Century City Doctors Hospital in Los Angeles, has placed itself on the leading—and luxurious—edge of health care. Operated by physicians, equipped with cutting-edge technology, and offering patient amenities that read like a hotel room guide (read: flat-screen televisions, movies on demand, and wireless Internet access), it is no surprise that the clinical laboratories are equally futuristic (read: automated, paperless, and compliant).
Sarina Rodriques, CLS, MT(ASCP)DLM, the hospital’s laboratory director, oversaw the installation of the new labs during the hospital’s year-long renovation. Formerly a Tenet Healthcare Corp (Dallas) facility, the hospital changed hands in Spring 2004 and reopened in stages beginning Fall 2005 after an extensive renovation.
The new owners, the Salus Surgical Group of Beverly Hills, Calif, wanted to create a new model for health care delivery—one that focused on the patient and used leading technology to achieve greater efficiency and better care. They invested $100 million to completely refurbish the building and purchase equipment to create a paperless system.
For the new laboratories, Rodriques was given two rooms to work with and could modify them as needed as long as she did not knock down walls, exceed her budget or time frame, or fall out of code. Rodriques started by developing goals, which included full automation, single-vendor use, high efficiency, physician outreach and business development, and a happy and experienced staff.
Rodriques notes that it has been a learning process, but 1 year after the hospital’s opening, she has met most of her goals—a fact she attributes to her devotion to the project. “I did give up my life for a short while, but you never want to look back and say, ‘Why didn’t I know that?’ or ‘If only I had known.’” I micromanaged the project, but there are a lot of things you can’t control, so it’s important to control what you can,” Rodriques says.
She explains that micromanaging for her meant being involved in every process, but not necessarily every step. “For instance, I didn’t actually write our policies and procedures, but I provided direction and edited the final draft,” Rodriques says.
Much of her attention was focused on the vendors. Rodriques held regular conference calls with them a minimum of once per week, but sometimes every few days. “Vendors may have five or six projects going on, and you have to be persistent,” Rodriques says. She insisted every vendor have a project manager for the Century City project.
One of Rodriques’ goals was to completely automate all of the laboratory disciplines, including hematology, chemistry, coagulation, blood banking, and front-end sample and centrifugation management. But because of the short time frame, another goal was to work with as few vendors as possible. “The ability of vendors to collaborate was extremely important because we had such a short period of time. I really wanted one vendor to provide all of the automated systems,” Rodriques says.
Rodriques came close, selecting a number of instruments from Bayer HealthCare Diagnostics (Tarrytown, NY): the Advia LabCell for sample preparation; two Advia 1650 chemistry systems; the Advia 2120 hematology system; the ACS 180 SE Automated Chemiluminescence System; and the Clinitek Atlas, part of Bayer’s Advia urinanalysis family. An STA-R Coagulation Analyzer from Diagnostica Stago, Inc was sold to CCDH and is also linked to the Bayer line.“Bayer and the coagulation vendor were a good match, because they had worked together in many places and there was no concern that there would be a clash between the instruments,” Rodriques says.
Rodriques wanted systems that could handle a large capacity. Currently, the system is running at only about 10% of what it can handle, Rodriques estimates. She expects the lab to build its volume five- to tenfold rather quickly and didn’t want to have to buy new analyzers.
For blood banking, automated instruments from Wyndgate Technologies (El Dorado Hills, Calif) and Ortho-Clinical Diagnostics Inc (Raritan, NJ) were selected. These do not link to the Bayer LabCell line (and are located in the second smaller room), but they do interface with the information system.
The information system was the one vendor choice Rodriques did not influence; the NOVIUS Lab information system from Siemens Medical Solutions (Malvern, Pa) had already been selected. “We had to take a leap of faith that all the automation systems would integrate with the information system,” Rodriques says. She was relieved to discover that someone had already been able to link to Bayer’s CentraLink network using a middleware product from Data Innovations (South Burlington, Vt).
With the laboratory information system (LIS) and the automated systems, laboratorians could potentially not touch samples at all, or paper. The LIS is easily accessible on computers placed strategically around the lab, and any monitor can show the status of any instrument. “We can access any instrument screen from the computer. We can access documents, the quality control program, and the Internet,” Rodriques says.
Customization means that alerts are produced according to when the lab’s protocol dictates they are needed. For instance, the system cautions the lab technologist when a result has not been completed within 30 minutes and alerts him with red at 45 minutes.
The LIS, in turn, interfaces with the hospital’s electronic health record so the laboratory can access information needed from the patient’s medical record and physicians can access results electronically. The paper trail has been eliminated. Workflow benefits at both ends, with more accurate ordering and efficient results delivery.
Efficiency is one way that hospital ownership has envisioned providing better patient care, but it also helps with a staff shortage. Having everything automated enables the lab to run at high efficiency with fewer full-time employees than would be needed with a more conventional setup. Rodriques cites the difficulty in finding clinical laboratory scientists (CLSs) as one of the main drivers for this push. “We run very lean,” she says.
Currently, the day shift is staffed by two technologists; one handles blood banking and the other microbiology. Evenings and nights are staffed by one technologist. Rodriques would like to add a technologist to manage the line, and as volume grows, she expects to add another.
The lab, however, has been challenged with retention. Rodriques’ original staffing goal was to attract high-level CLSs and laboratory employees with a passion for laboratory science and pride in their work. And the lab has hired employees who love the technology. “But retention has been difficult as they realize how demanding a start-up laboratory can be,” Rodriques says. She cites scheduling and multiple projects as issues.
Those who haven’t been frustrated have been lured away by other jobs. “Once a CLS has worked in our lab, they’ve been exposed to the future state of laboratories and find themselves in high demand,” Rodriques says. Some have wanted to grow their careers more quickly; others prefer to stay in one department and not multi-task.
“I’ve begun to rethink this strategy and to hire a few CLSs at a reasonable salary who I expect to hang around a little longer and who don’t mind routine bench work with growth potential,” Rodriques says.
Rodriques is sympathetic to those who found starting up a lab to be too much of a trial; there were many challenges. “We were sometimes without air conditioning. Other times, we had to send people home because we had no electricity,” Rodriques says.
She acknowledges that some of the biggest challenges were presented by construction. Four configurations were evaluated, and Rodriques worked with her vendor to develop these options. Though Rodriques didn’t knock down walls (which would have created greater delays), she did have counters and cabinets removed; a new floor put in; and the electrical wiring, plumbing, and air conditioning redone.
“California has a lot of special requirements, and the seismic retrofitting rules are very rigorous. Because we were considered new construction, we had to have a surveyor on-site full time. He wouldn’t let us proceed with any project until he had signed off on it,” Rodriques says.
Everything heavier than 400 pounds had to be bolted to the walls and/or anchored to the ground. “And not just anyone could do it. You had to turn in architectural drawings and get an approval stamp before proceeding with the work,” Rodriques says. Many delays were subsequently due to construction.
But at the same time, laboratory staff was trying to complete validations. Not only was this done in a construction zone, but because the hospital was not yet licensed, obtaining samples for validation also became a challenge. “We couldn’t even draw each other, so we had to ask other hospitals for specimens,” Rodriques says.
But the work got done and construction eventually finished. Looking back, Rodriques would not have changed her methods. Now, a year after opening, the lab is moving ahead with another goal: building business. She estimates that testing volume needs to double to realize the full benefits of the lab, including maximum cost savings. She first aims to grow the laboratory’s outreach with active physicians. “We are slowly starting this process,” Rodriques says.
Renee DiIulio is a contributing writer for Clinical Lab Products.