Located in Southern Pennsylvania, approximately 70 miles west of Philadelphia, sits Lancaster General Health Laboratory, part of Lancaster General Hospital (LGH). This 533-bed, nonprofit hospital is part of Lancaster General Health/Penn Medicine, a member of the University of Pennsylvania Health System (Penn Medicine). LGH offers a full range of tertiary services. It also includes the Women & Babies Hospital (WBH), a 97-bed specialty hospital and adjoining outpatient center focused on the healthcare needs of women at every stage of life and their newborn babies. LGH is also part of the Ann B. Barshinger Cancer Institute (ABBCI), a state-of-the-art facility offering access to a multispecialty network of professionals.
2018 marked the 125th anniversary of the institution and its service to the Lancaster Community. Designated a Magnet hospital for nursing excellence four consecutive times, LGH has been recognized regionally and nationally for clinical excellence and patient safety. Recognized among U.S. News & World Report’s Best Hospitals for 2017-18, LGH was also ranked sixth among Pennsylvania hospitals and named Best Regional Hospital.
Lancaster General Health Laboratory serves 75 percent of the county’s healthcare market. The lab is accredited by the College of American Pathologists (CAP) Laboratory Accreditation Program, CAP ISO 15189, AABB, and FDA. There are two fixed laboratory sites serving the system with multiple point-of-care testing (POCT) sites serving 16 ambulatory locations. The laboratory system at Lancaster General Health holds 19 CLIA Certificates, including High Complexity, Moderate Complexity, and Waived.
The laboratories offer a full range of clinical laboratory and anatomical pathology services including (a) General Laboratory Testing of Individual Lab Tests at LGH and WBH, (b) Pathology and Cytology Services, (c) Microbiology Testing, and (d) Blood Bank & Blood Bank Donor Center.
The laboratory completed a multimillion-dollar expansion in 2014. The original square footage of 28,000 expanded to a 43,000-square-foot laboratory that performs more than two million tests each year. The clinical laboratory renovation was a five-phase project spanning five years.
Both inpatient and outpatient providers order tests through the electronic medical record (EMR). Orders are placed directly in the EMR by the physician—eliminating transcription order errors. Inpatient orders are downloaded to the phlebotomy hand-held units. Upon receipt of the test order the phlebotomist scans the patient ID bracelet, confirming the correct patient, and prints the labels for bedside collection. Since the implementation of hand-held scanning devices and printers, the phlebotomy department consistently maintained a low deviation rate for misidentified samples. In 2018, the phlebotomy department reached 356 days without a defect. The phlebotomy department was awarded the Penn System 2018 Quality and Safety Award, Honorable Mention for Positive Patient Identification.
LGH laboratories offer convenience and easy access to outpatient services. There are 15 ambulatory draw sites in Lancaster county and two surrounding counties. Each site offers POCT for Protime/INR, and some sites offer additional POCT based on the services provided on-site, as well as pregnancy and creatinine for diagnostic imaging. The hospital courier department provides services to each ambulatory draw site, as well as Lancaster general physician offices. The samples are delivered to the LGH or WBH laboratories. The ambulatory draw sites use the laboratory information system (LIS)—samples are tracked on transport lists and lab pending lists to ensure specimen safe delivery.
The Off-Site Services department provides patient services for 25 extended care facilities in Lancaster and Lebanon counties with 4,157 skilled care beds overall. Routine and 24/7 STAT phlebotomy are provided. Starting this year, the team will be working with 23 area group homes to bring phlebotomy to their individual residences. This program is designed to help patients who are fearful of phlebotomy procedures and avoid compliance to necessary testing. This volume results in over 115,000 tests annually.
The Lancaster General Blood Bank is self-sufficient in that 90 to 95 percent of products transfused are collected at the Lancaster General Donor Center. The Donor Center supports a fixed site and mobile blood drive operations. Three community blood drives occur each week in the county. The Donor Center collects and processes approximately 10,000 donations per year including platelet pheresis for single donor platelet products.
A hospital transportation service is available to community members for transportation to and from blood drives. Many of the donor population comes from the Amish community and others in the community who want to participate but face transportation barriers.
Productivity
The Microbiology department has implemented the BD (Becton, Dickinson and Company) Laboratory Automation System. In 2013 the LGH laboratory went live with the InoqulA—an automated plating system which brings standardization to specimen plating. The final phase of the automation system was completed in 2017.
The fully automated Core Lab has a front-loading system connected to a line that transports samples to the chemistry, immunology, and urinalysis instruments. Another line for Hematology transports samples through the hematology analyzer/slide stainer and WBC differentials are read on a digital cell reader. Middleware is utilized to monitor and automatically release patient results from the LIS into the EMR based on defined limits.
Pathology utilizes a bar coding system, Vantage, for patient identification for sample grossing and processing in histology, reducing labeling errors by 94 percent.
In the Blood Bank, 6-/7-day platelet product expiration extension with bacterial detection testing was implemented which resulted in discarding 39 percent less single donor platelets. This resulted in less recruiting/collection of donors and the conservation of the donor pool.
LGH’s laboratory is focused on the continuum of care. Working closely with physician practices, they realized how the lab could assist in helping their patients meet screening requirements for colorectal cancer. An in-home testing product was selected by the Medical Director based upon sensitivity and specificity as well as ease of use for qualified patients. The laboratory tracks trends in physician orders, patient returns, and positive/negative results—reporting this information on a weekly basis. Receiving timely information allows physicians to provide early detection and treatment.
The Outreach Manager and Microbiology Manager are members on the Infection Control and Antibiotic Stewardship committees at each of the nursing homes serviced by Lancaster General Health Laboratory to offer expert guidance. One of the tools that has come about through this partnership is an antibiogram based on the patient population.
Lancaster General Health’s partnership with a new Behavioral Health Hospital which opened in 2018 allowed them to provide mobile laboratory and diagnosis services to a group of formerly underserved patient population in the community.
LGH has implemented a huddle process across the organization. Each department has daily huddles and huddle boards that are used to evaluate work processes to generate ideas for improvement.
Education and training
Mandatory annual continuing education programs are required for all laboratory staff. In addition, every employee is required to complete additional elective continuing education programs of their choosing. The content of the elective programs is reviewed with their immediate supervisor for approval. The department manager is responsible to prepare a yearly listing of educational activities available to employees, the Medical Director is responsible for approving the listing.
Recently the entire laboratory implemented an electronic document control system. All laboratory departments transitioned from a paper system to electronic systems in MediaLab.
The Electronic Document Control System for lab-wide policies and procedures ensures the current version of policies and procedures are available for staff at all laboratory sites. Users access policies and procedures electronically at the bench by desk-top computers and iPads. There is electronic access to the current version of policies and procedures for all laboratory departments. Each Ambulatory Lab has a corresponding site in MediaLab where staff can access site-specific policies and procedures. Staff members receive mail notification when a new document or major revisions are applicable to their jobs and automatically notifies supervisors if employees haven’t signed-off on time.
There’s also a process in MediaLab for periodic staff reviews of policies and procedures with documentation. And most importantly, it eliminated paper copies of procedure manuals! Today, the two fixed laboratories and Ambulatory Draw Sites are paperless.
Strategic outlook
Last summer, LGH joined their Penn Medicine colleagues in adopting the following Penn Medicine Experience Standards:
- Be compassionate: I serve with my head and heart.
- Be Present: I show up and remain engaged.
- Be Empowered: I drive results with intention.
- Be Collaborative: I partner with unwavering support.
- Be Accountable: I commit to every single moment.
LGH also continued deployment of the Lean Management System to align with the following senior level goals:
- Development of Huddle Board Quality Metrics.
- Gemba (a Japanese term meaning “the actual place”) Walks to identify and eliminate waste.
- Engage staff regarding problem solving in their area.
- Use of Process Standard Work.
- Corrective Actions through Plan-Do-Check-Act cycles.
Lab inspections
In 2018 the LGH lab implemented MediaLab Electronic Accreditation System, InspectionProof. The software allows for inspection documentation in one system. Documentation for checklist items are completed by entering text responses, uploading supporting files, and linking to policies and procedures. Compliance to CAP requirement is measured by the system.
Additionally, the laboratory has an internal audit team comprised of staff technologists. All members participate in ISO 15189 educational courses on internal auditing. The audit team developed the program’s policies, procedures, and training process. The first audit cycle started in 2014 after the CAP on-site inspection. A trained lab auditor audits each lab department once a year. The internal audit team helps each department to stay inspection ready.
