Investment in Automation and Efficiency Pays off for Small Hospital

Dameron Hospital Association, Stockton, CA
Perspective by Richard Wong, CLS, MT (ASCP),
Administrative Director of Dameron Hospital's Pathology Clinical Laboratory

DHA case study

Hospital Information
Dameron Hospital Association (DHA) is a fully accredited, 202-bed community hospital offering a full range of medical, surgical and health maintenance services for emergency and acute care. The system sees approximately 40,000 patients per year, averaging 120 patients per day. The lab is responsible for over 400,000 tests per year - 38% of those samples being blood and urine.

Dameron Hospital in Stockton, California may not be a large hospital when compared to some of the enormous health systems found across the U.S. but it has seen a tremendous increase over the years in the demand for fast, accurate testing from the microbiology lab. The lab's leadership quickly recognized that lab automation and better workflow optimization were necessary to meet the growing demand.

At the heart of the problem was the lab's Microbiology Pathway, and all the intervening steps between sample collection and patient care, were designed to meet the demands of a different time. The process was antiquated and unable to meet the demands for rapid turn-around-times, AST data, error reduction, growing patient populations, increased demand for testing, maintaining quality, and controlling costs.

"Automation, for me, was key to achieving the necessary improvements," "It was about freeing up staff for other tasks, letting the equipment do as much of the work as possible while staff is focused on analysis. That is where I felt we'd see the most improvement in terms of speeding up testing."

When Richard was approached in 2004 to become the administrator of the microbiology lab, he already was aware of the benefits of automation and LEAN Lab practices in hematology and clinical chemistry labs, so he insisted that the hospital take steps to automate as many micro processes as possible in order to realize significant improvement to turnaround times.

Wong chose bioMérieux's Full Microbiology Lab Automation solution because he was looking for a sole-source vendor he trusted and knew well. With help from the bioMérieux team, Wong realized that by implementing the PREVI® Isola, the lab would be able to fully automate its plate-streaking and could trust that cultures would be standardized and generated more quickly. Further, the PREVI Isola was easily integrated with the lab's Myla® middleware system and fit with the LEAN efficiency program the lab was implementing.

"I was recently in France and had an opportunity to view bioMérieux's Lab of the Future firsthand. It was clear to me that bioMérieux had a clear understanding on the path labs needed to take to evolve in order to address the challenges of test volume, resistant organisms and personalized medicine. I was able to see how instruments like the PREVI Isola could profoundly impact lab efficiency."

Dameron was one of the earliest PREVI Isola customers and the lab is very pleased with the investment.

"PREVI Isola is able to grow colonies much more quickly for isolation than manual streaking or other streaking equipment I've seen," Wong said.

After seeing the Lab of the Future, Wong was determined to discuss the need for investment in new technology with Dameron Hospital leadership.

"I think that's what most lab directors are afraid of; fighting for the money to make improvements,"
Wong said. "But it was important to the future of our lab. Having seen what is possible with a fully optimized lab, I was able to successfully make the point that investing in the lab will have tremendous cost-saving benefits, as our better turnaround times will ultimately help guide more effective patient therapies."

Richard Wong, Administrative Director of Dameron Hospital's Pathology Clinical Laboratory in Stockton, CA, is one of the earliest PREVI® Isola Customers. "The instrument grows colonies more quickly for isolation than manual streaking or other streaking equipment I've seen," he says.

 Richard Wong

Today, Dameron's microbiology lab utilizes several bioMérieux technologies; optimizing their Microbiology Pathway. In addition to the PREVI® Isola, the lab uses PREVI® Color Gram, BacT/ALERT® 3D, miniVIDAS®, Myla® and VITEK® 2 for identification and antibiotic susceptibility testing. Additionally, the lab recently implemented MALDITOF mass spectrometry as a research-use only tool for rapid identification. In addition to the improvements in automation, Wong worked closely with bioMérieux's Performance Solutions team to evaluate his lab from a LEAN perspective in order to determine areas for efficiency and workflow improvements.

"It is important to understand the pathway the specimen takes through your laboratory in order to understand where 'waste' may exist," Wong said. "Waste such as excessive motion and transportation can easily be identified by following the life of a specimen in your lab."

bioMérieux's Performance Solutions team was able to identify additional waste opportunities in the Dameron Microbiology Pathway, particularly as they applied to urine cultures. By automating thisprocess Dameron was able to reduce the time-to-the-incubator for each culture, removing the waiting period that used to be standard.

Additionally it was found that positive urine culture turnaround time was higher when the specimen wasreceived at night. It was clear that this occurred due to Dameron's lack of a night shift. Similarly, thefact that there was no night staff delayed results from the VITEK 2.

Laboratory design was also evaluated. In deciding where to place new instruments, the team reviewedworkflow from the LEAN perspective and made the recommendation to eliminate excess transportationand motion. All equipment is now placed in close proximity of the actual work related to that particularvalue stream.

"We have made numerous improvements to Dameron's Microbiology Pathway since the May 2011 LEAN assessment and we are seeing great results," Wong said. "We've established two start times and eliminated much of the unnecessary testing that was going on. We've added E swab cultures and installed Myla middleware for better information sharing throughout the system. We're seeing significant reductions in our turnaround times due to our use of the PREVI Isola for streaking and producing better colony growth. I also give a lot of credit to the workflow improvements we've implemented with bioMérieux's help."

Despite its relatively small size, Dameron's investment in its microbiology lab through automation and efficiency improvement make it a model for other systems across the U.S. looking to manage high volumes and produce accurate results with fast turnaround times.