Like all businesses operating in todays volatile economic times, hospital laboratories are experiencing several new pressures and changes such as staff layoffs, facility consolidation and budget cutbacks. These stresses, combined with a continually increasing daily specimen volume and a diminishing supply of skilled medical technologists, have created an expanding gap between a laboratorys workload and its ability to complete analytical processes and deliver laboratory services in an efficient, timely manner. As a result, laboratory administrators have begun to turn to automation to cost-effectively improve operations, and increase overall productivity and efficiency.
Automation has improved three healthcare organizations laboratory departments with the container management and autoverification features of Misys Laboratory and the Beckman Coulter automation system. NorthEast Medical Center is located in rapidly growing Concord, NC, with over 3,200 employees, including 275 physicians. According to Vickie Davis, administrator of Laboratory Services, the 457-bed hospital installed the container management and autoverification features in conjunction with a pre-analytical processor in 2002 as a first phase. Over time, NorthEast will add track with instruments to the system.
The Sacred Heart Health System is comprised of a 431-bed acute-care facility in Pensacola, FL, a 120-bed nursing home, a primary care network, a home health agency and a recently opened 50-bed hospital east of Destin. In January 2002, Sacred Heart became one of the first hospitals in the southern United States to implement a laboratory automation solution, explains Craig Wright, core laboratory supervisor. Its solution includes a pre-processor, plus a track with connected instruments. Sacred Heart plans to continue expanding its laboratory automation system (LAS) in the near future, adding a second line with hematology and coagulation and a 3,000 test tube refrigeration system connected directly to the automation line.
Northwestern Memorial Hospital is a 700-bed academic medical center with a service relationship with the Feinberg School of Medicine at Northwestern University in Chicago, IL. It installed a full automation system integrating the Misys solutions with a Beckman Coulter pre-processor, track with instruments and end-cycle storage in June 2001. Northwestern has a clear vision of its future with automation, says Kenneth Clarke, administrative director of Pathology Laboratories, which includes a completely integrated system beginning with positive patient ID and printed barcode labels at the patient bedside.
Decreased turnaround time
An integrated laboratory information/lab automation system can provide clinical laboratories with a dramatic reduction in average turnaround time. And when integrated with the Misys product suite, laboratories can place the tubes directly onto the line eliminating time-consuming, manual pre-analytical steps.
Sacred Heart experienced a significant drop in turnaround time immediately after implementation. Previously, our guidelines were to achieve four- to eight-hour turnaround time for routine specimens, says Wright. With the tubes being loaded immediately, they can run at a consistent pace with pre-analytical and analytical processes completed within 30 to 40 minutes. Test time is now dependent on the chemistry of the test, not the pre-analytical steps.
Northwestern has also experienced a notable reduction with its average routine chemistry turnaround time falling to match the average time of stats. All three organizations plan to further decrease turnaround time by completing the automation picture with specimen collection tools that will communicate collection information directly to the system.
Increased physician satisfaction
With an automation system, clinical laboratories are able to deliver more consistent service to their clients by decreasing the number of turnaround time outlier events.
Previously, the outlier rate at NorthEast had been 42%. Immediately after the implementation was complete and by using the laboratory instrument result autofiling feature for clinical chemistry tests, it was reduced to 27%. Just one month later, the rate dropped to 18%.
We plan to autofile all large volume test types in the near future starting with hematology, and then urinalysis, Davis says, resulting in a further lowering of our turnaround time outlier rate.
Increased volume capacity
Hospitals throughout the United States are experiencing the opposing pressures of higher patient volume vs. budget cutbacks and a rapidly declining supply of qualified medical technologists. For example, NorthEast Medical Center saw specimen volume increase by 31% between 1997 and 2002. During 2003, its labor costs are expected to account for 43% of the laboratory expense budget, while the cost of supplies, equipment and maintenance continue to increase. By implementing an automation system, NorthEast and other labs are able to reduce time-consuming manual steps and increase test throughput per employee.
Our patient volume had skyrocketed, states Wright. But since our lab had not grown in physical size, our budget had not increased and our staff remained constant, we required an automation system that would simplify our manual processes from drop-off to completion in order to decrease our turnaround time without increasing cost.
Currently, Sacred Heart can place 100 specimens at a time directly on the automation line and immediately time-stamp each tube, opposed to the previous method of manually placing each tube on the rack while its information was manually retrieved from the computer system. This step, which previously took one hour to complete, presently takes only five minutes.
Decreased time for add-on testing
Adding tests for an existing specimen is a common occurrence, and many labs spend countless man-hours searching for in-lab specimens for add-on testing. By eliminating the need to search through several racks of samples to locate a particular tube, tracking enables rapid completion of new tests and potentially expedites a patient discharge.
As Wright explains, If someone requests to add a new test on to a specimen taken the day before, I can go into the computer system, access the patients data and know exactly what row, in what rack, in what refrigerator the specimen is, and immediately obtain that specimen, rather than manually examine as many as 200 specimens searching for a single test tube. With the addition of the end-storage unit, such as the one at Northwestern, the LAS will send a message with the sample location to the automation system when the test is added to an existing lab sample number. The automation system will retrieve the sample, run the test and return the sample to storage.
Enhanced employee morale
Although the emotional human factor of laboratory staff members is usually not a determining factor in choosing an LAS, a positive work environment can have a powerful, beneficial effect on overall productivity. Sacred Heart previously had the critical problem of retaining its technical staff because of the high levels of stress and frustration caused by a manually driven system.
Before installing the new solution, we were like a locomotive going down the mountain with its brakes not working, says Wright. We couldnt maintain a consistent staff because it was too much work and stress for people to handle. Now they look forward to coming to work.
In addition to eliminating manual, pre-analytical steps, Sacred Heart improved employee satisfaction by evaluating its laboratory configuration and physically changing the placement of its hardware. This modification reduced the number of steps required to move between workstations; therefore better utilizing each persons time and energy.
Automation offers laboratories the ability to improve patient care, enhance client and employee satisfaction, and increase workload capacity while maintaining a cost-effective department.
The overall objective of any organizations automation project is simple to do more with less, better, states Davis.
We know our future is on the information systems side, Clarke states. Vendors investment in the development and creativity of automation is what is going to drive the future of the laboratory.
Implementing the automation solution was absolutely the right thing to do for Sacred Heart Health, says Wright. With the transition complete, we are pleased with the results. All we want now is more automation that will enable us to do even more with what we have.
Elinore Craig is director, Laboratory and Clinical Financial Product Management, at Misys Healthcare Systems, Tucson, AZ.
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