CEO SUMMARY: A merger of three hospitals in Harrisburg, Pennsylvania, forced PinnacleHealth’s lab director to find new ways to increase efficiency. A lab automation project helped improve turnaround time and staff productivity and cut costs. The cost savings is about 50 cents per test, which means the lab automation project is saving more than $1 million in annual operating costs. The key to getting the project approved was the savings on cost per test and having a proposal that matched the hospital’s strategic plan.
LABORATORIES CONTINUE TO LEARN new lessons in how to use automation. That’s certainly the case at Pinnacle-Health, in Harrisburg, Pennsylvania, where a carefully-planned integration of new instruments and lab automation triggered impressive gains in quality, productivity, and cost savings.
“Automating as many processes as possible is one key for laboratories seeking to survive well into the future,” advised Judith Darr, Administrative Director of Laboratory Services at PinnacleHealth. Her laboratory decided on a strategy of “best of breed” in looking for analyzers, instrument systems, and automation solutions.
Since automating hematology and chemistry in PinnacleHealth’s new core laboratory in 2005, Darr’s lab has delivered improved turnaround time (TAT), staff productivity, and cut 50¢ from the cost of every lab test. For a lab doing five million tests (including 2.5 million billable tests) per year, that 50¢ per test is generating more than $1 million in savings each year.
These numbers validate the return on investment (ROI) projected by Darr back in 2003 when she proposed the automation project to PinnacleHealth’s board of directors. The health system invested $11 million in construction costs for a new, off-site lab facility, along with $2 million in new instruments and automation.
“This presentation centered on three main points,” noted Darr. “One, lab automation had to deliver performance consistent with the health system’s service goals. Two, it had to meet ROI targets. Three, it had to demonstrate that automation would help our lab cope with the tight supply of medical technologists (MTs). Like most labs, demographics mean that we have an aging med tech staff that is steadily approaching retirement. Our view was that lab automation is an absolute necessity as a strategy to supplement a tight labor supply.
Final Consolidation Step
“We had two major business problems to solve with this project. One was the pressing need to develop a way to operate the laboratory even as the supply of trained staff continues to tighten. Another was to
resolve the outdated and inefficient lab operation that resulted from the merger of PinnacleHealth in Harrisburg with Capital Health System in 1996, followed by the 1998 merger with the Community General Hospital, also in Harrisburg. Although it was inefficient to run three separate laboratories, we did so for about six or seven years.
“Today, we have three hospitals with 670 beds, multiple primary care clinics, and five lab draw sites in the community,” she explained. “ The lab outreach program represents about 30% our volume. We now operate two laboratories with 197 FTES, seven full-time pathologists and one part-time pathologist.
“The merger of the three hospitals in the late 1990s left us with different instrument systems across the three lab sites and much of this equipment was aging,” Darr continued. “We needed to consolidate two city hospital labs and that consolidation would be the final component of the merger of the hospitals. The consolidation was necessary to eliminate facility obsolescence and inefficiency, improve low staff morale, and allow us to accommodate automation on a grand scale.
“In these labs, we had the wrong services at the wrong sites,” she noted. “We needed more room and better equipment. Planning for the lab division makeover commenced in 2001. After much consideration, we opted to centralize laboratory services in 30,000 square feet in a new building connected to the main Harrisburg Hospital. It was the last piece of PinnacleHealth real estate in downtown Harrisburg and there was a lot of infrastructure under that land. So, that was an extensive project.”
Having obtained board approval, Darr’s team moved forward with decisions on laboratory layout, new diagnostic analyzers, and laboratory automation solutions. The team decided to pursue “best of breed” in its selection of analyzers and instrument systems.
Seeking the Best Equipment
“Of course, high volumes make chemistry and hematology the most obvious candidates for automation,” recalled Darr. “Following plenty of research and trips to vendors and other laboratories, we made our decision. We decided the combination that would best meet our needs was Beckman Coulter’s chemistry and total lab automation system, Sysmex for hematology, and CellaVision for automated digital differentials.
“Many lab directors believe that, if you automate chemistry and urinalysis, you need to put hematology on the same system,” observed Darr. “But we came to different conclusion. Because hematology is so different and its sample tubes are quite different from chemistry tubes, we didn’t see the necessity of putting hematology on the same automated system as chemistry, particularly when we evaluated the needs of our lab against the analyzer choices in the marketplace.
“For automation, our needs were clear,” she added. “We wanted an automated system that could handle all specimens automatically from preparation to delivery to the instruments without any intervention by med techs.
Dramatic Gains In New Lab
“Planning, approvals, and implementation required two years and the new laboratory went live on December 6, 2005,” said Darr. “Since then, the results of our automation project have been dramatic. Median turnaround time (TAT) for emergency department (ED) specimens declined by 17 minutes while we accommodated an 11% increase in test volume. Via attrition, we reduced staff by 12 FTEs.
“PinnacleHealth has its own method for measuring staff productivity,” she noted. “Prior to the new lab project, we were already very productive by this measure, rated at 100% to 107%. Once the automated laboratory came into operation, staff productivity increased to 121%.
“Another important benefit was the increase in staff safety, since automation of these processes means staff no longer touches samples,” added Darr. “One of the most hazardous tasks in a lab is when a tech pops the top off a sample tube, creating an aerosol that could contain pathogens. Decapping is now handled by the automated system, along with centrifuging, aliquotting and delivery of tubes to the analyzers hooked onto the automated line.
Automated Storage Solution
“Once the tests are run, the automated system delivers the specimens to an easily accessible storage unit,” Darr explained. “This automation set up saved one FTE. We no longer manually search for specimens when additional tests need to be run from a specimen. Now, many of the specimens for add-on tests can by retrieved from storage by the automated system and delivered to the analyzers without manual intervention by our med techs.
“There’s another major benefit in addition to improvements in TAT, productivity, and safety,” she explained. “We have a goal of consistency in our performance on behalf of patients and physicians. Consistency incorporates several elements, including doing tests the same way each time in the same amount of time. This is just as important as the speed with which you deliver results. For most tests, it takes us about 15 minutes to get the specimen and then about 12 minutes more to make the result available. If we produce our results in the same time every day, our laboratory gets fewer phone calls. That means our lab operates with fewer interruptions.
“In fact, fewer interruptions is another benefit: Our laboratory is very quiet, and that enables our techs to work continuously in a productive environment,” she said. “That further enhances productivity because we don’t have staff spending much of their day in a reactive mode. Consistency is appreciated by both our physicians and our laboratory team.
“Another measure of our success came about six months ago when consultants toured the lab and had few suggestions to offer for further improvements and efficiencies,” Darr related. “They didn’t know what else they could do for us.
“Looking ahead, I know that in our next step in lab automation, we want to automate coagulation, urinalysis differential reading, and more fully automate our blood bank, a project we are now researching,” Darr said.
The experience of PinnacleHealth in consolidating and rationalizing their multi-site laboratory organization points to one of the most important drivers behind the increasing use of laboratory automation: the need to extend the productivity of medical technologists.
Darr pointed out the twin challenges facing almost every hospital laboratory in the United States today. First, a large proportion of the medical technologists are rapidly approaching retirement. Second, in an already-tight laboratory market, there are not enough medical technologists to meet current staffing requirements, let alone enough to replace retiring baby boomers.
Thus, it is significant that the laboratory team, administration, and the board at PinnacleHealth recognized that a well-designed laboratory automation project could ease the labor crunch in two ways. One, by substituting automation for manual steps in the work flow. Two, by automating work flow steps that extend the productivity of the medical technologists, allowing them to devote time to higher value responsibilities.
Gap Seen in Lab Staff Supply and Demand
FOR PINNACLEHEALTH in Harrisburg, Pennsylvania, a major factor driving its lab automation project was the shortage of available labor, said Judith Darr, Administrative Director of Laboratory Services.
“With tongue in cheek, you might say that medical technologists are a dying breed,” she explained. “Nationally, the gap between supply and demand is minus 32%. When we broke ground for this new lab in 2004, there were 31,500 open med tech positions throughout the United States.
“This national shortage is mirrored in our regional market,” added Darr. “Some 46% of our technical employees are aged 50 or older, and 22% are 55 or older. Retirement looms for many of these individuals. The PinnacleHealth Board recognized the implications of these demographics and understood why automating chemistry, hematology, and other departments in our laboratory is a viable strategy to maximize the contributions of a limited labor force.”
Using Middleware in Phlebotomy to Improve TAT On Morning Draws by Cutting Data Input Needs
FIVE YEARS AGO, consultants suggested a turnaround time goal that the laboratory team at PinnacleHealth in Harrisburg, Pennsylvania, considered to be almost unreachable.
“These consultants said the lab should have all our early morning testing finished by 8:00 a.m.,” said Judith Darr, Administrative Director of Laboratory Services. “At that time, this seemed to be an impossible goal, as we were meeting the 8:00 a.m. goal for early morning draws only about 60% of the time.
“Our first strategy was to send more phlebotomists out to collect and start them earlier in the morning,” she explained. “This did lift performance up to the high 70%—low 80% range. Then came the move into the new lab and the start-up of the automated line. Although there was a dip in the percentage of results released by 8:00 a.m., after about 60 days, that improved steadily, reaching 97%, a performance—a level we’ve sustained now for more than 18 months! Senior management and the physician staff have recognized this significant achievement.”
Another strategy to help early morning draws was the use of information technology. “Once the laboratory automation was operational and running smoothly, we then implemented Collection Manager software (from Sunquest Information Systems, Inc., in Tucson, Arizona) about 18 months ago,” Darr added. “The software allows our phlebotomists to carry a bar code scanner and a small printer with them. Now, when they collect specimens, the patient’s information is entered at the same time. This eliminates a step at accessioning. Then, specimens come to the lab through the pneumatic tubes and are placed directly on the automated line. We estimate that automating patient information at time of specimen collection saves an average of 17 minutes for each accession.”