DLM (ASCP) Exam Questions with Complete Solutions

DLM (ASCP) Exam Questions with Complete Solutions Project Volumes (forecasting stage) - Correct Answers: based on expert opinion, stats, historical data, shifts in patient mix, changes in medical staff composition, changes in inflation/reimbursement ratws, expansion/cutbacks, population fluctuations based on economy Steps to creating a budget - Correct Answers: 1. project volumes 2. convert volumes to revenue 3. convert volumes into expense requirements 4. Adjust revenue/ expenses as necessary to meet budget margin gross revenue - Correct Answers: Rates x Production Unit (Billable test volume) Expenses - Correct Answers: salaries/wages, reference service, instrument lease, maintenance contracts, education/travel Financial Statements - Correct Answers: convey the financial status of an organization 4 main types - income statement, balance sheet statement of changes in equity and statement of cash flows. income statement - Correct Answers: summarizes the operations of an organization with a focus on its revenues, expenses, and profitability. contains operational results over a period of time. depreciation - Correct Answers: noncash charge against earnings on income statement that reflect the "wear and tear" on a business' fixed assets (property and equipment). loss of value salvage value - Correct Answers: amount received when final disposition occurs at end of the asset's useful life. annual depreciation - Correct Answers: (initial cost - salvage value)/ useful life Profit - Correct Answers: net income -expense cashflow - Correct Answers: net income + depreciation Total Profit Margin - Correct Answers: Net income divided by total revenues. It measures the amount of total profit per dollar of total revenues. fixed costs - Correct Answers: cost not related to the volume of services delivered (ex. facilities cost, lab admin, instrument leases, maintenance contracts) variable cost - Correct Answers: directly related to the volume of services delivered (ex. supplies, labor costs) Profit Analysis - Correct Answers: technique use to analyze the effects of volume changes on profit. can also be used to analyze effects of volume changes on costs. Total Costs - Correct Answers: fixed costs + variable costs Variable costs = variable cost rate x volume contribution margin - Correct Answers: difference between per unit revenue and per unit variable cost. gives the amount left to cover the fixed costs. after fixed costs are covered what's left contributes to the profit. accounting breakeven - Correct Answers: Volume needed to produce zero profit. Revenues cover all accounting costs. Total Revenue (cost x volume) - Total Variable (variable cost rate x volume) - fixed costs = $0 economic breakeven - Correct Answers: occurs when all accounting costs plus a profit target are covered total revenue - total variable cost- fixed cost = profit Surcharge/Cost Plus - Correct Answers: used for reference/send out testing. Determine cost of doing a procedure then add markup factor to get appropriate price. weight value basis - Correct Answers: each test performed is assigned a weight based on cost of performing the test in relation to the procedure. patient day factor - Correct Answers: the number of patients in a hospital on a given day. (average patient day/ daily census for the year) x 365 tests per patient days - Correct Answers: test volume/ patient days revenue per test - Correct Answers: gross revenue/test volume direct costs - Correct Answers: test-specific costs (Variable) examples - supplies, instrumentation, reagents, tech time indirect cost - Correct Answers: remain constant examples - lab admin, medical records, house keeping, utilities, etc. (fixed/semi-variable) unit costs - Correct Answers: total direct + indirect expenses Employment cycle - Correct Answers: covers all stages in the process of employing staff: 1. recruitment and acquisition costs (pre-employment screen) 2. training/developmental costs (ongoing) 3. productive/operational periods 4. termination/separation of employee from institution costs analyze labor costs - Correct Answers: institutional labor cost evaluation (employment cycle) technical evaluation of labor cost - assign labor costs to production activities that generate expenses. helps manager identify where efforts are being expended and productivity accounting and budgeting labor analysis - helps monitor staffing levels, productivity and management performance against budget objectives preanalytical time - Correct Answers: specimen collection, prep, instrument analytical time - Correct Answers: performing/resulting tests post analytical time - Correct Answers: reporting and routine maintenance total hours - Correct Answers: productive hours + nonproductive hours productive hours - Correct Answers: actual worked hours includes overtime and training nonproductive hours - Correct Answers: compensated but not worked. sick leave, vacation, bereavement, etc. Full-time equivalent (FTE) - Correct Answers: An employee who works full-time, 40 hours per week, 2080 hours per year (total number of hours paid/ 2080) 171 or 177 hours - per month Productivity Measurement - Correct Answers: workload unit (WLU)/ labor units time studies - Correct Answers: time required for handling, testing, recording and reporting, daily and periodic activities, maintenance and repair, and direct technical supervision. paid productivity - Correct Answers: tests/ number paid hours number of tests performed per paid hour. worked productivity - Correct Answers: tests/ number worked hours number of tests performed per worked hour projected salary - Correct Answers: total paid hours x average hourly rate average hourly rate - Correct Answers: salary expense/ paid hours supplies - Correct Answers: meet specific time and price criteria. have shelf life of less than a year. economic ordering quantity (EOQ) - Correct Answers: Optimum amount to order at one time economic ordering point (EOP) - Correct Answers: base/safety level for reordering (annual usage/365 days) x lead time in days optimal reordering time (ROT) - Correct Answers: best time to reorder to take advantage of EOQ and EOP (EOQ/Annual Usage) x 365 days Payback Period - Correct Answers: the amount of time required for an investment to generate cash flows sufficient to recover its initial cost payback period formula - Correct Answers: cost of investment / annual net cash flow Average rate of return (ARR) - Correct Answers: calculates the average annual profit of an investment project, expressed as a percentage of the initial sum of money invested annual depreciation - Correct Answers: (cost - salvage value) / useful life Net Present Value (NPV) - Correct Answers: current value of an investment taking into account impact of interest and inflation on earnings and anticipated revenue received of a period of years. sum of present values of each net cash flow (each year) Initial Rate of Return (IRR) - Correct Answers: the discount rate that makes the NPV of an investment zero. top-down budget - Correct Answers: A process by which executive managers (hospital administration/pathologists) create the budget, and that budget is then pushed down through the rest of the organization. bottom up budget - Correct Answers: A budgeting process that begins at the lowest levels of management and filters up through the organization. comes from managers creating their own budget for their sections Zero-Based Budget - Correct Answers: allocates resources as if each budget was brand new operating budget - Correct Answers: budget for day-to-day expenses is based on historic/current performance and projection of future business. capital budget - Correct Answers: budget for major capital, or investment, expenditures (new equipment, replacement equipment and construction) Return on Investment (ROI) - Correct Answers: aka bottom line (gain - cost)/ cost Net Revenue - Correct Answers: gross revenue - deductions and allowances - budgeted direct and indirect expenses Budget Analysis - Correct Answers: The process of studying financial data to provide information that helps to make budget decisions; assessment of financial performance. tools needed - variance analysis, volume and productivity data cashflow statement - Correct Answers: a monthly or yearly document that breaks down cash from operations, investments and financing. balance sheet - Correct Answers: used at the end of the fiscal year. displays assets and liabilities account receivable - Correct Answers: income that has been earned but for which no cash payment has been received financial accounting - Correct Answers: bottom line. focusing on cash flow and financial position of the organization. recorded on balance sheet. diagnosis related groups (DRGs) - Correct Answers: reimbursement for medicaid and medicare patients by case or illness rather than by fee for service cost accounting - Correct Answers: focuses on the operation of the business semi-variable costs - Correct Answers: based on gradual changes in workload ex - hiring additional FTEs Purchase Order (PO) - Correct Answers: used to order from outside vendors traveling requisition - Correct Answers: catalog of products held in stock by materials management Minimum/Maximum - Correct Answers: establish a minimum (safety reserve) at which inventory is to be recorded and reordered to maximum level which is to be maintained. Just-in-time - Correct Answers: commitment by supplier to guarantee delivery of an item at exact moment of need. helps free up financial resources for other purposes cost of ordering - Correct Answers: expenses of purchasing section/ number of POs issued annual holding cost - Correct Answers: accounts for expenses of maintaining a stock room for storing material not needed immediately lead time - Correct Answers: time interval between ordering and receiving the order. influences minimum inventory that must be kept in stock and quantity that needs to be requested. FIVE phases of six sigma - Correct Answers: 1. define - reach agreement on scope, goals, $$ 2. measure -collect data on process speed, quality and costs 3. analyze - pinpoint and verify causes affecting variables tied to project goals. 4. improve - learn from pilots and execute implementation 5. control - complete project work and hand off improved process with procedures for maintaining the gains micro cost analysis - Correct Answers: performed to assess the cost of doing a specific test procedure (helps determine if test should be done in-house, added, eliminated, sent out) macro cost analysis - Correct Answers: evaluated the overall efficiency and productivity of the lab and/or specific cost centers 1. determine number of patient reportable tests for specific time period. 2 perform cost study --> breaks costs down into fixed and variable 3. total, fixed, and variable costs are divided by patient reportable tests operating leverage (OL) - Correct Answers: Ratio that tells the percent change in total profit that will result from a given change in revenue (revenue - variable costs)/ (revenue - variable costs - fixed costs) greater than 2 represents considerable risk OSHA blood-borne pathogens standard - Correct Answers: Guidelines designed to protect employees against occupational exposure to blood-borne pathogens hepatitis b, hepatitis c, and HIV issues in December 1991 OSHA Hepatitis B Requirement - Correct Answers: Hepatitis B Vaccine required to be offered free of charge if occupation puts you at risk engineering controls - Correct Answers: Devices that isolate or remove a blood borne pathogen hazard from the workplace. examples - sharps containers, handwashing facilities, etc. Exposure incident - Correct Answers: specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties Parenteral exposure - Correct Answers: Exposure to blood or other infectious materials that results from piercing or puncturing the skin barrier examples -needle sticks, cuts, or abrasions electrical grounding - Correct Answers: fastening electrical equipment to earth allows any spikes in electricity to be directed away from the electric circuit and into the ground where it can be absorbed. prevents buildup of voltage. Lock Out Tag Out (LOTO) - Correct Answers: OSHA Requirement to protect workers whenever maintenance/repair tasks are being performed on electrical equipment 1. Protects you from Electricity 2. Isolated - isolates you from the power source to keep it out/off of you and safe lock out - Correct Answers: placement of device on breaker or plug placed in canister to prevent use tag out - Correct Answers: tag placed on device to notify staff not to operate equipment class c fires - Correct Answers: fires that involve electricity. extinguished by CO2 and pressurized dry chemical ABC Extinguisher formaldehyde - Correct Answers: used to preserve tissue removed during surgery and autopsies. it's a disinfectant that kills fungi, bacteria, and other microorganisms. it's a human carcinogen. OSHA Formaldehyde Standard - Correct Answers: Aimed at specifically addressing hazards associated with exposure to formaldehyde, formaldehyde gas, it's solutions and materials that release formaldehyde. goal is to reduce risk of exposure by establishing safe exposure limits Safety Data Sheet (SDS) - Correct Answers: an OSHA-required document that explains the hazards of a chemical product. contains first aid information if there's contact, accidental release measures, handling and storage requirements, exposure control, PPE, product, manufacturer, number to call for emergency info, effective and review date, signature of person preparing the sheet, and other info. Permissible Exposure Limit (PEL) - Correct Answers: Exposure limit published & enforced by OSHA as a legal standard over an 8-hour average 0.75 ppm for formaldehyde exposure Short Term Exposure Limit (STEL) - Correct Answers: 15 - minute Time Weighted Average (TWA) exposure that should no be exceeded during a typical work day. 2.0 ppm for formaldehyde exposure Hazard Communication Standard (HCS) - Correct Answers: an OSHA regulation aimed at promoting awareness of hazardous substances and understanding of safe handling practices must have documented chemical hygiene plan Four Primary Management Functions - Correct Answers: planning, organizing, leading, controlling SWOT analysis - Correct Answers: strengths, weaknesses, opportunities, threats Directing - Correct Answers: process of influencing people to attain predetermined objectives. key elements include communication, delegating, motivating and coaching coaching - Correct Answers: providing a person or a group with the guidance, support, and confidence to enable them to enhance their performance continuously informatics - Correct Answers: practice of information processing centered around pathology tests and patient information. responsible for tools for scheduling, working with IT to improve efficiency, leading lab EMR selection, conducting evaluation of lab transaction databases and storage compliance - Correct Answers: responsible for designing and implementing a basic lab safety program including OSHA, MSDS, radiation safety, lab safety, biohazards, universal precautions, and electrical safety. CLIA Certification, CAP, COLA, and JCAHO accreditation root-cause analysis - Correct Answers: An analytical technique used to determine the basic underlying reason that causes a variance or a defect or a risk. A root cause may underlie more than one variance or defect or risk. Ishikawa diagram or Fishbone Diangram - Correct Answers: A graphical diagram that shows how causes or potential causes relate to create potential problems. performance management cycle - Correct Answers: performance development plan --> review lab strategic plan and annual goals --> set performance standards --> observe and coach (take notes, report and record) --> appraise performance Laboratory information system (LIS) - Correct Answers: An information system that collects , stores, and manages laboratory tests and their respective results. can speed up access to test results through improved effciency from various locations, including anywhere in the hospital, the physician's office, or even the clincian's home LIS Core Elements - Correct Answers: patient data, workflow processes, diagnostic interpretations, billing assistance, capture coding, quality assurance and other systems LIS Application software - Correct Answers: front end = user view back end = admin view Database Management System (DBMS) - Correct Answers: A system for managing data that allows the user to store, retrieve, and analyze information. contains patient information, specimen information, etc. Operating System (OS) - Correct Answers: System software that provides an interface between the user or application program and the computer hardware. Ex - windows, mac,etc. LIS Hardware - Correct Answers: computers, networking equipment ( printers, barcode scanners, etc.) and peripheral components LIS Regulations - Correct Answers: regulated and inspected by CAP, CMS, office of Civil Rights (OCR) for HIPPA, Joint Commission and COLA for CLIA '88 LIS Long term costs - Correct Answers: ongoing development and maintenance, instrument interface costs and implementation time is taken into consideration when selecting LIS LIS Selection Factors - Correct Answers: consider future of lab when selecting (expansion, test variety, etc.) functionality (regulatory compliance is key!) backend technology having support throughout the LIS Vendor Characteristics - record of past performance, does it fit within lab vision support -systems for technical support (response time, escalation, etc.) price - consider full set of costs - license, annual maintenance, hardware, 3rd part software, etc Difficult Employee - Correct Answers: someone who doesn't do what you need at the appropriate time Johnson's Theory - Correct Answers: performance = motivation x understanding x ability x opportunity Maslow's Hierarchy of Needs - Correct Answers: (level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization Herzberg's Two-Factor Theory - Correct Answers: proposed that work satisfaction and dissatisfaction arise from two different factors - work satisfaction from so-called motivating factors and work dissatisfaction from so-called hygiene factors budget - Correct Answers: detailed plan on how resources will be acquired and utilized during a specific time period statistics budget - Correct Answers: focuses on patient volume and need assumptions used in other budgets profit and loss statement - Correct Answers: An itemized financial statement of the income and expenses of a company's operations. Provides budgeted profit contribution margin - fixed costs = budgeted profit variance analysis - Correct Answers: realized values are compared with budgeted values to help control operations. profit variance - Correct Answers: actual profit - static/budgeted profit revenue variance - Correct Answers: actual revenue - static/budgeted revenues cost variance - Correct Answers: static/budgeted costs - actual costs volume variance - Correct Answers: flexible revenues - static budgeted revenues return on investment - Correct Answers: can be $ or % present value - Correct Answers: beginning amount (current value) of an investment of a lump sum, an annuity, or a series of unequal cash flows discounting - Correct Answers: process of finding the present value of a lump sum, an annuity, or a series of unequal cashflows annuity - Correct Answers: series of payments of a fixed amount for a specified number of equal periods compounding - Correct Answers: process of finding the future value (FV) McClelland's Achievement Motivation Theory - Correct Answers: need for achievement, need for power, need for affiliation reflection of job satisfaction - Correct Answers: turnover, absenteeism, attitude, and functional performance level. successful managers - Correct Answers: balance between concern for people and concern for production. good leadership - Correct Answers: delegate, sound job descriptions, and work assignments, fill motivational needs of workers, provide job enrichment resources job enlargement - Correct Answers: offers people opportunity to expand their knowledge and grow professional ( addition of tasks) job enrichment - Correct Answers: increased control, responsibility, and accountability in workstation job description - Correct Answers: job analysis, job design and work assignment. the communication between staff and organization on how work should be done. factors considered in job analysis - Correct Answers: working conditions (physical environment, manual labor exertion), technology (technical skills), job specifications (qualifications, skills, special knowledge and experience), availability of labor, personal interaction, legal aspects (personnel/facility licensure requirements), workflow (TAT, test requests, volume, stats) work itself, work process (steps and timing of tasks that must take place) industrial engineering - Correct Answers: focuses on the mechanical aspects of work. looks for ways to eliminate unnecessary motions Purpose of job design - Correct Answers: help with staffing, setting number and type of staff is part of the operational budget and dependent of volume of work being done. job specification - Correct Answers: a description of the qualifications necessary for a specific job, in terms of education, experience (skills and training), regulatory qualifications (licensure, union, etc.) and personal and physical characteristics scheduling - Correct Answers: focuses on matching people on a day to day basis with fluctuating workload. balance needs of both department and staff (vacation, holidays, illness) performance appraisal - Correct Answers: formal communication system used to assess and provide feedback to staff about job performance expectations Equal Employment Opportunity Commission (EEOC) - Correct Answers: Agency of the Department of Justice charged with enforcing Title VII of the Civil Rights Act of 1964 and other anti-discrimination laws. States that discrimination must be avoided against protected class of individuals. Value Stream Mapping (VSM) - Correct Answers: a qualitative lean tool for eliminating waste or muda use a flow chart to document every step in the process - implement process improvement. helps maximize available resources. value stream - Correct Answers: how value can be added to a product/service by changing form/function muda - Correct Answers: Japanese term for waste kaizen event - Correct Answers: short term approach to enhancing efficiency that focuses on improving an existing process or an activity within a process Pareto Chart - Correct Answers: a bar graph whose bars are drawn in decreasing order of frequency or relative frequency. analyze frequency/causes of problems in a process. most common measures -frequency, quantity, cost and time Histogram - Correct Answers: A graph of vertical bars representing the frequency distribution of a set of data. bell shaped curve = normal distribution Westgard QC - Correct Answers: helps in judgement of whether or not to report patient results. Need two different QCs according to CLIA regulations. laboratory design - Correct Answers: takes into account space allocation, ergonomic planning, placement of utilities, traffic flow of personnel, equipment and patients, storage area, safety/equipment and design, staff facilities Lean Management - Correct Answers: An approach that improves the efficiency and effectiveness of operations by eliminating waste in time, motion, effort/energy, space and costs while improving quality Ex: doing unnecessary testing (repeats), waiting, unnecessary movement) functional narrative document - Correct Answers: describes the purpose, functions, relationships and activities of the area under consideration. prepared by project design team for engineers to come up with formal plans and agreements. helps avoid mistakes and costly corrections Four P's of Marketing - Correct Answers: Product, Price, Place, Promotion halo effect - Correct Answers: particular aspects of candidates qualifications overshadows (favorably/unfavorably) over other factors regency effect - Correct Answers: applicants interviewed during end of selection process are given inappropriate stronger consideration because fresh in memory wage and salary administration goals - Correct Answers: recruit qualified staff, maintain stable workforce, incentive plans to maximize productivity, reward desired behavior, control labor costs, comply with legal regulations federal workers compensation act of 1911 - Correct Answers: requires employers to contribute an additional percentage of wages to a fund that paid employees if injured on a job corrective action and employee discipline - Correct Answers: investigate cause of problem, offer assistance and guidance when appropriate, seek advice from senior managers and hr, documentation and follow up on repetitive incidents, deal with falsification/illegal activities immediately. Vroom's Expectancy Theory - Correct Answers: argues that work motivation is determined by individual beliefs regarding effort-performance relationships and work outcomes Adam's Equity Theory - Correct Answers: Workers compare the reward potential to the effort they must expend. Workers also consider rewards of others. Equity exists when workers perceive that the reward equals the efforts. (motivation theory that focuses on behavior) Theory calls for a fair balance to be struck between an employee's inputs (hard work, skill level, tolerance, enthusiasm, and so on) and an employee's outputs (salary, benefits, intangibles such as recognition,and so on). Skinner's Reinforcement Theory - Correct Answers: Theory that proposes that through the consequences of their behavior, employees will be motivated to behave in predetermined ways. scheduling - Correct Answers: names of persons who will work at specific times. match people working lab with current workload requirements. four approaches to measuring performance - Correct Answers: 1. result oriented approach (quality assessment and improvement) 2. behavior oriented (tools rate worker against) 3. skill oriented (measure traits and skills of worker) 4. peer comparison force choice method - Correct Answers: group of predertermined descriptions select statements that best match employee. scored by third party critical incident method - Correct Answers: method of performance measurement based on managers' records of specific examples of the employee acting in ways that are either effective or ineffective Behaviorly Anchored Rating Scales (BARS) - Correct Answers: numeric rating scale (1-7) with behavioral category critical to the success of the job mixed standard scale - Correct Answers: method of performance measurement that uses several statements describing each trait to produce a final score for that trait peer comparison - Correct Answers: used to identify candidates for promotion, staff reduction and merit pay or recognition programs performance judgement issues - Correct Answers: rater biases, avoid favoritism, errors of leniency, halo effect, regency phenomenon. Quality Control (QC) - Correct Answers: quantitative statistical methods that focus on the final product, defined by standards set by the producer. controls are processed periodically to make sure that the procedure is within control limits Quality Assurance (QA) - Correct Answers: defined by the success of total organization not just individual components of system in achieving patient care. focuses on monitoring of outcomes and indicators of care. QA Monitoring Process - Correct Answers: assign responsibility for QA plan define scope of patient care identify important aspects of care construct indicators define threshold for evaluation collect and organize data evaluate data develop corrective action plan assess action document improvement communicate relevant info Total Quality Management (TQM) and continuous quality improvement (CQI) - Correct Answers: emphasis on satisfying the needs of the customer. focuses on identifying and troubleshooting problems that might occur at each stage of production quality assessment and improvement (QA & I) - Correct Answers: introduced by JCAHO. incorporates QA and TQM/CQI. quality is continuous process of improving the system. accuracy - Correct Answers: closeness of a result to the actual value of an analytic when performing a test. "hitting bulls eye" precision - Correct Answers: how well a procedure reproduces a value population - Correct Answers: items that are being studied at a particular time sample - Correct Answers: a part of a population that is used to analyze the characteristics of that population (size of 30 is satisfactory). select at random to avoid bias Gaussian distribution - Correct Answers: Normal or bell-shaped distribution of values symmetrically clustered around the mean +/- 1 SD - Correct Answers: 68% of data lie within this range +/- 2 SD - Correct Answers: 95% of data lie within this range +/- 3 SD - Correct Answers: 99.7% of data probability - Correct Answers: expressed as a decimal according to the likelihood of an event occurring nearer to O the less likely it is to occur. can be converted to a percentage mean - Correct Answers: the arithmetic average of a distribution, obtained by adding the scores and then dividing by the number of scores median - Correct Answers: the middle score in a distribution; half the scores are above it and half are below it Standard Deviation (SD) - Correct Answers: measurement of precision or tendency of values in population to cluster, center, or scater around the mean. the difference (variance) of each value from the mean is used to establish the acceptable range for each control level. A range of 2SD is considered the minimal limit for an individual control value to be acceptable (95% of all values should be in this range) Basic statistical graphs - Correct Answers: circle, bar, and line graphs used to illustrate comparative size of different components or factors skewed curves - Correct Answers: data doesn't accurately reflect parameters of population SBAR - Correct Answers: Situation - what is happening at the present time? Background - what are the circumstances leading up to this? Assessment - what do you think the problem is? Recommendation - what should we do to correct the problem? Trends - Correct Answers: systematic drift in one direction away from established mean nonpunitive policy - Correct Answers: focuses on improvement, elimination/prevention of errors/ rather than putting blame and punishment. FMEA - Correct Answers: Failure Mode and Effects Analysis variation is present in all processes. 2 Sources of variation - common cause and special cause. improvement strategies are determined by sources of variation. The less variation the more predictable the result. doesn't focus on who made the error, but making sure system is error free malpractice - Correct Answers: incorrect performances or improper conduct on the part of a purveyor either through negligence or by violating ethical and professional standards tort - Correct Answers: willful and harmful act involving a contract. can result in civil lawsuit CLIA '88 - Correct Answers: Clinical Laboratory Improvement Act of 1988 Regulates and classifies labs based on complexity of testing. waived tests (low complexity), moderate complexity, high complexity, provier performed microscopy procedures each level has requirements- level of PT, QM Monitoring and designated personnel standards handling flammable substances - Correct Answers: (CAP Requirement) only max of 10 gallons of flammable liquids can be used/stored in open outside safety room. 60 gallons stored in safety room. storage of flammable glass cylinders training of personnel walking with flammable chemicals firefighting equipment - Correct Answers: automatic sprinklers, building materials, self closing doors, fire hydrants, fire extinguisher, fire blankets account rate of return (ARR) - Correct Answers: Uses accounting information to measure profitability of an investment. The average yield that will be earned over the life of an investment. (average net profit/ purchase price of project) x 100 Marketing - Correct Answers: strategic process of attracting and maintaining a customer base marketing proposal for lab services - Correct Answers: 1. Purpose of proposal 2. market overview SWAT analysis (strength, weaknesses, analysis, and tactics) 3. opportunities with recommendation and implementation suggestions 4. approval request for implementation of plan Marketing Model - Correct Answers: evaluate lab service area, determine test demand, develop appropriate test mix, develop market through concentrated efforts. systemic evaluation of all tests and services 4 stages of workflow and lab design - Correct Answers: 1. organizations - management, planning process 2. budget 3. graphic display 4. written narrative description Six Sigma - Correct Answers: QM practices focused on reducing costs and increasing profit by systematically improving production process by eliminating defects (developed by motorola) standard - Correct Answers: used to determine where to place manual tests vs. automated. total productive hours/ WLU (workload units) The Capital Cycle - Correct Answers: Strategic Planning - annual update process Financial Planning - create capital capacity Capital Structure - manage the capital structure that ensures access to required debt and equity capital Capital Allocation - access investible dollars Implement selective strategic options Fire Prevention Plan - Correct Answers: keep flammable substances in separate rooms/cabinets use explosion proof fridges and hoods fire resistant building products perform procedures that result in highly combustible reactions underwater vacuum chambers health hazards - Correct Answers: toxins, carcinogens, irritant, tissue corrosive, sensitizer agents, that act on or damage the body Operational Safety and Health Administration (OSHA) - Correct Answers: A federal agency charged with protecting worker health and well being in the work place. Provides guidance and regulations concerning chemical and infectious materials fire extinguisher class a - Correct Answers: most common fire started by ignition of material like paper and wood. extinguished by water fire extinguisher class B - Correct Answers: fires consist of liquids like alcohol, gases and solvents. extinguisher contains dry chemicals or carbon dioxide fire extinguisher class D - Correct Answers: fire involves combustible chemicals/metals like Mg, Na, and Titanium. Need specialized extinguisher or sand. Labeling of hazardous chemicals and reagents - Correct Answers: color coded triangle, rectangle or combo label with danger rating. color code: red = fire hazard, blue = health hazard, yellow = instability hazard danger rating: 0 = none, 1 = minor, 2 = moderate, 3 = service, 4 = extreme Threshold Limit Value (TLV) - Correct Answers: designed by ACGHI 3 points to monitor for safe work environment 1. TWA 2. STEL 3. C Time Weighted Average (TWA) - Correct Answers: level of exposure a worker may experience in an 8 hour day, 40 hour work week Physical Hazards - Correct Answers: compressed gas, explosives, flammables, organic peroxide. oxidizer, reactive/unstable water reactive Ceiling (C) - Correct Answers: concentration which is the level above which no exposure is permitted at any time Safety Management Program - Correct Answers: overseen by safety committee and safety officer 1. manual with policies/procedures covering physical, chemical, fire, natural disasters, bloodborne pathogens. OPIM Dangers, chemical exposure control plans 2. communications - access to info, training equipment resources and support 3. disaster plan - special contingency and back up plans 4. safety audits and inspections 5. accident investigation and prevention Short Term Exposure Limit (STEL) - Correct Answers: max concentration level a person may be exposed to for a short period of time Lab Director - Correct Answers: CLIA '88 requires that they be board certified in Clinical pathology and Anatomical pathology. They sign off on personnel records annually and competencies or they can designate someone else to sign off. This person holds the CAP License for the laboratory. Technical Supervisor - Correct Answers: select test methodology; verify test procedures for precision and accuracy; oversee PT, QC, and QA programs; oversee resolution of technical issues. Can review high complexity testing. Must be a MD or DO OR have a bachelors with 4 years experience General Supervisor - Correct Answers: Can review moderate complexity testing. Need a bachelor's with 1 year experience Ergonomics - Correct Answers: a disicpline that involves arranging the environment to fit the person in it. when applied correctly in the work environment, visual and musculoskeletal discomfort and fatigue are reduced significantly (looking at screens, noise, repetitive motion, lifting heavy objects, slips/trips and falls. validation - Correct Answers: takes place on new test procedures before testing patient samples. need at least 2 controls (negative and positive) and the results must be within 2 SD. utilization management program - Correct Answers: critical to ensure the patient that we adhere to the central concept of precision medicine and perform the right test for the right patient at the right time. the balance of care and cost. look at tests that can be ordered outside scope of clinical context or ordered overzealously. Gatekeeper Method - Correct Answers: alerted when there's an unusual request for a test. discuss with provider to make sure test was ordered appropriately. only works for requests that come through the lab. Diagnostic Algorithims - Correct Answers: stakeholder determines which tests are appropriate for specific patient presentations staffing - Correct Answers: determining personnel and job needs, recruiting qualified staff, matching them with the appropriate job and training them to perform the work as assigned. Establishes how many and what types of personnel are needed. Determined by volume and workload, test mix, methodology, etc. workload projections - Correct Answers: come from historical records (productivity and financial data), analysis of future trends (based on past and current volumes, analysis of foreseeable changes (new tests, removing tests, new instruments) workflow analysis - Correct Answers: 1. what test should be done (discontinue out of date procedures) 2. where should test be performed 3. when should test be performed (use of reference labs to help in times of staffing shortages, batch low volume test, shift workload to shifts to shifts that may have slack time) Bottleneck Management - Correct Answers: work must pass through a narrow point before reaching internal production machinery OR a task that ties up the system (ex: Diff with abnormal cells, telephone calls, reporting critical values) Structural Requirements - Correct Answers: having a ventilation backup plan, location/ease of use and availability of safety equipment (fume hoods, first aid stations), structural safety involve building materials, storm damage control, fire prevention and firefighting systems class A flammables - Correct Answers: ether/isopentane class B flammables - Correct Answers: acetone, ethanol, methanol fire fighting strategies - Correct Answers: construction (structure and materials used), fire fighting equipment (automatic sprinklers, self closing doors and fire hydrants. fire extinguishers, fire blankets and sand), training and Practice electrical safety - Correct Answers: no extension cords, check equipment for compliance with electrical safety standards, electrical safety checks chemical safety - Correct Answers: training sessions required annually for hazardous chemicals. MSDS made readily available 1-2s rule - Correct Answers: run is accepted when both control results are within 2 SD limits from the mean value 1-3s rule - Correct Answers: the run is considered out of control when one of the control results exceed the +/- 3 SD limits 2-2s rule - Correct Answers: The run is rejected when both controls exceed the mean value +2SD or the mean -2SD limits R4s rule - Correct Answers: the run is rejected when both controls exceed a mean value of +2SD limit and one exceeds the mean -2SD limit or when the range of group of controls exceed 4SD 4-1s rule - Correct Answers: The run is rejected when the last 10 consecutive control results fall on the same side of the mean coefficient of variance (CV) - Correct Answers: allows for a comparison and check on precision and variability. Expressed as a percent. (SD/mean) x 100 Levy-Jennings chart - Correct Answers: a graph used to plot and visualize the results of control samples over time. helps determine if a procedure is in or out of control. Looks like a gaussian distribution curve. random errors - Correct Answers: indicative of imprecision systematic errors - Correct Answers: consistent, problems of inaccuracy External quality assessment programs - Correct Answers: proficiency surveys, lab inspections Parts of Quality Management Programs - Correct Answers: Preventive Maintenance (PM), policy/procedure manual writing and review, QC functions, staff orientation, CE and development, Participation in PT, problem solving and troubleshooting, lab inspection, accreditation and licensure process adverse event - Correct Answers: injury resulting from a medical intervention; it is not due to the underlying condition of the patient Sentinel Event - Correct Answers: an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof Characteristics of an acceptable RCA - Correct Answers: proximate factors, analysis of systems and processes, identify underlying systemic factors, potential improvements, action plan, measurement strategy, participation by leaders and those closest to the process, internally consistent. Lab Design - Correct Answers: takes into account space allocation (ensure sufficient room), ergonomic planning, placement of utilities, traffic flow of personnel, equipment and patients, sufficient and convenient storage areas, safety equipment and design, staff facilities Waived Catagories - Correct Answers: dipstick UA, occult blood, non-automated sed rates, pregnancy test kits, blood glucose analyzers criteria used to differentiate tests that may be performed at moderate complexity or high complexity labs - Correct Answers: 1. level of knowledge needed 2. level of training and experience 3. complexity of reagent and material prep 4. operational steps required in procedure 5. characteristics and availability of calibration, QC and PT materials 6. extent of troubleshooting and maintenance required 7. degree of interpretation and judgement necessary in testing process qualifiers of moderate complexity - Correct Answers: automated procedures, manual procedures with limited steps or reagent preparation Patient test management - Correct Answers: provide regulation in processing and receiving requisitions, specimen integrity in submissions, handling and referring, and issuance and maintenance of results and records requirements of moderate/high complexity to be performed - Correct Answers: certificate of waiver/registration, QC (2 levels of controls each day of use), QA (monitor overall quality of testing process), patient test management, inspection and personnel (education/experience based on title) Joint Commission (JCAHO) - Correct Answers: inspects lab as part of its overall review of medical facilities. Essential to professional reputation of facility. Vital for reimbursement and regulatory compliance (medicare and medicaid recognize JCAHO as equivalent in meeting their criteria) Planning - Correct Answers: determine the goals, collect info and evaluate the current situation, compare where organization wishes to be, establish a time period to achieve goals, set objectives, forecast needs and the use of resources and determine steps necessary to implement the plan, provide for a feedback mechanism to continually review the success of the plan and to implement necessary revisions. characteristics of a good objective - Correct Answers: clearly defined and understood, obtainable and realistic, strict time period in which its to be accomplished, its measurable feedback mechanisms - Correct Answers: monitored standards of performance, informal meeting and conversation with staff/customers, analysis of problems (through QM program), formal meetings with managers and staff