Hematology Workflow

Hematology

Whether yours is an all-purpose laboratory serving 27 physician sites across central Pennsylvania, or London’s largest single-site District General Hospital hematology lab, the inevitable day arrives: Workflow bottlenecks and over-taxed technicians strive to maintain quality and efficiency as volumes rise. Automation can make a significant difference, but automation alone won’t work effectively without a thorough analysis of existing processes, the right instruments and a willingness to think outside the box about workflow in your laboratory.

Probing the Reason Why Through Lean Principles

“I recently visited a lab where there were 25 full racks of samples to receive and test. They were from the day before because they couldn’t finish registering them from the previous day, let alone process them,” said Sergio Sanchez, North America marketing manager for workflow solutions at Beckman Coulter. “No lab wants to be working that way. They want to be the best they can be. And they are so busy that they can’t figure out how to stop and improve what is happening. So we talked about Lean principles, and challenging the status quo and thinking outside of the box. And the lab came up with so many great ideas. It was really powerful.”

Shawn Cotton, chief biomedical scientist, hematology department at Kingston Hospital in London, credits Lean principles with helping his laboratory re-engineer workflow to better handle the enormous number of samples arriving each afternoon from primary care practices throughout southwest London.

“The community work comes in between 3 – 5 p.m. in one big batch. The drivers arrive and there are mountains of samples dropped off in the reception area. And the acute work is still coming in, and must get tested and prioritized, so we had to find a better way to deal with the large volume of community samples arriving in bulk,” said Cotton, whose laboratory processes upwards of 27,000 full blood counts per month. “In the past, reception would barcode and label the samples from each batch before they came to us, then the samples would come to the lab where we would enter the information into the system and run the analyses. That would often lead to us having to track down information to enter into the system for the testing. With the Lean approach, no matter what the samples are, reception gathers them and puts them in a box and then barcodes, labels and enters the information into the system for all samples in the box before sending them to us for processing. It is a much smoother flow now that reception handles all of the steps in the process prior to sending them to us and the samples come to us in a more consistent way.”

Pre- and Post-Analytical Automation

Thinking outside the box also allowed Cotton – along with Laboratory Manager, Ann Marie Renard, and Assistant Laboratory Manager, Ange Ulrich, at Family Practice Center in Middleburg, Pennsylvania – to approach automation creatively as well. Both laboratories implemented an AutoMate sample processing system for all pre- and post-analytical ðprocesses in their labs, a first for hematology in their respective regions.

“When we first saw the AutoMate while visiting other labs, we thought, ‘Why do they only use it for chemistry?’ We put everything but swab cultures and urinalysis tubes in there. You’ve got to use it to its full potential,” Ulrich noted.

“That’s right. Seeing it used only for chemistry – no hematology, no serology – was heart-breaking,” Renard said. “We made the sample processing system the focal point of our lab, and all disciplines clover leaf from it, and then we all have our own little area and we are all equal distance from the specimens.”

Family Practice Center (FPC) also went from four staff working 8 to 10 hours a day “just doing pre-analytical sorting, getting the specimens analyzer-ready,” said Renard, to allowing two of these full-time staff to perform more valuable work. “We were able to free up two staff to do additional specimen prep, like plating our cultures, dipping our urines for us – all the things that you don’t need a technical person to do. They can be true lab aides now, making outreach calls to our providers to make sure that they have everything they need.” The same is true for FPC’s laboratory technicians. “Instead of spending time on things like sample aliquotting for a test, they can piece together the puzzle on a critical patient result and make sure it makes sense. They can focus on being a tech, and not just someone who runs the analyzer,” she said.

Cotton agrees. “With the sample processing system, our scientists spend more time looking at and interpreting the results they provide to the physicians. Instead of just saying ‘Here are the numbers,’ they can add value and offer some likely causes that are producing the numbers. It also frees up the senior members of our team to do their quality processes,” he said. “And there are other advantages. We have had a 40% increase in Hematinics test requests. Primary Care doctors are requesting more B12 and Folate screens along with blood work, such as when they are testing an elderly patient for dementia. The system is set up so that once we’ve run every possible test in hematology; it codes and racks the tubes to go to chemistry – and vice versa. It also sorts and receives all the samples, handles the retests and all the archiving. The archiving alone saves us so much time, as previously highly qualified staff were spending hours manually archiving over 2,000 tubes a day.”

Making Every Hour Count

One common misconception about Lean principles is that they promote cutting resources. In fact, says, Sanchez, the focus is on ðoptimizing resources. “An hour is huge. An hour saved is an additional hour of valuable thinking – being creative, working on more complex problems, working in teams. You free up your laboratory scientists from doing the repetitive tasks to doing more high-value tasks and analysis. They can spend their time now solving problems, like how to optimize their processes, quality and instruments further. There is never a lack of work in the laboratory – there is always more work than can be accomplished. The vision is about reassigning resources to more valuable tasks and accomplishing more.”

“We handle well over one million samples each year,” added Renard. “The ability to have high-volume tests on two analyzers, with both analyzers sharing the tests throughout the entire day, and to put low volume tests onto one specific analyzer all day, has really reduced any bottlenecks.” The lab also staggers maintenance times, so that prep and testing is always under way.

Kingston Hospital added a slidemaker stainer in hematology (UniCel DxH) to further optimize lab resources. “That by itself is saving us at minimum one man hour a day, every day. We direct the instrument about what films we need, and it makes the slides precisely and to our specifications,” said Cotton. “The clarity has allowed us to reduce the number of films we need to review. With the science and technology at the analytic level we review just 3% of the films now, which is so much better.”

“At the end of the day, it’s all about simplifying very complex processes in the laboratory. Take out the guesswork and standardize and get the higher quality and improved outcomes,” said Sanchez. Bill Bailey, North America senior marketing manager for Hematology at Beckman Coulter, agrees. “Process improvement is key. Automating a bad process doesn’t make sense. You analyze and improve the process, then automation can bring significant advantages.” Advantages that include improved workflow enhanced quality, cost savings and a fulfilled laboratory team.