Labs' dedication to colleagues, patients, communities reigns in '11

Edited by Carren Bersch, Editor

Each year, MLO sponsors a friendly competition, open to all medical laboratories, in conjunction with the annual celebration of National Medical Laboratory Professionals Week (NMLPW). A panel of judges from MLO selects the top three laboratories based on specific criteria: customer service, contributions to patient care, teamwork, productivity, efficiency, quality control, innovation, and creativity. To the winning three laboratories introduced here this year, and to all laboratories that entered the Lab of the Year 2011 contest, it is an honor for MLO to have hosted this caliber of competitors.

RURAL LAB WITH A “BIG-WORLD” VIEW

In the heart of the world-famous Catskill Mountains nestles Catskill Regional Medical Center (CRMC), a rural 160-bed facility with a 64-bed skilled nursing unit — the only hospital in New York's Sullivan County, two hours from New York City. A second division, a 12-bed facility in Callicoon serves western Sullivan County and parts of northeastern Pennsylvania. CRMC services 75,000+ permanent county residents and triple that with summer's snowbirds and vacationers of diverse ethnic backgrounds. With these patient numbers, CRMC's lab continually focuses on patient needs, from drawing their blood to reporting their test results to physicians. Outpatients annually grade CRMC's lab performance, from “cleanliness to friendliness.” The lab gives its diverse outpatient population post-phlebotomy instructions in four languages and a phone number to call with questions. Lab supervisors participate in the Patient Rounds Program, interviewing inpatients to assess their satisfaction and surveying physicians to ensure patients receive exemplary service.

CRMC's laboratory not only believes in community service but also continually looks for ways to improve quality of life in its community. In January of each year, CRMC co-sponsors the “Blood Bowl,” the largest blood drive in Sullivan County. Its establishment of a CRMC donor center with the American Red Cross (ARC) means that, monthly, donors have a place to donate and replenish the blood supply. Blood-bank staff participate in the Thunder 102 radio station Red Cross Minute to promote blood drives and increase donations. ARC currently uses CRMC's program as a model to create donor drives at other hospitals.

Christmas photo: Patti Andersen (QAO), Mona Makofsky (Admin. Dir. of Laboratories), Lisa Soderblom (LIS), Jen Soderblom (Confidential Secretary) and Rosemary Steuber (Blood Bank Supv.) All of the Lab staff participate in our Holiday gift giving program with the United Way which includes food drives. In addition, we 'adopt' a family and provide presents & a Holiday meal.

Other CRMC lab initiatives include working on several projects with United Way (and through the OP oncology unit) by adopting families for the holidays; sponsoring hospital-wide food drives for Thanksgiving and Christmas; and assembling and donating Easter baskets to local children. Some of the lab's “ghouls” volunteer at the local elementary school for Halloween Trick-or-Treat Night. The lab donates themed gift baskets to benefit hospital fundraisers; contributes to the annual CRMC Heart-A-Thon; participates in the American Cancer Society “Relay for Life” and the local “Rock and Ramble” to raise money for cancer research.

At the Harvest Festival at Bethel Woods (home to the 1969 Woodstock festival) lab volunteers distribute print information and answer questions about CRMC with the backdrop of an outdoor music venue, a museum, a farmers' market, and artisans. If that is not enough, the CRMC lab pros participate in health fairs by screening for cholesterol and glucose; offer phlebotomy services to area nursing homes and other facilities; and raise money for Iraq/Afghanistan War Veterans, victims of Haiti, and Doctors Without Borders, among others.

Catskills Regions Medical Center houses this year's winning laboratory in this modern building nestled in the mountain pines.

The CRMC laboratory contributes educational opportunities to the BOCES Health Academy students who get introduced to the field of laboratory science; the high-school honor students work one-on-one with a section supervisor for an in-depth look at laboratory medicine; MLT students from Orange County Community College train in CRMC's lab, and phlebotomy students receive training from the laboratory's phlebotomy team, all preparing for a career in laboratory medicine, while Sullivan County Community College forensic-science students come for a criminalistics lecture and tour of CRMC's morgue. Some lab personnel also participate in the Career Day for high-school students held at the local community college.

A more serious side of CRMC life

But while community service takes up a large part of the CRMC laboratory's time — off-duty and otherwise — its personnel are downright serious about their healthcare responsibilities. A few examples? To aid in preventing mistransfusions, the lab implemented a blood-type verification policy for patients with no transfusion history, an interdepartmental process approved and accepted by all departments. To improve patient safety for transfusions, a new issuing process in the blood bank for non-emergent transfusions was implemented, requiring a copy of the patient consent and the physician transfusion-order form before releasing blood, which improved documentation compliance hospital wide. To respect the wishes of patients who refuse blood and blood products based on religious beliefs, the laboratory developed and implemented a “no blood” policy — written in collaboration with nursing and CRMC medical staff — to protect the patient's rights — and the hospital.

GVH Div. Quiet room photo: Patty Corigliano (MLT & LIS ass't), Becky Sander (Lab Supv.) and Milo – our therapy dog seated in the chair in the GVH Div Quiet Room. This area was the brainchild of Becky S. so that her Lab staff can have a quiet area to go to and relax a little.

During a significant right-sizing several years ago, the lab was challenged to maintain excellence and quality in spite of a 20% decrease in staffing and cost reductions. Among changes made to protect its goals, the lab combined special chemistry with chemistry and moved immunology under microbiology. With the cytotechnologist eliminated, the lab's two pathologists (once certified) began screening cytology slide specimens. More efficient use of evening/night staff developed when its two MTs began processing reference send-out testing with an earlier pickup which improved turnaround time (TAT). This group also keeps specimens and requisitions together throughout a “rapid order-entry system,” a direct result of “right-sizing.”

Through a review of testing ordered by the emergency department (ED) medical director, some non-STAT testing was eliminated or changed to “pathologist approval required” — saving $20,000 in reagent/testing costs. Two new high-speed centrifuges reduced centrifuge time from 10 to three minutes, getting ED's STAT specimens onto analyzers faster.

This lab, having seen many reductions in staff, relies heavily on teamwork. All med techs receive cross-training to cover all areas of the lab: microbiology and histology to chemistry, hematology, and blood bank. While not “experts” in these areas, cross-trained staff enable the lab to cover critical areas during call-outs and emergencies. MTs and supervisors are trained to troubleshoot all analyzers and test-reporting systems. The lab has both multidisciplinary and facility-wide teams that function on hospital-wide committees: hospital-infection control, transfusion, trauma, compliance, performance improvement (The Joint Commission readiness) — and the electronic medical record team in conjunction with an affiliate hospital from the Greater Hudson Valley Health System. The lab has 12 inspectors for the College of American Pathologists (CAP); its medical director has been a divisional commissioner for western New York from 2003 to present. The blood-bank supervisor is a certified AABB inspector. Inspections help lab personnel work together, understand each other's issues, find common solutions — and make the lab a well-functioning unit.

Easter Baskets: Timika (MT), Roe Steuber (Blood Bank Supv), Kathy Watson (Histology Supv) and Dr. Napolitano (Medical Director of the Laboratory). Assembling Easter Baskets for the United Way has become an annual event and has grown throughout the years. These are just a few of the many baskets we gave to area children last year.

Among the CRMC lab team are 25 technical staff, 12 phlebotomists, two per-diem MLTs, three per-diem phlebotomists, a courier, and four administrative/IT staff in both divisions performing more than 1 million tests yearly. Relationships with other labs benefit CRMC's in keeping current with methods and complying with regulatory requirements. Its work with other hospital departments allows lab staff to develop relationships, such as with nursing. This opened the door for teaching nurses about transfusion practices, and nurses asked for lab help in documentation compliance — a collaboration that resulted in a new blood-issuing process, enhancing patient care. The lab leads in hospital-patient ID improvement, having suggested ways to increase patient ID compliance, gathering data, performing a root-cause analysis with other departments, and writing a competency for nurses in patient ID and labeling of specimens.

Grover Herman Division: Becky Sander (Lab Supv.), Patty Corigliano (MLT & LIS ass't), & Milo (therapy dog). This photo was taken near the entrance to our satellite CRMC hospital in the western part of Sullivan County- a Critical Access Hospital. Milo can be found eagerly assisting patients at both divisions.

Process review is a regular CRMC lab habit

A high level of quality control (QC) is maintained by committed lab personnel, with each section responsible on a shift-by-shift basis. QC is reviewed daily, weekly, and monthly by a supervisor to identify trends and shifts in order to make calibration decisions. A broad range of monitors is examined: 62 aspects of quality practices and patient care are audited along with the 14 performance-improvement projects; enabling identification and problem fixes using the DMAIC (define, measure, analyze, improve, and control) system. Numerous accreditations inspire the high level of quality: NYSDOH licensure, CAP, AABB, and The Joint Commission accreditation, and CMS. The lab, noted as exemplary in two CAP Q-Tracks on critical-value reporting and outpatient order entry, placed in the top 10% of participating facilities. Transfusion service scored in the top percentile for the CAP Q-Probe for Specimen Acceptability Errors. The lab processed 194 sets of CAP and NYSDOH proficiency tests. 99.5% of the proficiencies scored 98% or above.

PRESENCE WITH PURPOSE

The Franciscan Missionaries of Our Lady arrived in Louisiana from Calais, France, 100 years ago, in 1911. Their health ministry grew out of the state's need for adequate healthcare. Their first hospital, the St. Francis Sanitarium in Monroe (now the St. Francis Regional Medical Center), was opened just two years later. Our Lady of the Lake (OLOL) Sanitarium, 186 miles from Monroe in Baton Rouge, was the second Franciscan institution opened. The OLOL laboratory has played an important role in supporting the mission of the hospital and service to this community since 1923. Today, the Franciscan Missionaries of Our Lady Health System consists of four regional hospitals moving toward standardized instrumentation and LIS to provide uniformity in resulting, troubleshooting, and sharing resources. An outpatient lab also is located within the medical plaza at OLOL.

OLOL's laboratory offers the surrounding community outreach and inpatient lab services, plus blood-donor programs and community services. Combined outreach totals for OLOL and sister hospital, Our Lady of Lourdes, have doubled in the past five years, with totals for procedures increasing from 60,364 in March 2005 to 112,696 in March 2010. Meanwhile, the lab-outreach call center — Lake Lab Services (LLS) — provides top-notch customer service to clients, expedites reports and calls to physicians when needed, and resolves customer-service questions that arise. LLS has established several satellite labs and venipuncture draw sites for added customer convenience. Of all lab tests ordered (most available 24/7), 98% are completed in-house, so physicians get rapid result reporting.

Donor program

In 2010, many Louisianans were affected not only by the Gulf Coast oil crisis but also the Haiti earthquake. The OLOL lab team participated in a food drive for Haiti-earthquake victims, collecting canned goods and other non-perishable items. Employee blood drives — held twice a year at all facilities — offering incentives, a cruise raffle, and an option to forego a blood-drive T-shirt in order to donate its monetary value to the Franciscan mission in Haiti.

OLOL's blood-donor program recognizes top donors and donor groups throughout the year. Blood-donor services collects and processes blood and blood products from more than 30,000 donors yearly, and operates four donor buses and four fixed-site donor rooms, including a collection site at a chemical plant — the first of its kind in the U.S. OLOL donor services has full-time nurses on staff who perform therapeutic phlebotomies, red-blood-cell exchanges, and plasma exchanges.

In 2010, more than 300 donor-guests attended the blood-donor appreciation banquet, receiving more than 40 awards, and where transfusion recipients shared personal stories with donors. The service also provides blood and blood products to other service facilities, including three area hospitals and many smaller regional facilities. An onsite blood-distribution-center service allows for blood components to be made in house; those and blood are a phone call away to fill OLOL needs.

In addition to implementing automated blood-bank testing to eliminate human error, the transfusion-services department was engaged in the initiation of a massive-transfusion protocol that set up a systematic process for providing blood products in cases that involve massive bleeding, freeing physicians to focus on patient care.

Core laboratory

The blood bank and hematology play vital roles in the processing, cryopreservation, and transplanting of hematopoietic progenitor cells. The Hematopoietic Progenitor Cell Program is one of only three Foundation for the Accreditation of Cellular Therapy (FACT-) -accredited programs in Louisiana and the only one in Baton Rouge.

In addition to implementing blood-bank testing to eliminate human error, the transfusion service was engaged in initiating a transfusion protocol that set up a systematic process for providing blood product in cases of massive bleeding, freeing physicians to focus on patient care.

OLOL's phlebotomy department trains ECU technicians in the art of dermal and venipuncture techniques, emphasizing the importance of the preanalytical stages of lab testing. With the point-of-care (POC) program, the lab trains all nursing employees and students attending nursing and nursing-assistant programs, and seven healthcare training affiliates on how to appropriately utilize POC testing and instrumentation.

The newly developed Pediatric Residency Program provides many positive outcomes for pediatric intensive-care unit patients. With more neonates for treatment, the blood bank has developed a new process for aliquoting blood products for smaller volumes to accommodate these patients.

The lab's chemistry and blood-bank departments recently supported a sister institution in its preparation and transition to a new LIS, while the transfusion-services department routinely provides antibody workups for yet another sister hospital.

Awards-winning laboratory

Award-giving is part of OLOL's way of doing business with its dedicated volunteers and employees. The Franciscan Service Award is the highest, most prestigious award given to honor OLOL team members in recognition of excellence in performance; contribution of service; leadership; teamwork qualities; and dignity in dealing with patients, visitors, medical staff, and employees. One of these awards is given monthly; out of some 4,000 employees, two from the laboratory received this award in 2010 (one for the second time).

Lab managers and staff participate in “Everyday Excellence” huddles, which keep employees on each shift aware of pertinent communications, remind them of the hospital mission, and review its core values. Lab-team members serve on hospital committees: patient safety, environment of care, and patient satisfaction “test and treatment,” for example, and lab supervisors make patient rounds, speaking to patients and nurse managers regarding the quality of the lab's services.

Examples of the laboratory's contributions to patient care include microbiology's receipt of a “Guardian Angel” award for its involvement in patient-safety solutions regarding blood-culture contamination. The micro team also began the use of selective media to aid in the recovery of common pathogens found in OLOL's children's hospital cystic-fibrosis patients.

Microbiology recently introduced two new real-time PCR tests (CSF Enterovirus and C difficile toxin gene) which have greatly improved the TATs for clinicians. Chemistry currently processes approximately 3 million tests annually. Hematology brought vitamin Ds in-house, saving the hospital more than $17,000 monthly.

Growth of the OLOL laboratory over the past 10 years can be attributed to an increase in volume brought on by an expanded outreach program, coupled with increased local population following Hurricane Katrina in 2005. Reconstruction of the lab was completed in 2005, and the new core lab improved movement of specimens among departments.

Central processing was instituted to aid in the preanalytic phase of testing: centrifugation of specimens when necessary, distribution of specimens to appropriate department(s), and loading specimens onto instruments in hematology and chemistry.

Additionally, a specimen-tracking system was devised, a call center was brought online, and the use of licensed medical lab assistants for waived and moderate-complexity testing has made room for technical staff to focus on results and reporting to improve TAT.

And to support the field of medical technology, OLOL's laboratory acts as a clinical training site for MT students of Louisiana State University (LSU) Health Sciences Center and Our Lady of the Lake College. A phlebotomy-training program at OLOL College provides opportunities for newly trained phlebotomists in the venipuncture and blood-donor departments.

While employee contributions are lauded every Friday with “Friday Treats” from lab administrators and “Spirit Chip(s)” (metal doubloons redeemable at the hospital cafeteria, gift shop, and company store), a “Section Celebration” is sometimes held to recognize special accomplishments within a certain department.

But during NMLPW, OLOL lab's festive, creative, and competitive “Poster Contest” is held. Last year, the theme was “At The Movies,” with departmental posters sporting a popular movie.

Throughout the year, a team of lab volunteers help produce “Lab GAB” magazine — a compendium of personal stories and accomplishments, favorite recipes, riddles, and puzzles. Lab administration also gives lab employees free CEUs via an online P.A.C.E.-approved medical lab continuing-education service that allows each section supervisor to custom design required courses to keep licensed lab team informed of medical trends and advances in the field.

The OLOL laboratory is accredited by the CAP and actively participates in the CAP proficiency-testing program and in the inspection of other CAP-accredited labs. Both transfusion medicine and donor services are accredited by the AABB and FACT, and are FDA registered. Lake Lab Services has four COLA-accredited outreach laboratories located throughout the Baton Rouge area.

Our Lady of the Lake Regional Medical Center's laboratory continues to play a significant role in the Franciscan healthcare ministry in the region. Customer-centered service, state-of-the-art testing, and accurate and timely test reporting are proof of the commitment to patient quality and delivery that has made the the Lake laboratory successful since 1923.

FILL 'ER UP WITH PRMC LAB

Should MLO readers get the notion that Lab of the Year competitors are “all work and no play,” it is during Lab Week that creativity oozes through the halls at Peninsula Regional Medical Center Laboratory (PRMC). This year's PRMC theme for Lab Week is “All Around the World,” which is celebrated with food from countries representative of its international employees. Creativity is also used to satisfy some of PRMC lab's educational requirements — employees participate in a safety scavenger quiz yearly to test all techs' knowledge of safety protocols and equipment. Lab Week celebrations from past years include murder-mystery dinners and twisted lyric performances — like the lab team's rendition of “MRSA” sung to the tune of “YMCA.”

But throughout this and the other 51 weeks of the year, PRMC lab personnel focus on providing good service to its “internal customers,” which results in good service for PRMC's patients. (PRMC is located in Salisbury, MD, founded in 1732 and the largest city [pop. 30,434] on the Eastern Shore of Maryland at the head of the Wicomico River, the navigable waterway that leads to the Chesapeake Bay.)

A LEAN lab is a productive lab

Lab staff members work on PRMC interdisciplinary teams. The severe sepsis team recently won PRMC's Chairman's Award for Clinical Improvement. This team collected data showing that, in the past year, a lower mortality rate was achieved by early recognition and management of patients with severe sepsis. Additionally, the micro lab partnered with infection prevention to help reduce hospital-acquired infections by performing surveillance testing for MRSA and VRE for all patients admitted to intensive-care units and is expanding this testing to include pre-surgical patients. Knowing that a patient is colonized with MRSA before surgery allows PRMC to take steps to reduce the risk of patients getting a MRSA infection during recovery.

Prior to 2010, PRMC's laboratory was divided into departments, physically and administratively. Cross training among these was non-existent. In April 2009, five frontline employees developed and implemented a LEAN lab initiative. This group analyzed data from the lab's then-operational condition and advised management on physical design and workflow changes. In a million-dollar renovation, walls preventing the flow of specimens and information were demolished, and the high-volume automated instruments got consolidated into a “cell” design. For example, a chemistry sample used to travel 116 feet from specimen receiving to the chemistry analyzer. After the LEAN renovation, a specimen now travels a mere 39 feet.

As the physical design of the lab changed, chemistry and hematology merged into the “core.” Today, laboratory staff continues to work toward cross training for its core laboratory. The LEAN principles applied to workflow allowed PRMC's lab to identify steps in its processes that did not add value to patient results. Standardization of procedures, workflow, and environment continues as the goal, with lab staff eliminating waste and errors, and maximizing value-adding activity for its end product. Being part of this team now means each member can be called upon to learn a new skill or technique based upon the entire lab's needs and is able to recognize a higher level of effectiveness and success as an individual and as a team member.

By January 2010 when construction was finished, training began in how to process specimens in a LEAN environment. The changes in workflow and physical design allowed the lab to reduce by 25% to 30% the time to result key tests (e.g., CHEM8s, CBCs, protimes, and troponins). TAT for these key tests are printed directly after morning draw results. Times exceeding benchmarks mean contributing factors in delays can be identified immediately. Unacceptable specimens received from the ED (e.g., clotted, hemolyzed, and low-volume) are tracked each month; this data is shared with ED personnel. The micro lab now monitors contaminated blood samples collected by the ED personnel, reducing that percentage of contamination by giving feedback to ED culture-collection personnel and by changing processes that contributed to culture contamination. Tracking misidentified specimens is another quality indicator monitored and reported monthly to risk management; hospital personnel involved with a misidentified specimen are counseled immediately.

Applying LEAN principles means reduced FTEs in several areas through attrition and improved TAT through a restructured workload. Phlebotomy now has fewer staff members daily compared to last year, yet has decreased morning-draw completion time. The core lab reduced staff by 3.5 FTEs, yet decreased its morning TAT for key tests. PRMC lab had its latest unannounced inspection by CAP in September 2010 and received full accreditation. In January 2011, AABB inspected and accredited the lab as well. The PRMC lab's next goal is ISO 9000 accreditation.

This LEAN lab is a caring lab

An aspect of lab employees' care and concern for others is reflected in their partnership with a local community college and a university to offer PRMC internships for clinical-laboratory students, recognizing the value of their future contributions. Another aspect of pride is its staff's compassion for others. Recently, after his blood draw at a PRMC outpatient center, an elderly patient exhibited confusion over where he had parked. An outpatient lab tech found his car (keys in the ignition) behind the building, moved it to the front, and noticed an “empty” gas gauge. The patient confessed his trouble with pumping gas but did not want to take a taxi. The lab tech, whose shift was ending, followed him in her car to a gas station, pumped his gas, bought him dinner, and made sure he got home.

 
NMLPW is a time to recognize and celebrate the significant contributions of approximately 300,000 medical-laboratory professionals and 15,000 board-certified pathologists who play a vital role in every aspect of healthcare. Since laboratories often work behind the scenes, few people know much about the critical testing they perform every day. NMLPW is a chance for lab personnel to use this special time to inform and educate medical colleagues and the public about the medical laboratory. Lab Week is April 24-30, 2011, with the theme of “Laboratory Professionals Get Results.”

PANEL OF JUDGES

Our esteemed MLO Editorial Advisory Board Members who served as judges for the Medical Laboratory of the Year 2011 Award are:

Leland Baskin, MD, F(CAP), Medical Director, General Laboratory, Calgary Laboratory Services, Calgary, AB, Canada

Dennis Ernst, MT(ASCP), Director, Center for Phlebotomy Education, Corydon, IN

Sharon M. Miller, PhC, MT(ASCP), CLS(NCA), Professor Emerita, Clinical Laboratory Sciences, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL