Automation in the blood bank can be a turnaround time saver and staffing force multiplier. However, optimizing the testing workflow on the existing platforms should be the first order of business when considering new automation. There are companies that can be hired to do this, and they may present ways to optimize current analyzers with minor adjustments in the workflow process. Beginning with the end in mind, mapping the current workflow processes will provide a baseline for improving operations in any blood bank and laboratory.
Consider the laboratory structure. Is there a core laboratory concept with blood bank and microbiology located in the same workspace? Is it necessary to consider changes to the power, IT connections, and physical space in the planning process for new automation? Many laboratory structures limit the ability to share technologies and products, which creates operational gaps and challenges staffing models. Workflow process mapping will ensure that a lab leader has defined the many interconnected operations that impact the overall efficiency of a laboratory and point out key areas where automation may help make great strides in productivity. Placement of automation can allow for integration and cross training of the technical staff. A well-trained, cross-functional staff can be a great tool in generating efficiencies as well as reducing laboratorian burnout.
Transforming workflow to support quality patient care is the outcome we strive to accomplish. One of the daily challenges shared by many laboratorians is improving quality and efficiency while at the same time reducing overall production costs for the organization. This is why any consideration to increase automation should be conditional on Lean Management concepts.1 That is, efficiency, not only size, is the key to selection of new equipment. One of the goals in automating processes is avoiding the inadvertent creation of new inefficiencies. Lab leaders should consider additional items such as computer support, the electronic health record (EHR) system, and validation of the equipment when deciding what kind of automation they wish to purchase, as these key factors can add efficiency or create inefficiency for the work process.
Communication connections
Computer systems and the aligning of the new automation to the current health information technology (IT) system of record are vitally important. Each analyzer has different communication connection requirements and needs to be part of the planning and follow-through when installing and planning IT connections throughout the laboratory. As the mapping of the workflow layout is designed, power, water, and communication lines for new and existing analyzers and equipment must be physically defined. Automation line vendors who may already be consulting in the core laboratory or chemistry departments may be helpful in offering design recommendations for the new workflow in the blood bank.
With the advent of the EHR, it is important for lab leaders to find out if the new automation they are considering will link to the patient’s EHR. If not, manual entry into yet another system will increase workload and frustrate staff. In one of our largest medical facilities, the amount of workload and throughput justifies researching automation. However, each analyzer or piece of equipment, such as refrigerators, have IT configurations or requirements that do not necessarily play well with other systems. We have declined bringing online a new piece of equipment because it is yet another place where we must manually enter information into or extract information to enter into our system of record.
Shifting workload from testing to administrative actions can occur simply because the software to link the automated analyzer to the healthcare system employed in the facility does not work or may require purchase of additional equipment. “Surround” systems or “middleware” are designed to connect testing platforms and the system of record or the EHR. These have both pros and cons and must be factored into the equation of how to best utilize automation.
Decision makers should be careful of the fine print. Commercial off-the-shelf (OTS) products have been highly advertised the last five years, but these products may not really be “OTS” for a given facility because of additional requirements an organization may add. For example, some analyzers or equipment may advertise being wireless-capable, but an organization may have limitations on connecting and firewalls that do not allow utilization of the wireless feature. We purchased equipment in hopes of utilizing the wireless feature on our mobile blood drives and were disappointed when we could not utilize that function due to IT security requirements which made us take extra equipment versus less equipment. The system was created to provide more flexibility with the wireless feature, but a given organization’s requirements may not allow it to use that feature.
Validations
Validations for the new equipment will be a major consideration to the planning and implementation process. Blood testing analyzers and equipment have more specific validation requirements than the chemistry or hematology platforms. The AABB Standards2 is an outstanding resource to consult when developing the validation plan, to include the Installation Qualifications, Operational Qualifications, and Performance Qualifications as well as the final summary report for the validation. A well-developed quality plan should define the process of bringing equipment and automation into the blood bank. Most important, the medical director and the blood bank leadership must provide written approvals on the pre-plan as well as the summary plan.
Implementing LEAN management tools such as workflow mapping and considering the multiple applications and other platforms in the laboratory that will be impacted by purchasing new automation will decrease the challenges. Workflow mapping and staff feedback will create successes both for increasing the efficiency of the blood bank and transforming the organization’s ability to provide the best quality care.
REFERENCES
- McElhiney B, Tood H, Longshore J. Using Lean principles to design a centralized laboratory. Med Lab Mgmt. 2016; 5(10):2-7.
- AABB Standards, 30th edition, 1 Apr 2016.
Angela Gambone Hudson, USAF, BSC, is a Lieutenant Colonel serving in the United States Air Force as Commander, Laboratory Flight, Joint Base San Antonio-Ft Sam Houston.
Robert J. Curtis, USAF, BSC, is a Major in the United States Air Force and serves as Flight Commander, Diagnostics Services, F.E. Warren Air Force Base, Wyoming.
