Flexible and functional: a case study in efficient laboratory design; Several key design issues must be addressed when planning new or renovated laboratory space for the most positive impact on operational efficiency.

Flexible. Open. Adaptable. Expandable. Functional. Safe. Efficient. These are the critical design issues that must be addressed when planning new or renovated laboratory space. The ultimate objective is to provide efficient lab space that enhances operations and ultimately profitability. By thoroughly analyzing operational issues such as specimen, staff, supply, and waste flow; workstations; FTEs; and test volumes, effective design solutions can he created that will have a positive impact on operational efficiency.

Trends in laboratory design

The operational issues that influence lab design have completely changed over the last five to seven years. "Lab design today is predicated on new issues and criteria that did not even exist 10 to 15 years ago. In the past, the size of the lab was determined by evaluating the hospital bed count, FTEs, and test volumes," says Linda Wilson, executive vice president of the Karlsberger Companies' Birmingham, AL office (formerly Garikes Wilson Karlsberger), a national planning and architectural firm specializing in laboratory and healthcare design.

"Automated instrumentation, outreach programs and the emergence of central core labs serving multiple hospitals and healthcare systems have completely changed our approach to lab planning. In today's environment, design is based on projected workstations (by type and function), instrumentation, and the degree of automation currently in place and projected," she explains.

With rapid advances in automated instrumentation and testing procedures, the lab must be able to readily adapt to progress and the changing needs of each department. Flexibility and adaptability are critical issues that must be incorporated into the laboratory design. The ability to expand and modify the functional relationships and flow within the lab can be achieved by utilizing an open lab plan. A large, open lab area with limited partitions allows for enhanced flexibility of staff assignments, the ability to share equipment, and the consolidation of workstations and equipment.

The use of flexible lab casework can also provide a convenient method for modifying and reconfiguring the workstations. Work surfaces can be raised, lowered, added, or deleted. Base and wall cabinets can also be similarly changed. All of this can be accomplished with minimum inconvenience and down time to the surrounding workstations.

The planning process

The development of a comprehensive facilities program, which describes the laboratory's strategic and operational objectives, is the first step in the lab planning process (see Table 1).

"Major factors which determine a project's success are established by the time the programming phase is completed," Wilson says. "The accommodation of function, technology, environment, organization, comfort, amenity, safety, interaction, and efficiency form each design decision. The programming and planning process should be a balanced, integrated and simultaneous resolution of all project objectives."

Intensive interaction with the lab leadership and user groups is the best way to develop a comprehensive lab facilities program.

"Our challenge is to test early assumptions and existing systems by applying an objective process of data gathering and analysis with active lab administration and staff participation followed by the generation of creative alternatives and solutions," Wilson says. "Only through this participatory and objective planning process can an accurate road map be created for future growth and development."

Utilizing this interactive and participatory approach, a functional, flexible, and efficient laboratory design was created at the regional reference and core lab for DSI Laboratories, a NCH Healthcare System affiliate, in Fort Myers, FL.

DSI Laboratories

DSI Laboratories is located in the rapidly growing area of southwest Florida. DSI Laboratories was established in 1984 at the Naples Community Hospital with a mission to provide the quality and range of testing equal to that found in large academic medical centers. To initiate this process, several board certified Ph.D.s were hired to provide the technical expertise to develop esoteric testing in the areas of toxicology, special chemistry, and infectious disease.

Over the next decade, the laboratory services expanded as a second hospital was added in 1990, and the volume of outpatient testing increased. Offsite outpatient service centers were added and the courier routes extended to a growing number of physician offices, physician's office labs (POL), assisted living facilities, and extended care facilities. As space on the main hospital campus was limited, the NCH Healthcare System acquired a shopping center a few blocks off campus. DSI Laboratories established its administrative services including marketing, payroll, human resources, accounting, billing, and purchasing at that site.

The molecular medicine lab was also developed at this location. In addition, testing sections moved from the hospital to this site over a several year period starting with virology, then immunology and followed by microbiology in 1994. This, in effect, created the infectious disease department.

A second offsite testing facility, toxicology, was established in 1990, 30 miles north and adjacent to their outpatient service center in Fort Myers. In this large urban area, DSI had a broadening market to provide employment-related drug testing and forensic services. It is one of only four laboratories in Florida that are certified by the National Certification Program (SAMSHA/NIDA/DHHS).

Declining reimbursements forced DSI to economize in the 1990s despite continuing growth. The hospital labs were still crowded and handling both inpatient and outpatient hematology, coagulation, urinalysis, chemistry, transfusion services, histology, and cytology. Samples were being moved between four facilities for testing. A plan was developed to build a freestanding regional reference laboratory that would serve as a core laboratory for NCH hospitals and, hopefully, others. Their two hospital labs would downsize to immediate response labs (IRLs).

The benefits to this endeavor would be twofold. Moving outpatient testing out of the hospital would enable the IRLs to concentrate on the inpatient/ER needs for rapid turnaround. Secondly, costs were projected to decrease with consolidation of the esoteric testing and all routine outpatient procedures at the core lab with potential to expand test volumes and gain equity partners.

Jim Warnken, chief financial officer of the NCH Healthcare System and former chief executive officer at DSI, advocates planning early on for expansion, and believes laboratory owners and operators should "build your facility with flexibility for growth. If you do not build the common areas with vision for the future, you will be faced with additional costs and disruption of workflow. Growth is inevitable for a successful organization."

Many teams were formed to create a business plan, such as test menu/database, logistics, equipment, staffing and human resources, finance, and core lab site/design. Laboratory administrative director Brenda Vanderheyden says of the planning effort, "I think that one of the biggest rewards of our efforts was that all the planning was worth it. Even though it was time consuming, it was crucial to how things turned out. Also, the fact that people were willing to compromise and understand that there were limited resources."

Core lab site selection

The site selection was crucial to DSI's success. Naples is the last major southern coastal town on the western side of Florida. The Everglades frame this area to the east, with significant business opportunities to the north. DSI focused its attention on land that was central to their projected increased service area based on marketing reports and demographics. DSI wanted to be close to the interstate and a large airport. The logistics of moving samples between its two hospitals and potential core lab partners was also carefully studied. By this time, DSI had outpatient service centers as far north as Sarasota and one east in Hollywood, FL. They had hundreds of clients consisting of physician offices, home health care agencies, extended care, and assisted living facilities, POLs, drug testing clients, and other hospital labs. The most central location was determined to be Fort Myers. A site was selected at an office park located five minutes from Southwest Florida International Airport and just two miles off Interstate 75.

Planning design team

Concurrent to site location was the selection of a design team. While many fine local architects were available, DSI narrowed its search to firms within the U.S. that had previous laboratory design experience. The Birmingham-based firm of Garikes Wilson Karisberger was selected based on its extensive laboratory portfolio.

By this time, the laboratory administrative director and supervisory team for the core lab and IRLs had been chosen from existing staff with no increase in management ETEs. A preliminary staffing model, testing menu, and equipment list were developed. Meetings began with the architects, who interviewed each core lab manager looking at current procedures and discussing expectations for their new areas. Concepts were developed for efficient workflow and use of space. Flexibility and safety were considered key components. From these meetings, a preliminary design emerged with four primary areas of operation: Clinical Laboratory, Toxicology Laboratory, Support Services, and Common Space (see Table 2).

Design objectives

An excellent synergy developed between the managers and architects. Working with an architectural firm knowledgeable in laboratory systems, safety regulations, and code requirements facilitated the process. The architects advocated special design features that truly enhanced DSI's operations (see Table 3).

Special design features were incorporated into the microbiology department, according to Robin Williams, microbiology supervisor, who stated, "The cabinets and casework were designed with a workstation in a pod formation and strategically placed to meet the unique needs of this department to consistently interact with each other. UPS lines were installed in specified locations to place instrumentation against the walls out of the main workflow area. The AFB room was designed to meet the needs of a Bio-Safety Level 3 Lab with an anti-room for safe entry."

When commenting on the use of flexible lab casework, Nancy Schafer, MT, supervisor in the manual assays department at DSI, said, "The flexibility of the units has been beneficial to our department. When our needs changed, we easily adjusted the units, or even traded units with another department, to tailor the workspace."

Other design issues were also thoroughly evaluated and developed. These issues included flow, separation of lab from nonlab areas, future expansion, introduction of automation/robotic instrumentation, budget, schedule, and the exterior building design.

Vassilios Nicolaou, project architect with Karlsberger adds, "We created two distinct flow spines to accommodate the specimen, supply, and employee flow without crossing each other. We located the three entrances and their parking areas to the north, east, and west of the building, expressing their functions, to better serve public, employee, and specimen/supply access. The shortest flow spine is dedicated to the couriers for easier and faster access to the clinical and toxicology laboratories."

Areas of operation were organized around the flow spines. Laboratory areas were separated from nonlaboratory areas, and the employee and laboratory support functions were arranged next to their respective entrances.

"We anticipated the expansion of the laboratory functions into the 4,200-square-foot area of the support services located near the specimen flow spine and the relocation of those services to the future second level," says Nicolaou. Administrative areas, including senior management, human resources, accounting/payroll, marketing, compliance/QA, and employee health are currently located in less expensive leased space in an office complex directly across the street from the core lab building.

The use of a 22-by-33-foot column grid, an open lab concept, flexible casework, and the strategic location of the automated assays (chemistry and hematology sections) will facilitate the use of a future robotic line without disruption to the other laboratory areas.

"We designed a simple, aesthetically pleasing, and inviting building integrating the outside environment with the interior, giving it a dynamic identity," says Nicolaou.

"In addition to the efficiency of the laboratory design," Barbara Glinski, marketing director at DSI, adds, taking potential clients through our core lab is fantastic marketing. The building has a professional appearance and feel. Our lobby is spacious and attractive, which makes a great first impression."

"Building materials and finishes were utilized in adherence with the project's program objectives and budget. We also gave special emphasis to ADA accessibility, ergonomics, fire safety evacuation, and energy conservation," Nicolaou says.

DSI continued over the months working in a ream approach which facilitated a feeling of ownership and excitement. Plans were posted for staff input and redesign. Groundbreaking occurred in the spring of 1997.

Lab completion and implementation

During the core lab construction, detailed phasing plans were prepared for the consolidation of services from three different sites spread over 45 miles. The challenge was to provide uninterrupted resting. This was accomplished by a cascade of moves over a six month period, starting with information services during the spring of 1998. As one section moved in and worked out any problems, the next area followed. This allowed DSI to conserve its resources and make adjustments as necessary. Its eight-year-old Cerner Laboratory Information System provided good facility logic for specimen tracking. The use of its e-mail function, along with printed newsletters, kept everyone in close contact and informed of the progress. The transfer of all outpatient testing from the hospital labs was facilitated by simulating the core lab automated assays department first within the hospital campus. While setting up the new analyzers in very tight quarters for a short period was difficult, it allowed the staff relocating to the n ew facility to first train on their instruments and develop workflow for the outreach business. This made for an effective transition.

The core lab facility became fully functional by the end of 1998. In the two and a half years since, DSI's business has experienced a 30 percent increase in net revenue. The facility still has excess lab testing capacity. Efficiencies have been realized by consolidation of departments in one site and crosstraining of staff.

A final thought

DSI's former CEO, Jim Warnken, provides some advice for anyone considering a lab design and construction project. "Be thrifty, but don't cur corners where it counts in terms of quality and positive work environment," he says. "Build a professional building that supports a professional image and attracts professional people. Just like the book 'Dress for Success, 'build for success.' There was not one person I toured through the facility who wasn't more impressed with our organization after the tour than before."

With efficiency as a primary design objective, the success of any laboratory design and construction project will be greatly enhanced.

Ron W. Garickes is senior vice president of the Karlsberger Companies' Birmingham, AL office. Suellen Maxwell, MT(ASCP) is special project manager for DSI Laboratories in Fort Myers, FL.

Table 1

Facilities program components

* Existing and projected area analyses and space utilization

* Specimen, staff, supply and waste flow analyses

* Workstations (by type and function)

* Staffing -- existing and projected

* Test volumes -- existing and projected

* Departmental relationships/adjacency diagrams

* Conceptual floor plans

* Site options

* Construction phasing options

* Equipment schedules

* Preliminary construction/cost projections

* Summary of conclusions and recommendations

Table 2

Areas of operation

Clinical laboratory

a. Central processing

b. Automated assays (general chemistry, hematology, coagulation, and urinalysis)

c. Manual assays (immunology and special chemistry)

d. Infectious disease (bacteriology, parasitology, virology, molecular medicine, and mycobacteriology/mycology -- Biosafety Level 3)

An open floor plan without walls was requested for a, b, and c.

Toxicology laboratory

Special requirements included security and restricted areas.

Support services

a. Information services

b. Billing

c. Client services/help desk/UA audit

Common space

1. Employee support

a. Central bathrooms with lockers

b. Vending area

c. Large conference/break room

d. Small conference room

2. Laboratory support

a. Lobby

b. Storage room

c. Biohazard storage room

d. Gas tank room

e. Mail/courier room

f. Facility mechanical room

g. Waste holding room

h. Deionized water system

Table 3

Special design features

* Gas tanks centralized in one room near the courier/supply delivery entrance. These were piped to the particular instruments in the testing areas.

* Deionized water centralized and piped to specific sinks.

* Design of minimal steps from the courier/supply delivery entrance to the clinical and toxicology labs sample receiving areas.

* Structural support of the roof to accommodate a second floor when business increases dictate.

* A folding wall partition for the large conference room so that meetings could be held on one side while employee used the other side for their meals and breaks.

* Only three entrances are provided for security purposes: lobby, staff, and courier/supply delivery. Other "emergency only" exit doors were positioned at critical locations. Use of security fobs to gain access to the building was mandated by the security system except through the lobby, where the receptionist controls access to the rest of the building.

* Flexible casework in the laboratories allowed efficient use of space as needs change. The architects had experience with many vendors. They involved the managers in the selection process.

* Centralized UPS and generator power.

* Special glass used in exterior windows to sustain hurricane-force winds.

* The laboratory is inundated with natural light.