By Sarah Schmelling

The laboratory at Mercy Medical Center, a 387-bed, not-for-profit health care and level II trauma center in Rockville Centre, NY, has not had its modular preanalytic solution in place long—just since September of last year. But for Luann Regensburg, administrative director of clinical support for the lab, the results of the solution’s implementation were immediate, and have made a world of difference. “We are extremely happy with it,” says Regensburg, who has worked at the medical center for 17 years. “We’ve seen huge benefits.”

Pictured with the Modular Pre-Analytics-3 and Modular PPE solution is Pat Demetriou, LIS manager; Steve Buenviaje, technologist; and Calvin Graham, evening/night supervisor.

The medical center is a busy facility, employing more than 1,800 people, and is known best for oncology, physical medicine and rehabilitation, orthopedics, maternal and child health, and behavioral health services. The center is one of five acute-care hospitals within the Catholic Health Services of Long Island, and it has consistently received accreditation with the Joint Commission on Accreditation of Healthcare Organizations. The lab, says Regensburg, has a microbiology department, a blood bank, a “typical” chemistry lab, hematology, pathology, and point-of-care testing. There are currently 56 full-time employees (FTEs), with 45 on the technical staff; and the lab conducts approximately 1.5 million tests per year, 28% of which are stat tests.

In such a fast-moving place, Regensburg and her colleagues last year faced the same challenges many labs are coming up against: How do you handle increased volume when the number of new technologists available for work continues to drop? How can you overcome the rising costs of medical testing? And how can you reduce the time it takes for a specimen to be tested while also lowering risks to safety?

Regensburg believes the lab has solved all of these problems through an automated, preanalytic and analytic modular system from Switzerland-based Roche Diagnostics that streamlines the testing process, reduces costs, and helps refocus the staff on the tasks for which they are most needed.

The Dilemma
The first challenge the lab noticed when they began to consider streamlining solutions was the continuing rise in the volume of specimens needing to be tested. The trend was a steady increase of about 3%, Regensburg says. Then there were the rising costs in reagents. “It was estimated in 2004 that we would be spending approximately $940,000 per year on reagents,” she says. “And that is not a nice place to be.”

There was also the staffing issue. Regensburg explains that from 2000 to 2001, the lab was consistently open one FTE. In the 2002–2003 time frame, they were open two FTEs; and by 2004, before the solution was implemented, they regularly had 3 to 3.5 vacancies, “which makes it really hard to get what needs to be done,” she says.

It was becoming increasingly difficult to attract new technologists to join the staff, she explains, due to both the national reduction in medical technology training programs and the fact that on Long Island, where Mercy is located, there are only two such accredited programs graduating about 20 to 25 technologists per year. And those persons have the choice of 20 different hospitals in the area, not including those in nearby New York City.

Mercy was also losing potential technologists to physician assistant programs. “We noticed that medical technologists have more options today,” Regensburg says. “Years ago, if you wanted to go on to be a doctor, you were talking about 4-plus additional years. But now you’re looking at just 2 more years, and that’s tempting a lot of these students to go on.”

Furthermore, Regensburg knew that the lab, which ran 18 billable tests per work hour, was already above average in productivity and couldn’t handle additional tests, especially as the number of FTEs continued to decline. In addition, the lab had relatively old equipment, ranging from a few to 15 years of age, and all of the equipment required one technologist per machine. “With the staffing we had, we just couldn’t afford it anymore,” she says. “We had to make some changes.”

Finding the Solution
Once the management team of the Mercy lab determined what their biggest challenges were, they had to find the right equipment to overcome them. Regensburg says they decided to go about making this decision in an unusual way. “Traditionally, you go out there, and companies show you what they think your size of hospital should have,” she explains. “Then, you take that solution, and you build your work processes around that equipment. You would replace box for box—for example, take out two chemistry analyzers and put two new chemistry analyzers in—and then fit your processes around those new analyzers.”

However, Regensburg, the chemistry supervisor, and the chemistry lead technologist chose to take the opposite approach. “We said, ‘We’ve got to be visionaries here,’ ” she says, explaining that they thought the box-for-box method wasn’t going to work for the lab as they progressed. “So we asked, ‘What is the process that we want for the lab? Let’s draw it out. What do we want to see happen?’ And then we went out and found the company that fit our vision the best way possible.”

In the analysis of the lab’s processes, they first studied where time was spent in different areas. They had to determine where the “nonvalue-added” tasks were. For example, how much time was spent moving specimens from machine to machine? How long were specimens waiting to go into the centrifuge or onto the analyzers? They realized there was quite a bit of unnecessary time spent on small tasks that weren’t vital to the testing process. Regensburg says that, especially with the number of FTEs decreasing, they had to look at ways to eliminate some of these smaller tasks, and get the technologists doing what they needed to do: evaluating the results at the end of the line.

With this in mind, the group began to focus on preanalytical tasks such as centrifuging, decapping, and aliquotting, the work that “techs spent all day long doing,” Regensburg says. “We wondered if there was something out there that can do all of that for you, so we could get our staff where they need to be.”

Once they knew that this was what they wanted, it was easier to go to the different equipment vendors and say, “Show us what you’ve got to fit our processes,” she says. They first narrowed their search down to five vendors, and asked them what they had for both preanalytical and postanalytical steps in the lab. They ran into a variety of answers. Some of the solutions, Regensburg says, at first looked as if they did the preanalytical steps, but they turned out to be more like specimen-transport systems that didn’t really do all of the needed tasks. Others, she says, did have those functions, but were not connected to the analyzers, which meant adding the step of a technologist putting the specimen on the machine. But the Roche system, they noticed immediately, is a “continuous line from point of entry to point of exit,” she says. “And we thought that made sense; the shortest distance between two points is a straight line.”

The lab then went back to the three remaining companies that offered preanalytical solutions and asked them, “Where are you going to be in 3 to 5 years?” She explains that they wanted technology that could grow with the lab, because the way they manage now will be different in a handful of years. Regensburg also knew that if she changed 90% of her lab then, she would never be able to convince the hospital’s administration to change it again when they grew out of the new equipment.

In the end, Roche not only had the solution for all of the preanalytical tasks, but they also had a modular system with equipment that the lab could grow into, Regensburg says. “We bought the Modular Pre-Analytic 3, but we can grow into a 7,” Regensburg explains. “So it has more potential. If my volume exceeds my current centrifuge capabilities, I can plug in another centrifuge. I can add a recapper when I have the money. You can snap pieces together like Legos.”

The system includes the core unit, a centrifuge, a decapper, and an aliquoter—in short, it handles all of the preanalytical steps that the lab once had to pay a technologist to do, Regensburg says. Now, they’re paying the technologists to do the tasks that are fundamental to their jobs.

Mercy Medical Center purchased the Roche system in July 2004, and on September 20, it was up and running.

The Outcome
In the time the system has been running, victories have taken place in a variety of areas. In staffing, the lab now has two open spots for FTEs—down from the 3.5 positions that were vacant prior to the solution—and just one FTE vacancy from midnight to 8 am. During this night shift, where Regensburg says some of the greatest benefits have come about, a technologist who used to have to run back and forth between up to four different analyzers now simply puts a specimen on the front of the system and waits for the result at the end of the line.
The environment of the lab has changed, too. “We used to have a very harried setting,” Regensburg says. “Phones would be ringing off the wall. People would be yelling, ‘Do you have Mr Smith’s specimen? I need to run it on this analyzer.’ And then you always had someone saying, ‘Check the centrifuge,’ but it was stat, so what was it doing in the centrifuge for so long? Was anyone paying attention to it?”

Now, she says, for the 90% of the tests that the system handles, there is just one entry point and one exit point. “We’re getting our results out prior to the doctors leaving for their rounds. Phone calls are minimal,” she says. “We’ve been doing demos and tours, and other laboratories are just astonished at how quiet it is. The results are out, so there’s no need for anyone to call. There’s no need to check in the centrifuge because specimens no longer wait in the centrifuge.”

Altogether, she says, the lab has been able to cut out about 30 minutes of time spent on preanalytical tasks. They’ve gone from 18 billable tests per work hour to 29, primarily due to eliminating the preanalytical steps. With the reallocation of 1.5 FTEs in staffing, the salary cost per billable test has decreased by 48%, and the lab saved $108,000 in the first quarter of 2005 over the same period in 2004. “These are very big numbers,” Regensburg says.

Regensburg also notes that these improvements have had an impact on the length of stay for patients. If the results of a test get to physicians before they make their rounds, she says, they can write the discharge orders on those rounds, instead of waiting a whole extra day “pending lab results.”

In fact, the testing process has become so fast, there is no longer a need for priority testing for stats. “In my mind, if you have the right process, and you’re getting all of your routine tests done in a timely fashion, there’s no difference between a stat and a routine,” she says. They are now tracking to determine if the number of stat tests ordered has been reduced, which would make sense, as so many stat tests are requested simply because routine results haven’t been returned.

Conclusions
The system, Regensburg says, has posed a minimal amount of problems, especially considering that 90% of the chemistry lab was changed out. She believes they had fewer problems than if they had replaced their equipment box for box.

Other labs would do well to follow this kind of model, she explains, adding that with the way medical lab technology is going, labs “really don’t have a choice but to start looking at that front-end piece.” Simply put, since the pool of available medical lab technologists does not seem to be growing, “We definitely have to move away from that old mentality of one box per FTE,” she says, speaking from experience. “That just wasn’t going to do it for us anymore.”

Sarah Schmelling is a contributing writer for Clinical Lab Products.