CEO SUMMARY: Many hospital labs are evaluating laboratory automation options. The fastest-growing problem which needs an answer is the shortage of trained medical technologists and technicians. At William Beaumont Hospital’s new laboratory, selective workstation and modular automation solutions were chosen as part of a master plan to reduce overall lab testing costs and minimize labor needs.
IN THE DETROIT SUBURB of Royal Oak, William Beaumont Hospital (WBH) opened a brand-new laboratory just two months ago.
This new laboratory’s design and operation is typical of how many of the nation’s hospital labs are responding to the inexorable pressures for continuously cutting lab costs even while coping with an inadequate supply of trained medical technologists.
“There was one primary goal which never changed in the six years of planning that led to this new laboratory,”? stated Frederick (Fritz) Kiechle, M.D., PhD., Chairman of the Department of Clinical Pathology at WBH. “That goal was to design a laboratory which would allow us to steadily reduce the average cost per test year-after-year.
“The result of our planning process was the construction of a new five-story building of about 50,000 square feet. It is next to the hospital and houses the clinical laboratory on the bottom three floors and research labs on the top two floors. Our lab is connected to the hospital by a pneumatic tube system,”? explained Dr. Kiechle.
“We currently handle about six million tests per year in the lab,” he added. “Half of this volume comes from hospital inpatients and outpatients. Our outreach lab, called Beaumont Reference Laboratory, generates the other half from its physicians’ office clients.”
Of particular interest is how the new laboratory incorporates automation solutions. “For us, the most cost-effective decision was to pursue modular automation,” observed Dr. Kiechle. “During the planning process, I made plenty of trips to visit automated clinical laboratories, including two trips to Japan. For many reasons, total laboratory automation (TLA) was not a good fit for our needs.
“Our approach was to combine workstations and use modular automation,” he continued. “We configured our new lab to have three modular testing lines— coagulation, hematology, and chemistry.
“Our primary vendors are Roche and Sysmex. For specimen tubes already labeled within the hospital, we use Roche’s PSD workstation for specimen sorting and the pre-analytical unit,” noted Dr. Kiechle. “Our pre-analytical unit has two centrifuges, an aliquotter, and cappers/decappers. It runs in a U-shape and connects directly to our chemistry instruments. Other specimens are racked and hand-carried to the appropriate testing station.
“For specimens which need to go through the full accessioning process, we use the Labotix track and specimen sorter. A track connects 26 workstations to the unit and we can do registration, if needed, as well as the typical accessioning steps,” he said.
According to Dr. Kiechle, the start-up of the new lab went without major incident. “We attribute that to diligent planning, lots of meetings before the new lab went live, and quick response to any problems or issues,”? he observed. “Certainly there were glitches and headaches. For example, we learned some of the new equipment was having trouble reading the existing bar code labels. The solution required replacing bar code label printers throughout the hospital while the vendor tweaked the bar code readers.
“We moved into the new facility by lab division, usually over a single weekend,” added Dr. Kiechle. “That method worked well and allowed us to give full attention to each division’s move.”
Because the new lab is still undergoing fine-tuning, it’s still early to evaluate the amount of savings it’s generating. “We’ve projected savings in two ways,” noted Dr. Kiechle. “First, our primary goal is for this new configuration to drive down our average cost per test by 20% to 25% once we’ve ‘dialed in’ our workflow. Early indications are that we’ve already achieved a 10% reduction. “Second, our new laboratory building and equipment configuration is expected to contribute to further cost reductions over time. The new lab arrangement was designed to be a foundation that sup- ports our efforts at ongoing work process redesign,” he explained.
Med Tech Shortage
The shortage of trained medical technologists is ever-present in the design and operation of this new laboratory. “I can say this absolutely. At this time, we find it impossible to hire all the med techs we need. The new work flow and instrument systems in this new laboratory are what allow us to turn out the existing volume of work.
“It’s also important to understand that our test volume continues to grow each year,” he added. “That’s because our laboratory outreach program is steadily generating new client accounts. We are using automated solutions as one way to compensate for the shortage of med techs and still accommodate ever-growing volumes of specimens.
“In fact, from a management perspective, one of the intriguing aspects of operating this new lab configuration is determining how it should be properly staffed,”? mused Dr. Kiechle. “We are constantly learning ways to streamline workflows and eliminate unnecessary steps. Our team is learning that creativity and innovation directly translate into higher quality and lower costs.”
Full Internet Capability
Prior to settling on the final design of the new lab, Dr. Kiechle and his team evaluated a range of equipment options and lab configurations. “Over 60 different scenarios were modeled. For capital invested in the new lab facility, we decided to base our economic rate-of-return strictly upon the specimen volume which we could control,” he said. “That means our inpatient and outpatient work, which amounts to about 3 million tests per year. We wanted to be conservative, so we did not rely on anticipated future volume increases that would result from outreach testing or other external sources.”
Diagnostic Vendor Talks
In designing its new laboratory facility, William Beaumont Hospital needed solutions for the same market pressures confronting most hospital labs, namely; how to sustain effective cost-cutting over a multi-year period and how to work around the absolute shortage of trained medical technologists and technicians.
The selective use of automation in specific testing areas, combined with a more sophisticated approach to both the pre-analytical and post-analytical stages, was a deliberate management decision. The goal was to create an operational platform that would support further process improvement and cost reduction initiatives in coming years.
This is also significant. The expectation of hospital administration is that the lab’s management team will continuously drive down costs in future years by using the same management methods and tools commonly found outside healthcare. It shows how the responsibilities of lab administrators are evolving to include work flow redesign and resource allocation.
Kiechle Offers 3 Tips For Laboratory Design
DESIGNING A NEW LABORATORY often ends up as a trial and error process, since many hospital lab administrators may only do it once during a career.
When asked to pass along some useful lessons, Beaumont Hospital’s Chief of the Department of Clinical Pathology, Dr. Fritz Kiechle, offered these three tips:
1. Reduce workstations as much as possible before the final implementation. “Every workstation is a drop-off site that must be identified by the aliquotter and specimen sorter,”? said Dr. Kiechle. “By reducing the number of workstations in your lab, you will greatly simplify the requirements for automating your lab. You will also reduce the overall cost of the required infrastructure and equipment.”?
2. Develop auto-verification as much as possible, as early as possible . “The high throughputs of automated workstations generate lab test results at an equally fast pace,”? he stated. “Auto-verifying these results is cost-effective and requires less labor.”?
3. Don’t organize as a “core”? lab. “We’ve maintained our testing sections because we wanted to benefit from that expertise,”? explained Dr. Kiechle. “However, we placed the instrument systems in a tight configuration so that our people could sup- port each other more easily throughout the working day.”?