By Lisa Fratt

 Nebraska Heart Hospital

It is an unavoidable reality of the health care business; hospital real estate is at a premium, and the top contenders for prime real estate typically include operating suites and emergency departments—not clinical laboratories. The increasing numbers of patients not only take up more space, they also require more service. Laboratories outside of the hospital environment face space constraints as well. Many labs across the country are coping with cramped quarters with technologists and phlebotomists tripping over each other as they complete their work.

Tiny rooms teeming with miscellaneous inventory and harried staff can create a difficult work environment. A number of laboratories across the country have overcome the shrinking space conundrum and reinvented themselves into tightly organized units. The results are impressive and can include improved work flow, enhanced clinical service, and reduced costs via better inventory management.

Several options allow labs to better use space. Some laboratories focus on storage solutions that allow them to better manage inventory. Others turn to work-flow analysis to improve processes and reduce foot traffic. And some tout the open lab concept as a means to achieve economies of scale. Others start from scratch with new construction. Each option can optimize space and improve processes. Determining the right option for a particular laboratory requires a fair amount of homework, but it does bring a significant payoff. This month, CLP visits with a few labs to learn about how they maximized their space.

 Spacesaver mobile systems are customized with drawers to organize small items.

Using Storage Solutions to Boost Space
“Space is always a problem in the cath lab,” admits Jackie Mendoza, cath lab team leader for Nebraska Heart Hospital, a state-of-the-art, 92,000-square-foot hospital that opened in 2003. The cath lab, like other departments, is being squeezed by several forces. For starters, more patients and more beds add up to a need to keep more materials on hand. Multiple specialty providers each require particular equipment and supplies. In the cath lab, catheters and stents arrive in boxes and packages that vary in size, and packaging size can change from month to month. Hospitals tend to want to cut construction costs, so even in new facilities, storage areas tend to be undersized. In fact, Nebraska Heart Hospital had not accounted for storage in its building plan.

When Mendoza joined the staff, one of her first orders of business was to design an efficient, affordable storage plan. The new hospital offered the luxury of starting at ground zero in an open space. Mendoza began the process by consulting with the operating-room team leader and listing criteria for shelving. The pair decided that shelves needed to be flexible, expandable, and movable. This would enable the lab to switch configurations as box sizes changed or inventory increased.

Mendoza presented her criteria to several vendors, including Midwest Storage Solutions, the local Spacesaver area contractor. A Spacesaver consultant worked with Mendoza to ensure that the storage system met the cath lab’s needs. For example, the consultant helped design a pullout storage system for catheter storage and customized the shelving unit to fit at the point of use within the cath lab procedure room.

“Supplies aren’t sitting on the floor. It’s in the room and readily available to staff, which cuts their frustration and increases utilization, so we can take better care of patients,” says Mendoza. There are patient- safety benefits as well. Packages are stored behind glass doors, which prevent dust and other contaminants from accumulating on shelves and supplies. A secondary benefit of the glass doors is at-a-glance locating of catheters, stents, and dressings.

The new solution appears to be well-equipped to stand the test of time. “I’ve changed the configuration four times already, moving shelves and boxes and adding bins,” says Mendoza.

Work-Flow Analysis
Healthsouth (Braintree, Mass) resembles hospitals in other parts of the country in that business is booming. In fact, Laboratory Director Don Newton believes the facility is outgrowing its space. But Newton, like his colleagues across the country, is managing to handle a growing procedure volume in the same 20- x 50-foot space.

Newton’s secret is simple. “I’m very conscious of flow from the staff perspective. I analyze internal and external lab flow to schedule the right people at the right time.” This includes minimizing foot traffic via careful placement of equipment.

In one of the laboratory arrangements, the centrifuge was placed in the back of the lab, while phlebotomy chairs were located side by side in the front of the lab. “The flow was similar to salmon swimming upstream; phlebotomists had to weave through technologists and ping-pong off of each other to reach the centrifuge,” recalls Newton. Newton devised a simple fix that had significant results. He moved the two phlebotomy chairs to the front corners of the room, so they remained easily accessible for patients. The centrifuge took front and center stage.

“Each phlebotomist had her own space and no longer had to snake her way through the laboratory to process specimens, and phlebotomists and technologists no longer bumped into each other on a routine basis,” says Newton. The effects of the changes rippled through the lab. The front-and-center placement of the centrifuge meant staff kept a closer watch on it and removed samples in a more timely manner. Staff took fewer steps to process samples and reduced the amount of back-and-forth traffic in the lab. The upshot? Samples moved through the lab faster, turnaround time decreased, and the error rate fell.

Naturally, the corner chair/central centrifuge configuration is not ideal for all laboratories. Each laboratory has a unique size, staffing model, and patient load. Nevertheless, lab directors can optimize the space in their lab with a careful analysis of flow, says Newton. “It’s important to analyze work flow at peak times. I spent a few Mondays watching patient flow and tracking samples through the process,” Newton says. Another key piece of the space-optimization process is staff input. “Solicit input from the people in the trenches. I’ve excluded supervisors from some meetings and invited front-line staff to share their ideas for improvement,” explains Newton, who claims moving just one piece of equipment from point A to point B can be very beneficial.

The Healthsouth laboratory includes a separate area for educational material and shelving for patient records. One space-saving option for some auxiliary equipment is off-site storage. Laboratories can rely on an extra refrigerator, with careful temperature monitoring, in another part of the hospital to save space, says Newton.

Newton, like Mendoza, realizes that space optimization is an ongoing process and that change is a constant. In fact, change can serve as an opportunity for improvement. For example, adding new equipment can help optimize space if the laboratory makes wise decisions. “Whenever a laboratory purchases new equipment, it should factor in the footprint,” advises Newton. That’s because the footprint represents an indirect cost in terms of space. “One analyzer might cost $5,000 to $8,000 more than another, but a smaller footprint may be worth the extra cost,” says Newton. It’s also important to determine where the new equipment will fit as the lab makes the purchase decision—not after, notes Newton.

Going Open
Another space-optimization option is the open lab concept, says James Alford Jr, director of operations for Life Sciences Institute at the University of Michigan (Ann Arbor, Mich).

The research lab implemented the open space concept and realized economies of scale and space. The open lab concept consolidates traditionally segregated laboratories into one larger space. The Life Sciences Institute merged 19 laboratories into one open space the size of a football field. A hallway bisects the room, and the entire space is segmented into 30-person quads the size of one to three conventional laboratories. Rooms that require darkness or other special accommodations for tasks like tissue culturing can be separated as needed.

The open arrangement provides economies and flexibility. Alford explains, “Typically, each lab is its own box with its own equipment such as centrifuges. The open lab concept allows us to share some equipment and decrease the overall number of centrifuges.” Open laboratories also can realize supply economies as gloves, syringes, and other disposables can be stored in one central area. “As one task or lab expands or contracts, we simply add bench spots,” says Alford.

Although economizing is key, there are other equally important benefits to this arrangement. “The real advantage is the increased collaboration made possible by this approach,” claims Alford. Alford offers some final advice to colleagues. “A good rule of thumb is that the more flexible you keep any space, the better off you are.”

 Acupath Laboratories Inc opted for an open laboratory design.

The New-Construction Option
Sometimes, no amount of rearranging or clever storage solutions can solve a laboratory’s spatial dilemma. Take Acupath Laboratories Inc, a specialty pathology and cancer genetics laboratory in Plainview, NY. Over the past several years, the lab has grown 20% to 30% annually. The business boom translated into tight quarters at the lab’s 5,000-square-foot facility. A thorough analysis revealed that the best course of action was to relocate to a new site. Acupath recently opened a new 23,000-square-foot facility that is a model of clinical laboratory work flow. In fact, administrative staff actually walk less in the 23,000-square-foot lab than in the 5,000-square-foot space because of the close attention paid to work flow during the 8-month design process.

 Each piece of Acupath’s equipment was measured to ensure the architects could design and build chemical-resistant countertops.

Executive Director Barbara Jurysta describes the design process. “The first decision the lab must make is whether or not it can reorganize its current space. This entails looking at the business plan of the company and comparing its anticipated use to building codes.” Building codes can be a real hurdle in new laboratory construction. “It’s important to get information about space allocation, storage, and research and development allocations in writing from the local building department,” says Jurysta. Another essential ingredient for success is constant and detailed communication with the architect of the new lab. Acupath Lab Manager Bhupendra Patel measured each piece of equipment to ensure that the architect could design and build appropriate chemical-resistant countertops.

 Acupath’s new laboratory, designed to handle 2,000 histology specimens daily, is built for the long haul.

In addition to homing in on the nitty-gritty details of new construction, laboratory directors must peer into the crystal ball, creating a lab built for the long haul. This means deciding what type of testing and services the lab will provide in 5 years. Acupath is designed for the future; the new laboratory is designed to handle 2,000 histology specimens daily rather than the current levels that hover in the 250 range. Also, the new space is designed to accommodate gene-rearrangement testing, even though the lab is not yet licensed for such testing. “It’s less expensive to design for this up front rather than rebuild in the future,” explains Jurysta.

Acupath opted for an open laboratory design with half walls separating some sections, including flow cytometry and cancer genetics. Although the open concept did not cut down on the amount of equipment, Acupath did consolidate some equipment in the same area to minimize foot traffic. The open configuration is more comfortable for staff and facilitates better ventilation than the traditional segregated lab, says Jurysta.

The new administrative space at Acupath is equally well-designed, with the proofing department located directly outside the pathology department. This means pathologists have instant access to secretarial assistance.

“This lab is designed for continuous work flow from specimen arrival to processing, proofing, and the final field package and report,” Jurysta says. Indeed, the Joint Commission on Accreditation of Healthcare Organizations dubbed Acupath a model laboratory. That “model” label is the result of a meticulous planning period, consultations with other labs, and the hiring of an experienced architect with previous laboratory experience, says Jurysta.

A well-designed laboratory space can bring numerous benefits, from improved work flow to enhanced clinical service and increased staff satisfaction. There is no single path to success. Lab directors need to account for their specific space and work flow and analyze all of the options, including storage solutions, a redesigned layout, and new construction, to devise a solution for the long-term.

Lisa Fratt is a contributing writer for Clinical Lab Products.