For Newton Medical Center, a 103-bed, not-for-profit facility serving a rural community of about 60,000 people in and around Wichita, Kansas, the philosophy of continuous improvement applies to every facet of healthcare delivery. That vision, which was articulated by the highest level of leadership, started with a seemingly simple organizational strategic goal— reducing paper use, storage, and maximizing full-time employees’ time. This vision ultimately led to automation across more laboratory functions, including the transfusion medicine department, to help drive positive change at every level.
It was a bit of an unprecedented move. Core labs have been early adopters of automation, taking advantage of the time and cost savings it offers in accelerating throughput for screenings and sample management. Clinical labs gain real benefits when workflow is automated, streamlined, and standardized using the right solutions. However, blood bankers traditionally (and rightly so) focus primarily on safety and have been more hesitant to automate.
Benefits of automation
Now, more hospital decision makers are recognizing the benefits of automation in transfusion medicine, as enhanced standardization and result reproducibility help to optimize staff time and skills.
For Newton Medical Center’s lab, which conducts 1.2 million laboratory tests and 1,100 transfusions annually, the journey toward achieving meaningful improvements through automation took 10 years. Creating a paperless system using electronic health records (EHRs) and rules was just the beginning. Management looked to automation to reach all lab goals, which included:
- Improving specimen and operator workflows,
- reducing risk and random error potential,
- reducing variation and total time for test results, and
- increasing employee productivity and satisfaction.
When Newton Medical Center undertook the effort, blood bank automation was a relatively new concept. According to Aaron Hurst, a seasoned laboratory supervisor of quality systems, the shift required a significant change—not just to day-to-day tasks but to the mindset and culture of the entire staff.
“Implementing a culture change involved sharing the plan on the supervisory level, which then helped champion the cause with the nurses who would be implementing the new process,” he said.
Over a six-week period, Hurst took the time to explain the advantages, showing nursing teams how the new process would make their jobs easier. He identified key goals for the blood bank operations:
- Reducing waste and the potential for errors,
- optimizing blood product utilization,
- addressing an aging and shrinking blood bank workforce,
- improving efficiency, and
- improving transfusion services on a 24/7 basis.
The administration’s vision set the direction to create a paperless system in the lab, with all blood product placed into an electronic inventory and unit retypes automatically ordered. This process change drove a new culture, with provider orders following EHRs blood transfusion rules. The staff was now able to view all orders on mobile handhelds and to monitor key tasks and samples using tracking boards. The engagement with nursing administration continued, with ongoing dialogue and once-a-shift huddles focused on the advantages of implementation.
Other changes were introduced to protect patient safety, a paramount concern for Newton Medical Center. In blood banking, patient history is critical to avoid administrative errors. Checking and answering questions about patient history is routine, with patients having no blood type history automatically added to a blood type confirmation order.
But while many blood banks still write labels, Newton Medical Center automated the process by enabling positive patient identification (PPID), with staff members printing labels for scannable wristbands at the bedside. The labels included one unique barcode for the blood bank wristband and another for the blood bank tube, with a barcoded lock combination code assigned to each specimen. The introduction of PPID increased productivity by 12 percent for the entire lab and reduced turnaround time (TAT) by nine minutes for all blood draws.
Integrating an analyzer
Effectively integrating an analyzer into the laboratory introduced significant efficiencies. Newton Medical Center wanted an analyzer that was bidirectional, offering two-way communication with the LIS for a standardized, flexible process, and a seamless flow of information. The system went beyond middleware by bridging the gap between instruments and hospital networks to operate as a powerful interface and efficiently communicate patient information to and from instruments and practitioners.
The system’s predictable TAT benefitted patients, staff, and clinicians. Besides improving workflow, the analyzer offered traceability features, producing the documentation needed for accreditation and offering proof that the hospital was delivering high-quality service. Proactive and predictive monitoring afforded reliable system uptime.
Newton Medical Center recognized the value of automating more of their complex tests. The analyzer they chose utilizes advanced software to automate a large menu, allowing laboratory technicians to effectively manage both the blood bank and the specimen processing area while helping to cover automated and manual loops.
This innovative approach can serve as a model for other labs, many of which automate only basic tests and screens while assigning a highly skilled staff member to handle time-intensive complex tests manually. Effective full menu automation via the right analyzer can benefit every lab, even those that manage a small percentage of complex tests. Data management and performance metrics while automating and standardizing lab processes offers operational control. Decreased hands-on time, simpler skill level requirements, and streamlined operations optimize lab resources. Automation yields trusted results by elevating quality, increasing safety, and ensuring greater compliance.
Results
With these and many other changes, Newton Medical Center saw significant positive results. For example, risks for critical errors in processing and documentation were reduced from 164 to two, or by 99.8 percent. The two remaining risks were 1) the manual process of unit selection/assignment, and 2) nursing staff members opting to bypass the mechanical barrier.
Blood product utilization was also down by 34 percent, with a 79.8 percent reduction in units returned to the supplier. Previously, the standard process was to order two units of blood, which were not always needed. Now, orders are for a single unit followed by a reassessment, with more ordered only if necessary. The hospital’s analysis shows that 38 percent of transfusions require a single unit.
The process changes lowered the cost per blood product by $151.71, saving $1.97 million from 2008 to 3Q 2015. The method changed reduced cost per blood product by $51.27, with the total cost per unit given at $202.98, representing a savings of $761,000 from 4Q 2015 to 2018.
TAT from blood draw to start time (PPID) was reduced by 12.5 minutes (58 percent), while time for routine types and screens went down 26 minutes (36 percent). The new process optimized staffing, as well, with an 85 percent reduction in transfusion services staff time. All transfusion service staff reported less stress, and competency and proficiency training time decreased by 50 percent.
Automation across tasks
Automation across tasks reduced the risk of human error, while allowing the reallocation of staff for more value-based activity, i.e., diverting cognitive thought to problem-solving, not routine testing. At the outset, the lab had 20 technologists and four dedicated blood bankers. After automation processes were put into place, there were 18 technologists and no specialists, with the lab techs doing blood banking and covering all aspects in the lab. Of the original 20 staff members, one retired and the other was reassigned.
While Newton Medical Center’s initial focus was on transforming the facility’s blood bank processes, it also used automation to make improvements in the core laboratory testing functions. Those improvements included incorporating a discrete testing platform and instituting bar code tracking from start to finish. The lab also automated testing and built standardization into the laboratory information system (LIS).
The staff played a crucial role, with its support optimized using a computerized rule-out assist for antibody identification, on-board analyzer prompts, and remote access. The laboratory’s policy and procedures were also computerized for quick access and consistency. Altogether, these improvements resulted in a 40 percent increase in lab testing capacity.
Potential future improvements to the hospital’s chemistry functions focus on layout, identification, and mitigation of hidden costs, flexibility for future expansion, and growth and resource utilization that minimizes space, staff, and capital resources for 80 percent of lab testing.
In terms of optimizing operator process flow, factors such as distance for med techs to accomplish tasks, required waste, and time spent could all be improved with the right automation solution.
Change yields big benefits
The decade-long transformation for Newton Medical Center reaped tremendous rewards. According to Hurst, the keys to successful implementation were:
- A clear vision from leadership,
- a focus on opportunities and advantages for patients, the nursing team, and the laboratory and,
- cultivating a culture of continuous improvement.
“Looking back over the past 10 years, we learned that change happens when leadership sets a clear vision,” Hurst said. “Although change may be challenging at first, the focus should be on the benefits.”
And a culture of continuous improvement involves embracing ongoing change.
“We make two to three changes every month in our lab to benefit patients or improve productivity,” Hurst said. So, for Newton Medical Center, the automation journey continues.
