Creating a lab for tomorrow, today
Staffed 24 hours a day, seven days a week, the Core Laboratory at London Health Sciences Centre (LHSC) is one of the hospital’s busiest areas that patients never see. Performing roughly seven million tests citywide each year, this lab analyzes thousands of tests and specimens every day. Each one of those millions of tubes has an important story to tell, one that can help a physician make a diagnosis or guide a critical decision about patient care.
The team of nearly 110 medical laboratory technologists, medical laboratory assistants, biochemists and hematologists in the Core Lab provide initial rapid testing and screening in the areas of hematology (blood), coagulation (blood clotting), and chemistry/immunochemistry (groups of tests that show the amounts of certain chemicals in a sample of blood).
When many of the systems and equipment in the Core Lab began nearing the time for replacement in 2016, the team saw a natural opportunity to create a lab for tomorrow and the technologists, administrators, medical, and scientific staff began to brainstorm just exactly what that ideal future environment could look like.
“We always knew it was about more than just replacing equipment,” says Mike Kadour, PhD, Director, Pathology and Laboratory Medicine (PaLM), LHSC. “Yes, a refresh project had to take place, but how we approached that was driven by our aspirations to create a world-class environment where our skilled staff would be able to provide the highest quality results in the shortest amount of time possible.”
With a strong desire to improve patient safety and advance the quality, efficiency, and delivery of diagnostic tests, the team identified priorities such as:
- Decrease movement and handling of samples to reduce the risk of human error
- Reduce the number of aliquots (small additional tubes of samples that are moved from one location to another for testing)
- Maximize automation
As a result, LHSC invested in automated diagnostic technologies that would increase efficiencies and volume. Now nearly 160,000 additional tests per year are able to remain in the Core Lab for complete testing, eliminating the need to physically transfer multiple blood samples between different laboratories.
The new equipment is also able to consolidate 30 additional tests to a single tube, reducing the need for patients to have multiple blood draws for testing. At Victoria Hospital, this has reduced the need for 44,000 tubes and at University Hospital 9,000 tuber per year from patients.
Today, all tube samples receive a barcode that contains the relevant information required to properly process it – the patient name, ID number, and all of the orders that the physician has placed are embedded in the barcode.
Tubes are delivered to the front-end station of the automated technology where they are photographed to check volume and quality, and then sent to the appropriate analyzing equipment for hands-off testing. If it needs a closer look, it’s done by professionals in a new dedicated manual testing area.
Another key investment was made to improve the process for add-on tests. In many cases physicians will order extra tests for patients following the initial test results. Across University and Victoria hospitals add-on testing is ordered approximately 15,000 times per month.
Before this meant that staff in the lab would need to manually seek out the original tube sample, add the test order to the queue, place it on the instrumentation to complete the analysis and share the results. In some cases, if the sample couldn’t be located or wasn’t suitable for re-testing, patients would need to have more blood drawn.
With the new technologies in place, Victoria Hospital now has an add-on buffer – an automated holding area for up to 1,000 patient tubes for future tests - as well as a 30,000-tube capacity automated fridge. University Hospital also has a 1,000-tube add-on buffer.
Today when called to add on tests, automation allows for the tube to be pulled from its holding buffer and automatically deliver it to the correct analyzer as well as return it to its original location for storage all hands-free.
Another significant improvement of the automated technologies has been the turnaround times – dramatically reducing the gap in processing times between urgent and routine orders. All orders are now processed between 15 and 60 minutes, where under the old system urgent orders would be processed within an hour and routine orders within four hours.
The new system achieves over 99 per cent success with meeting turnaround times, and the difference between urgent testing and routine testing is typically less than 10 minutes.
In addition to sourcing new equipment, physical changes to the laboratory spaces were needed. Without the option of temporary lab closures, this meant that staff had to work around the renovations as they were occurring and relocate to temporary spaces in other parts of the labs in a phased sequence.
“We dared to think big and commit the energy to transform ourselves, and there’s no question that was the right thing to do for both the organization and the patients we serve,” says Kadour. “Our teams have designed a lab that delivers breakthrough improvement today, but is also ready and able to continue innovating for our future needs. We have truly built tomorrow’s lab today.”