Like many hospital laboratories, the Good Shepherd Medical Center core lab used to struggle with poor and inconsistent productivity, an ongoing labor shortage, a growing workload and a continual demand for reduced costs and faster turnaround time. Yet after revolutionizing its operations with a three-phase process, the lab discovered a whole new level of efficiency.
Good Shepherd Medical Center is a 412-bed, not-for-profit community hospital that serves the residents of Longview and Northeast Texas (USA). When Diane Honey joined the team as Laboratory Director in late-1999, the laboratory had expiring chemistry and immunochemistry contracts and was searching for ways to consolidate workstations and lower costs.
Outdated equipment, however, was just one of this lab’s challenges.
It was also facing an industry-wide labor shortage, high reagent costs, low staff morale and increasing demands for faster turnaround time.
In order to address these needs, the lab decided to form a “chematology” department, which would blend chemistry, immunoassay and hematology into a single section, run by cross-trained staff members performing both automated and manual processes.
The lab also wanted to start autovalidating test results—a move that would greatly improve the lab’s accuracy, turnaround time, productivity and time savings. After thorough vendor discussions, site visits and reference checks, the laboratory finally decided on Beckman Coulter. “In the end, Beckman Coulter was the one vendor I knew I could live with for a number years—and the one I trusted to live up to its end of the bargain,” explained Honey. “Beckman Coulter was the easiest to deal with—that’s why we chose their systems.”
Phase One: A Consolidated Platform With Autovalidation
With a new partner on board, the laboratory launched into phase one of its solution in 2001—installing new instrumentation that included two SYNCHRON LX®20 chemistry systems, two Access® immunoassay systems, a Gen•S™ hematology system (with a MAXM for backup) and a DL2000 data manager.
As each system went live, the laboratory began autovalidating its test results. Since technologists now only had to review 30-40 percent of test results—with the DL 2000 autovalidating the rest—the lab started to witness immediate improvements in turnaround time, while also increasing test volume by 37%, reducing outliers and avoiding the need to hire more FTEs.
“Even though our staff was resistant at first, within about a week of autovalidating results, they realized how wonderful the technology was,” said Honey. “We started to see better turnaround time and there was less stress in the workplace because technologists were reviewing far fewer specimens and could concentrate on only those specimens that needed their attention and expertise.”
The financial benefits were equally impressive. “From the very beginning, our lab realized an immediate cost savings of about $66,000 a year over what we had been paying three separate vendors for chemistry, immunochemistry and hematology instruments,” said Honey. “Right off the bat, our consolidation efforts were paying off.”
Phase Two: Adding Front-End Automation
In March 2003, the lab underwent another huge transformation when it brought in front-end automation.“I had gone to a Beckman Coulter symposium where I heard from the Lab Director from Baptist Hospital in Knoxville, Tennessee,” said Honey. “The lab was very much like ours and he was getting phenomenal results from front-end automation. Once I visited his lab and I saw exactly what automation had done for their laboratory, I was sold.”
Within months, the lab had replaced its central processing area with a new Power Processor for front-end automation—and the results were phenomenal. “We used to have lots of variability in our turnaround times because so much of our testing was done manually,” said Honey. “Soon after installing the Power Processor, however, we had reduced our TAT, decreased our variability and watched our STATs become indistinguishable from our routine tests—they were all equally fast. We even started getting compliments from our ER staff.”
Before front-end automation, for example, the lab’s average troponin results were reported in about 65-75 minutes; after the Power Processor, those results were down to about 40 minutes. Likewise, the average STAT results for Potassium that used to take the lab 45–95 minutes now dropped to 25-35 minutes after implementation—just like all the routine tests.
Plus, front-end automation helped the lab accommodate an increase in workload—from 1,200 to 1,800 tests per day—and contributed to a reduction of two FTEs by natural attrition. “Furthermore, the staff was much happier with the new processes, and recruiting new staff members became easier because our whole operation was much smoother and safer than other labs,” she said.
Phase Three: Pulling It All Together With Total Automation
In 2006, the laboratory added the final piece to its laboratory redesign plan—by connecting the Power Processor front-end automation system to each of the testing analyzers, thereby creating a total laboratory automation solution. “As soon as our original contract was up, we knew it was time to complete the picture—and maximize our productivity to the fullest—with total automation,” said Honey. “We rewrote our contracts to include the latest-model instruments and added in-line connections to the analyzers.”
Within the first month of implementation, the laboratory accommodated another workload increase—from 1,800 to 2,300 tests per day. Plus, turnaround times dropped once again, with Potassium results (STATs and routines) consistently down to 25 minutes (a 74 percent reduction overall), and troponin results down from 40 minutes to 25 minutes (a 66 percent reduction overall).
The post-analytical automation offered additional benefits.“In the past, when a doctor would call in for an add-on test, we could spend about 30 minutes searching for the right specimen,” explained Honey. “Now the computer automatically finds the tube, reloads it onto the track, reports the new results and returns the specimen to storage. Our staff is unbelievably happy and staff morale is at an all-time high.”
Next Steps
Very soon, Honey plans to use her new solutions for growth. “Through new outreach testing efforts, I know I can double our volume without adding any new staff—or affecting our inpatient service,” said Honey. “This new outreach testing will cause our revenue to go way up and our cost-per-test to go way down.
“Through this whole process, I learned that you don’t have to be a huge reference lab to have automation,” she added. “I’m convinced that many labs that are smaller than ours can do it and realize just as many cost- and labor-saving results.” |
