Maximum Efficiency Data Management Revolutionizes Workflow at Akron City Hospital

Ever-increasing test volumes, multiple (aging) instruments, and a need for greater overall lab efficiency. In 2004, these factors caused growing frustration for Akron City Hospital’s chief of clinical pathology, Dr. Nickolas O’Donnell, and director of lab operations, Phyllis Barlette, who began researching the costs and feasibility of automation for the critical care laboratory. That same year, the lab manager position became vacant.

In January 2005, the position was filled by Allen Nickels and the tough work began.

A Need for Change
“The lab’s previous issues were substantiated immediately, and it was clear we had to improve our processes, as well as turnaround times,” explained Nickels. “We needed to address a few lengthy turnaround time outliers; shorten the specimen-tracking time for add-on testing; and re-engineer our overall testing process.”

Aging hardware only complicated matters—with some systems nearly nine years old—and the service contracts were expensive.

All things considered, it was time for change.

Teaming Up With Beckman Coulter
When Nickels joined the lab, the 525-bed hospital had already been researching automation and was close to final vendor selection. Nickels quickly concurred with the team choice for Beckman Coulter.

“Not only was Beckman Coulter more cost-effective, I felt the solution was simply a better fit for our lab’s needs,” he said. “It was more complete—front-end to backend—which was exactly what the lab required.”

By the end of 2006, the lab had completed the installation of a full Power Processor core automation system, with an automated centrifuge, aliquotter, labeler and 3,000-tube stockyard; two SYNCHRON LX 20 systems; a UniCel DxI 800 Access immunoassay system; an Access 2 immunoassay system; two COULTER LH 750 hematology systems with SlideMakers and a Slide Stainer; and a REMISOL Advance data management system.

“Once we put in the new analyzers, we saw improvements immediately because of their inherent speed,” he said. “With the addition of automated patient data, getting the results to the doctors became even more efficient.”

“In the past, our phones would be busy with requests for repeats or add-on tests,” he explained. “We committed our procedures and experience of our staff to REMISOL Advance and now the phones are quieter.”

REMISOL Advance to the Rescue
The final piece was the autoverification of results.

With the help of two Beckman Coulter application specialists, Nickels and his team soon implemented autovalidation on the lab’s DxI system to help speed the flow of test results to physicians. After building their experience level on that first implementation—and attending a one-day training course to further their knowledge—Nickels and Senior Technologist Barbara Heard felt confident enough to transition the lab’s two LX20s over to autovalidation on their own.

“Our Beckman Coulter specialists gave us excellent support on that second implementation,” he said. “They were there every step of the way, and the training class was worth its weight in gold. Together, these resources made the whole transition to autovalidation very simple and easy.”

Today, the lab is enjoying the fruit of this labor.   

“Before we got REMISOL Advance with Command Central, releasing results was more time consuming than it needed to be,” he said. “Our techs had to go to the each analyzer’s computer, pull up the results, review the patient on the interface and decide if anything needed review before finally releasing the results.”

All that changed once they installed REMISOL Advance with Command Central, and enabled autovalidation.

“Now, at least 70 percent of our specimens fly through without any need for technologist intervention—and those results get reported right away,” said Nickels. “This has really sped up our process, helping us report results more quickly. Today, the ER docs are very happy with us.”

“Before, the techs were stuck in testing processes that were workable, but far from ideal,” he said. “Now, we’re like NASA (National Aeronautics and Space Administration). Command Central does everything. A tech can sit in one seat and control the whole line, which runs the entire length of the room. This saves us valuable time, which can now be spent on quality improvement projects and the diagnostic testing correlations for which our technologists were trained.”

Impressive Results
“Before the switch, our lab had trouble hitting turn-around time (TAT) targets—our 60 minute goal was only reached about 75 percent of the time,” said Nickels. “We had plenty of outliers—and an even busier emergency department.”

That all changed once we got the automation system. Everything was being processed so smoothly, we no longer had a distinction between routines and STATs—they all went through equally fast. The lab reduced its ER target from 60 to 45 minutes—and began hitting that goal consistently.

In fact, the lab now reports 93 percent of all its results—both stat and routine—in under 45 minutes. This represents a huge reduction for routine tests, which used to require up to four hours before.

The lab was also able to consolidate immunoassay specimens being done by the special chemistry lab onto the automation line, reducing the number of tubes drawn on each patient by about 30,000 per year. The consolidation cut three chemistry analyzers down to two—thus decreasing maintenance and reagent costs.  Additionally, there were reduced labor costs of 6.7 percent, through attrition.

Meanwhile, workload continues to increase at a steady pace—roughly 10 percent annually—due to hospital growth, fewer send-outs and increased reference testing.

“Fortunately we can handle it because of our new processes—we’ve got plenty of capacity to grow,” said Nickels. “I no longer worry about any sort of surprise. If we do something for the community—like a health fair—and I’m going to have hundreds of prostate-specific antigens (PSAs) coming in, it’s no problem. We just throw them on the machine and it just keeps going full speed ahead.”

Peace at Last
Very soon, Nickels plans to add another UniCel DxI to his automation line and upgrade his two LX20s to UniCel DxC 800 Synchron clinical systems. Not only will this increase the testing capacity, it will double the reagents on board, which will help accommodate more incoming tests.

“Overall, I’m very happy with this new solution,” said Nickels. “If I could do it all over again, I definitely would. The thing I like best is the quiet. The phone hardly rings at all now—and our former inefficiencies are gone.”

Beckman Coulter, the stylized logo, SYNCHRON, UniCel, Access and COULTER are registered trademarks of Beckman Coulter, Inc. REMISOL Advance is a trademark of Normand-Info SAS.