CEO SUMMARY: With the hospital adding specialist physicians and at the same time enjoying sustained growth in outreach test volume, the lab was hit with the dual need to expand the in-house test menu and reconfigure workflow to handle predictions of ongoing growth in outreach testing. Sarah Bush Lincoln Health System’s laboratory examined bottlenecks in its work process, created a multi-year strategy to address those problems, and used automation to improve testing services.
CLINICAL LABORATORY DIRECTORS CONTINUE TO FACE TOUGH CIRCUMSTANCES as 2022 gets underway, including staffing shortages, greater demand for COVID-19 testing amid the ongoing pandemic, and stress.
If clinical laboratories have not increased their automation capabilities in recent memory, now is a good time to expand use of the technology.
Newfound inspiration may come from the clinical laboratory at Sarah Bush Lincoln Health System in Mattoon, Ill., which achieved multi-faceted success by ramping up its automated processes. In doing so, the lab increased operational efficiency—including an impressive 75% reduction in process steps—and improved turnaround times (TAT). Lean and Six Sigma methods informed and enabled the lab team to leverage the new automation to its fullest potential.
“We aimed to focus on processes and production,” said Jodie Warner, Director of Laboratory Services at Sarah Bush Lincoln. “And the best way to do that was through new automation in our Sarah Bush Lincoln Health System in Mattoon, Ill., which achieved multi-faceted success by ramping up its automated processes core laboratory.”
Sarah Bush Lincoln’s hospital laboratory has been on a five-year journey to automate workflow and improve efficiency and quality of diagnostic services. Leadership at the lab knew transformation was needed to handle growth and changes in test volume, menus, and orders originating from more physician specialists served by the laboratory outreach program.
Located in east central Illinois, 103-bed Sarah Bush Lincoln Health System serves a nine-county area. Included in the market are a hospital, regional cancer center, 17 primary care sites, and 14 community clinics. Additionally, lab services extend outreach to a 20-county area. A satellite lab operates in Effingham, Ill.
Increased Test Volumes
“The laboratory was experiencing growth with more physician offices and outpatient business,” Warner said. “Because of new tests, new methodologies and new diseases, we saw regular increases in specimen volumes and expansion of our test menu. At the same time, our hospital was adding specialists, which meant a higher acuity of patients.
“All of those things were coming into play,” explained Warner during her session at the 2021 Executive War College, titled, “Our Lab’s Multi-Year Journey to Automate Work Processes and Use Analytics to Reduce Errors, Boost Efficiencies, and Improve Care.”
“So, growth was great, but also a pain point,” she continued. “We asked ourselves how our lab could handle that growth, especially with strong growth in specimen volume projected for several years into the future?”
Growth in Tight Labor Market
Warner acknowledged that the shortage of laboratory professionals in a tight labor market made it difficult to address growth with more staff. Since early 2020, the pandemic has also increased the difficulty of hiring experienced lab staff.
“To handle projected year-over-year growth, our big imperative was to improve efficiencies and quality,” Warner stated. “Consistent with Lean methods, we strive for continuous improvement while looking for opportunities to eliminate or reduce errors and to establish consistent processes.
“There were differences in how our lab handled stat orders versus routine work, and the variability was impacting staff, quality, and results output,” she noted. “The consistency just wasn’t there. And we needed to have the appropriate staff performing the right types of work.”
To meet these challenges, decision-makers chose to implement Beckman Coulter’s DxA 5000 Total Laboratory Automation System, with the following configuration:
- Two centrifuges
- Two clinical chemistry analyzers
- Immunoassay systems
- Hematology workstations
- Refrigerated units for samples
The DxA 5000 offers a streamlined hospital lab workflow through pre-analytic connection to chemistry and hematology analyzers to post-analytic volume detection, according to Beckman Coulter.
Setting Lab Goals
A preliminary challenge was appropriately scaling the automation equipment and software.
“One goal was to plan far enough ahead to have the capacity to handle future growth,” Warner said. “No matter what you build, you often feel you have outgrown it a few months later. Our lab team wanted to manage capacity and grow our outreach business, as well.”
The team set a goal of 3% annual growth by 2024, which represented 1,900 specimens total per day. Then, lab managers began the tedious work of mapping out lab processes to create value stream maps. This helped identify when wait times happened and where probable sources of errors originated.
“Much effort went into this,” Warner said of the attention to workflow. “Concentrating on the detailed steps between specimen and result, as well as the pre- and post-analytical phases of testing, was critical to determining the right fit for our lab.”
Applying Six Sigma
To further help promote efficiency, the lab team incorporated elements of Six Sigma methodology. Six Sigma aims to make processes, such as those used in clinical labs and pathology groups, more uniform and precise through application of statistical methods.
The term “Six Sigma” comes from the goal of producing services that meet a quality specification that is within six standard deviations (SD) from the mean value. The lower the SD, the closer the value is to the mean.
The team at Sarah Bush Lincoln worked with Beckman Coulter on its map of current processes to identify steps without value (e.g., waiting, movement, over-production, and over-processing) and how automation could eliminate waste and biohazards.
The team also focused on closing the gap in TAT for routine testing and stat testing. “We wanted to implement a consistent solution to handle both stat and routine processes so we could eliminate outliers,” said Warner, who noted wide dispersion of data from the mean for key tests’ TAT.
With the assistance of technology, Sarah Bush Lincoln’s lab saw impressive results through a more consistent testing process and improved TAT.
“We have one process now and know that it is working well for tests—stat and routine,” Warner said.
In fact, the implementation of Beckman’s DxA 5000 automation line decreased steps in the lab process from 122 to 31 for a 75% reduction, she added.
Also, according to Warner, standard deviations (SD) and TAT for these high-volume tests improved as follows:
- Potassium: SD improved from 10 minutes (stats) and 22 minutes (routines) to a consistent SD of nine minutes; mean TATs were reduced from 35 minutes (stats) and 50 minutes (routines) to 25 minutes for all potassium tests.
- Complete blood count (CBC): SD improved from 15 minutes (stats) and 20 minutes (routines) to a consistent SD of four minutes; mean TATs were reduced from 14 minutes (stats) and 20 minutes (routines) to nine minutes for all CBCs.
- Troponin: SD improved from 14 minutes (stats and routines) to six minutes; mean TATs were reduced from 37 minutes to 34 minutes.
As for capacity with the automated system, the lab quickly surpassed its target set for 2024, as it processed 2,200 tubes in one day during the COVID-19 pandemic.
“The volume of testing on that day far exceeded what we projected would be future volume,” she noted. “The surge in specimen volume was initially due to the pandemic but has continued. However, our new automation and core lab workflow give us the horsepower and throughput to handle that growth.”
Access to real time data is another important factor in helping the lab team handle the increased daily volume of testing. Beckman Coulter’s data management integration tools made it possible for lab leaders to use granular dashboards to determine use of automation. “We looked at staff’s adoption—comparing auto load to total load—and utilization is at 90%, confirming that lab staff are using the new automation effectively.”
The automated system also allows the laboratory to review workload balancing. That guides the distribution of tubes while allowing the medical technologists to investigate any variances that might indicate supply or maintenance issues with a particular analyzer or reagent.
Leveraging Lab Automation
As the experience of the laboratory at Sarah Bush Lincoln Health System demonstrates, today’s generation of laboratory automation can deliver increased productivity, improved accuracy, and lower costs even to smaller and mid-sized hospitals. Two other elements in this successful lab operations case study are integral to the lab’s ability to grow while maintaining service levels to the inpatient, outpatient, and outreach clients it serves. One is the diligent application of Lean and Six Sigma methods with the automation.
The second is the use of informatics and management dashboards to provide data in real time that allow laboratory staff to spot problems and identify underperforming instruments and congestion in work processes.
Clinical lab administrators and pathologists should not overlook several other interesting and relevant aspects of this laboratory case study. First, this is a 103-bed hospital in a town with a population of 17,394 in 2021. Yet, the hospital has a strategy of adding specialist physicians to provide a wider range of clinical services to the communities it covers in the 20 counties that it serves.
This strategy requires the lab to expand the menu of in-house tests commonly used by the new specialists. But this also comes with the benefit of shortening turnaround times for inpatient test results. The ability to get a fast test result may mean that the inpatient can be discharged a day early. That is a major cost saving to the hospital.
Second, continuing improvements in lab automation and testing instruments mean that they are smaller and more efficient. This allows smaller hospitals to utilize more automation in their labs. That’s true at Sarah Bush Lincoln Health, but its lab’s journey to automate its lab work process will go on, according to Warner.
“We want to continue what we started. And the way to do that is with continuous quality improvement utilizing technologies like automation and analytics as our profession continues to innovate and evolve,” she said. “We’ve been fortunate to plan and implement solutions that augment the talents and ability of our staff to grow and be successful. We plan to continue that strategy.”
Quality Improvement Methods Implemented with New Lab Automation to Deliver Solid Results
PROCESS IMPROVEMENT CAN WORK HAND-IN-HAND with core laboratory automation to deliver substantial gains in productivity, faster test turnaround times, and lower costs. During her presentation at last November’s Executive War College, Jodie Warner, Director of Laboratory Services at Sarah Bush Lincoln Health, described how the lab team used Lean, Six Sigma, and other quality improvement initiatives in tandem with the installation of new lab automation, as follows:
- Interfaces with electronic health records (EHRs) in outreach client offices resulted in cleaner claims and needed data for improved reimbursement.
- Positive patient identification enabled phlebotomists to print labels for specimens at bedside, transfer collection information (e.g., collector, date, and time) back to the laboratory information system and document delays and “no draw” reasons.
- Automated examination of peripheral blood smears (especially for oncology patients) allowed the lab to more efficiently complete differentials on low white blood cell counts and confer with specialists and pathologists.
- Auto-verification expedited the reporting of results meeting established criteria and acceptable quality control and enabled clinical laboratory technicians to focus on tasks and results needing their attention.
- Laboratory expansion and redesign of standardized equipment reduced the risk of repetitive-use injuries and enhanced teamwork.
- Customer service systems, point-of-delivery devices, and GPS improved client relations with better documentation of interactions and marketing, courier dispatch, recording of specimens and pick-up times, and route optimization.
- Point-of-care connectivity helped capture results in the hospital’s EHR system and allowed the lab to monitor users’ competency and quality control.
Contact Jodie Warner at firstname.lastname@example.org.