Planning the Hospital Laboratory — Ten Key Questions
By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Winter 2016
www.spacemed.com
Laboratory testing has grown from a manual, “hands-on” process providing a simple test menu — with staff organized by testing methodology or discipline in multiple small rooms — to an automated, multidisciplinary, high-volume instrumentcentric clinical enterprise. A visit to a hospital laboratory today reveals a varying
array and number of instruments, often operating with little human intervention.
While test volume and staffing were once used to determine the amount of space in
a laboratory, today, the instruments and degree of automation dictate the test volume capacity. The number of staff required to support the instrumentation is then
determined.
The following ten key questions should be addressed prior to planning space for a
hospital-based laboratory:
What laboratory services will be provided? Although a full-service laboratory will
include outpatient specimen collection, central specimen processing, core clinical
laboratory, transfusion services (blood bank), microbiology, molecular diagnostics,
and anatomic pathology, most healthcare centers will not need all of these components. In fact, many hospitals only need a central specimen processing area, a
highly automated core laboratory to provide quick turnaround testing (with hematology, chemistry, coagulation, and urinalysis), and a blood bank. Some laboratories
may operate an aggressive outreach program involving marketing and selling tests
to physicians’ offices, other hospitals or clinics, nursing homes, veterinarians, and
other organizations. A courier service is used to pick up the specimens and bring
them back to the laboratory for testing. Space must be provided for specimen receiving and processing, courier management, and supplies, along with convenient
parking and easy laboratory access.
How will specimens flow through the laboratory? Most specimens are either
carried into the specimen processing section by couriers, hospital staff, or phlebotomists, or arrive via a pneumatic tube. Pneumatic tubes are used in most U.S.
hospitals to transport of blood and urine specimens, as well as blood products and
tissue samples. Specimens and paperwork may also be transported by autonomous mobile transport robots. Specimens move through specimen processing into
testing areas and most are stored for a period of time (typically a week) before they
are discarded. Anatomic pathology and microbiology specimens, and frozen sections and gross anatomy specimens from the surgical suite, may be taken directly
to the respective testing area.
What instrumentation and automation is planned? The instrumentation required
to perform the test menu in the laboratory, and the degree of automation, are the
primary drivers of space. In the automated laboratory, a very large volume of tests
can be performed on one analyzer run by one person. Full automation lines can
connect many analyzers and require very little staff interaction other than loading
them and making sure supplies are sufficient. Each instrument requires space for
the instrument itself, supporting computers and printers, and an open area to hold
and prepare samples.
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Planning the Hospital
Laboratory — Ten Key
Questions
Continued
Clinical laboratory automation also involves the integration or interfacing of automated or robotic transport systems, analytical instruments, conveyor or track systems, and pre- and post-analytical process equipment such as automated centrifuges, decappers, aliquoters, recappers, sorters, and specimen storage and retrieval systems. In addition to the electrical and mechanical interfaces of these
various components, the computers that control them must also be interfaced to
each other and the laboratory information system. The vendor specifications will
dictate the footprint, appropriate clearances, and supporting infrastructure and, in
the case of a total laboratory automation system, the vendor may assist with the
design and layout of the space.
Automated Laboratory
Incoming
Specimens
Central
Specimen
Processing
Pre-Analytic
Automation:
- Centrifugation
Post-Analytic
Automation:
Automated
Laboratory
Instruments
- Decapping
- Aliquoting
- Sorting
Robotics/
Conveyor/
Track
Systems
- Recapping
-Storage
- Retrieval
Robotics/
Conveyor/
Track
Systems
Laboratory Information System
What front-end automation will be used? Preparation of samples for testing
includes receiving them into the laboratory information system to verify and confirm
the orders and labeling. Depending on the level of automation in the laboratory, the
specimens will either be placed on the automation line for front-end preparation, or
manually centrifuged, aliquoted, and sorted into racks. From a facility planning
perspective, this automation should run directly from where specimens are received
to the testing areas.
How will specimens be stored? Archived specimens can be placed in a centralized area, such as a walk-in refrigerator in the specimen processing area, or in a
refrigerator in the section where testing is done. In fully automated laboratories, the
archiving can be part of the automation line. This will not eliminate the need for
space to archive the non-automated testing and the spillover as the automated
equipment reaches capacity. The overall space need will depend on the type and
volume of tests being performed and the standard time the specimens are retained.
When the specimens are no longer needed, they must be discarded into biohazard
bags for disposal. In small laboratories, red bag receptacles may suffice; in larger
facilities, a separate biohazard storage room will be necessary.
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Planning the Hospital
Laboratory — Ten Key
Questions
Continued
How much bulk storage space is required? Refrigerated and room temperature
storage is required for reagents and supplies. The amount of space required for
storage will depend on the size of the laboratory and the materials management
procedures deployed.
Where will outpatient specimen collection occur? With hospital-based
outpatient services increasingly centralized to enhance patient convenience and
expedite treatment, outpatient specimen collection is routinely co-located with other
outpatient services. Alternately, outpatient specimen collection may be performed
at the point-of-care — within a physician office, clinic, or specialty treatment area. A
small phlebotomy area may be provided within the hospital laboratory to be used
during hours when outpatient areas are closed.
Where else will testing occur? The proliferation of point-of-care testing in recent
years adds another dimension of complexity to laboratory services planning. Immediate results are provided using tabletop analyzers and handheld devices at the
patient bedside, in the emergency department, and in outpatient and other clinical
areas which expedites patient care.
What type of education programs will be provided? Education programs —
typically found in large hospitals or academic medical centers — may require a
significant amount of space in the laboratory depending on the training programs
offered. This may include classrooms, study areas, and administrative offices and
workstations, as well as practice equipment for students in the technical areas.
What about the blood bank? Minimally invasive surgical techniques, along with
new transfusion guidelines, have dramatically reduced the utilization of blood products within the hospital, which impacts the amount of space required for immunohematology and the storage of blood products.
All of This Requires Increased Flexibility
Laboratory automation continues to evolve, with more and more testing procedures
placed on large analyzers and integrated with an automated system. Some
technology and instrumentation is changing as often as every two months. New
automated platforms are being introduced for microbiology and anatomic pathology
that will transform the traditional layouts of these sections. The storage of
specimens, slides, blocks, and supplies is also becoming more automated. Flexible
casework systems, adjustable-height countertops, and overhead utility systems,
which allow rapid connections for gases, water, power, data, and air, without major
renovation, are becoming standard in clinical laboratories. Over time, an open,
flexible space facilitates transitioning into new technologies with increasingly
higher-volume testing capabilities. As a result, less space and less staff may be
needed.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC in
Ann Arbor, Michigan (www.hayward-assoc.com).
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