This has amounted to a shortfall of $7,000.

It is important to note we did receive sponsorship for all the presenters.  The shortfall is reflective of paying for meals and accommodations for the delegates.

The delegates, exhibitors and guest speakers were asked to complete an evaluation of the Symposium prior to leaving the Conference. Unfortunately only one delegate and two guest speakers responded so that information is not included in this report.  Five (5) of 24 vendors did respond.

Appendix C

Newsletters

Screening Tests for Possible Liver Disease: 2007-01

Fecal Occult Blood: 2007-02

Legal and Ethical Framework for Blood Product Therapy: 2007-03

Red Cell Transfusions: 2007-04

Rh Immune Globulin (WinRho SDF): 2007-05

Plasma Protein (Fractionation) Products: 2007-06

Guideline for the Collection and Storage of Bacteriology Specimens for Testing: 2007-07

Blood Cultures: 2007-08

Sore Throat – Diagnosis and Management: 2007-09

Antinuclear Antibody (ANA) Testing for Connective Tissue Disease: 2007-10

Guideline for the Use of Laboratory Tests to Detect Thyroid Dysfunction: 2007-11

Antilepileptic Drug Concentration Measurement in Adults: 2007-12

Guidelines for the Collection of Stool Specimens for Culture and Sensitivity: 2007-13

Guideline for the Appropriate Use of FSH, LH and Prolactin in Women: 2007-14

Community–acquired MRSA:  An Overview: 2007-15

An Update on Professional Regulation for Laboratory Assistants / Technicians: 2007-16

Ordering Blood Cultures for Optimal Detection of Bacteremia: 2007-17

Appendix D

Regional Meetings

Onsite Visits

Appendix E

QMP-LS Non-Conformances per Discipline

QMP-LS Non-Conformances per Laboratory

Explanation of Discordant Results