|Stormont-Vail’s new patient pavilion spurred the creation of an efficient new pneumatic tube station and bench for its lab.
When the lab at Stormont-Vail Regional Health Center, Topeka, Kan, was told its hospital would be opening a brand-new emergency and trauma wing—all but guaranteeing an increase in specimen volume—the lab knew it would have to implement some big changes to keep pace. The problem seems familiar enough, but the lab’s forward-thinking, Lean-like solution was anything but.
Stormont-Vail Regional Health Center, a 586-bed acute care referral center, is in the midst of a growth spurt. Designed to keep up with an annual 5% increase in emergency department (ED) patients, a new four-story, 120,000-square-foot patient pavilion—which boasts a new emergency and trauma center, inpatient beds, a clinical decision unit, and a critical care unit— opened in June 2009.
Currently, the Stormont-Vail lab is responsible for performing reference work for not only its own burgeoning health care community but also for a variety of smaller hospitals and clients. With demand for lab services streaming in from all directions, the lab was forced to take a close look at its own efficiency.
“We felt that we had gotten as much improvement as we could with the processes we had,” says Shelley D’Attilio, MT(ASCP), the lab’s manager for chemistry, cytology, and histology, who has been with Stormont-Vail since 1992. “There was no way really to control the amount of time that it took once the specimen was sent by the emergency department to when it got on the desk in chemistry and could be spun down.”
No one wanted to have to put point-of-care analyzers right in the ED. However, to continue keeping its head above water with a potential flood of new specimens pouring in, the lab knew it would have to improve its current workflow.
Fortunately, the right solution was only steps away. The lab already had a fully functional pneumatic tube system in place, which zips samples from the point of care right into the lab for testing, much like the chutes used to send checks at a drive-through bank. But the existing tube station was a trek from the lab’s centrifuges and analyzers, and ferrying samples over to the testing area and back took techs a considerable amount of time. With construction soon to begin on the new wing anyway, the obvious solution seemed to build a new tube station right at the main testing area.
“We built a new station directly into the core lab in-between chemistry and hematology,” D’Attilio explains. Anticipating increased volume from the new hospital wing, the new station, and adjoining bench, was built to exclusively link the lab and the emergency department.
“Our goal was to improve our services and turnaround time,” she says. “And hopefully limit the introduction of point-of-care testing in the emergency department.”
The entire process from conception to implementation took about 9 months total, which included about 2 weeks of in-lab construction. Finally, the lab began its trial period in late January 2009.
To further speed up turnaround time, the lab also purchased new StatSpin Express 4 centrifuges from Iris Sample Processing, Westwood, Mass, and placed them right at the new core lab tube station.
Before purchasing the StatSpins, the lab had tried another centrifuge near the tube station, but it didn’t quite stack up. “The footprint was a little bigger and it was a little bit noisier,” D’Attilio says. The real deal breaker, however, was the noise. “It was just too loud,” she says of the site’s previous centrifuge. At the time, the tube system did not have an audible alarm signaling when a specimen arrived. “If you had a centrifuge roaring right next to your head, it was very difficult to hear the tube drop,” she says.
The StatSpin Express 4 is a high-speed horizontal centrifuge that can provide separation in as little as 3 minutes and can process as many as eight samples at once. The StatSpin’s compact footprint was an added bonus, allowing the lab to nestle it directly adjacent to both the tube system and chemistry analyzers—perfect for the lab’s limited workspace.
And while centrifuges are generally some of the most stable lab equipment, D’Attilio praises the centrifuge company’s responsiveness to any problems that might arise. “We actually had an issue when we first got it, when it was in its demo period,” she says. “We called Iris tech support, and they talked us through it and were really great.”
Results Are In
Before building the new emergency-exclusive tube station and STAT bench, the lab was experiencing a veritable traffic jam of specimens from all over backing up in the tube and waiting to be spun. Now, after specimens are collected and labeled in the ED and sent through the tube system, they are ready to be spun and put directly on the analyzer—all in one shot. The results are then interfaced with the lab’s laboratory information system and even auto-verified.
Many techs, however, expressed some initial trepidation about unwanted expense and potential inconvenience the project could bring, and D’Attilio remembers the techs asking if they would even see a decrease in turnaround time.
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The results, however, spoke for themselves. Using national benchmarks, the lab discovered just how big a difference the seamlessly integrated tube station and centrifuges have made. In April 2008 the lab had about one quarter of its specimens verified within 30 minutes of receipt in lab, with most, 70.4%, completed in less than 45 minutes. Just 1 year later, post-implementation, a stunning 63% of all specimen samples were being returned within 30 minutes, with only about one-third taking up to 45 minutes or more.
“You can see the marked improvement,” D’Attilio says of the impressive new numbers—which have been prominently posted on a side of the tube system for all to see.
“The project has required everyone to get on board—even those who were skeptical and resistant,” she says. Improved numbers have led to improved attitudes among techs working the new station, and D’Attilio is grateful for the way her team has stepped up to the plate. “I think it definitely shows,” she says. “We’re very proud of the improvement.”
Stephen Noonoo is associate editor of CLP.