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Redesigning the lab for today's workflow.

Redesigning the lab for today's workflow

By imagining what your lab might contain in the future, you can create a setting versatile enough to accommodate virtually any development. You needn't be a visionary; wise planning will do.

There once was a time, many years ago, when all lab tests were performed manually. In the old days, the chemistry bench typically displayed an impressive assortment of reagent bottles. The technologist, usually a woman, would assemble a rack of specimens and several of empty test tubes. A sectioned drawer in the bench held a collection of pipets, neatly arranged by size.

To process a specimen, the technologist reached for a clean pipet and transferred the appropriate amount of serum to a clean test tube. After transferring all the specimens, she pipetted one or more reagents into each tube and then perhaps placed the entire rack in a boiling water bath heated by a Bunsen burner. She next moved to a colorimeter or spectrophotometer and took a reading for each specimen. Then she would record the readings on a log sheet, perform the necessary calculations, and note the results on the log sheet and the patient's report slip. Finally, the labwork completed, she emptied the tubes into the sink and placed the glassware, including the pipets, into a bath of hot, soapy water for washing. * Every little movement. These early procedures entailed myriad motions--retrieving reagents from shelves, opening drawers, pipetting, moving test tubes to a colorimeter, recording readings, calculating results, and writing the findings on lab slips. The laboratorian stayed on her feet because many of these movements would have been awkward to accomplish while seated. Certain hematology procedures, such as hemoglobin measurement, resembled the testing routine in the chemistry lab. Other tests, such as cell counting and differentials, were done at a microscope. Yet before the technologist could sit down at the scope, she had to prepare the slides, which meant standing at a sink to do the stainding. (Incidentally, the work routine in microbiology departments and blood banks has changed very little over the years.)

Thirty years ago, the popular laboratory design was ideal for performing manual work. It consisted of rows of benches approximately 30 inches deep with a counter height of 36 inches, suitable for standing. Ample shelf and cabinet space housed the multitude of reagents needed for each test. Typical supplies included test tubes, racks, and a large number of pipets sorted by size. Because testing produced large amounts of liquid waste, sinks were installed at work stations throughout the lab. Most lab sections also needed vacuum, air, and gas hookups.

In contrast, electrically powered instruments were much less common 30 years ago. Paperwork was minimal, and much of today's voluminous quality control documentation had yet to be implemented. Computer terminals did not exist. There were few requests for Stat results; testing was inherently slow, with many procedures done just once a day.

The traditional laboratory layout of the 1950s and 1960s still predominates, even though it is no longer appropriate. Many of today's instruments are freestanding and no longer clutter bench tops. Some units, such as automated blood cell counters, are modular and consist of several components connected by a maze of wires and tubes. Although designed to sit on the bench, with some parts placed underneath, these instruments can be stacked--neatly and compactly--on a rack, keeping precious counter space free.

Technologists' work patterns have changed as well since the advent of high-volume instrumentation. Instead of assembling several reagents to perform a single test on a group of specimens, technologists now typically set up an instrument for an entire shift or day, transfer unmeasured specimens into special containers, inspect printed results, record QC data, and perform routine instrument maintenance. Many of these tasks can be done while seated and more closely resemble the duties of an office worker of today than those of a technologist of 30 years ago.

The fact is that the last three decades have brought major changes in laboratory medicine. If it's time for you to clear away the cobwebs and bring your lab up to speed for the 1990s, you'll have to address the following issues: * Design flexibility. Since labs are dynamic, they require a flexible design that can accommodate change with minimal disruption. The life span of most automated instruments is three to five years. Thus in as little as three years, the space designed for one large instrument must often be modified to accept its replacement. In a study conducted by a leading manufacturer of lab furniture concerning the need for lab renovation, 23 per cent of responding labs expected to undergo at least a partial renovation in the coming year, while 18 per cent predicted that a total renovation would be necessary within three years. * Design trends. Central lab areas housing several activities have replaced the formerly common arrangement of separate rooms devoted to single tasks. A rapid increase in testing and the consequent need for expansion underline the restrictions imposed by single-purpose layouts.

Laboratories require flexible, user-friendly furniture to meet a variety of unforeseen needs. Furniture that can be rearranged allows labs to adjust the floor plan as the workflow changes and to accommodate the wide range of test systems that will undoubtedly be available some day. * Utilities. Placement of utilities can limit a laboratory's future flexibility. Plumbing is difficult and expensive to modify. The good news is that many of the new automated instruments require far less water and liquid reagents than the older ones did. The reagents and diluents are often stored within the instrument. Waste liquid usually runs into a collection container and does not require a drain. Such features eliminate the need to place the instrument near a plumbing hookup. Confining plumbing lines to the lab's outside walls further enhances flexibility and lets you rearrange furniture and equipment as necessary. It is also possible to restrict the lines for other piped utilities, since fewer tests than before require air, vacuum, or gas.

Electrical power frequently falls short in terms of the number and location of outlets, amperage capacity, type of voltage, and freedom from voltage fluctuation. When building a new lab, it is tempting to install 220-volt dedicated circuits only where a need has already been demonstrated. Since the cost of bringing in new lines later is high, however, it is wise to "oversupply" the laboratory from the start.

The same more-is-better strategy holds when planning for computer terminals, data lines from instruments to a computer, and telephones. It is possible, however, to upgrade later: Power poles can be installed anywhere in the lab with a minimum of fuss. The mass of wires, tubes and power cords can easily be run within a plastic wire chase at the back of a bench top to keep the electrical spaghetti from becoming an unsightly, tangled mess. * Storage. Some of the laboratory's storage needs have decreased as new automated instruments for chemistry and hematology have come on the market. The old AutoAnalyzer family of instruments consumed a large amount of storage space for the diluted reagents that continuously flowed through its tubing. Today's discrete analyzers boast of a more economical reagent use, which makes it unnecessary to keep vast amounts of reagent on hand.

Bulky consumables, such as reaction tubes and rotors, pose a real challenge. If ordering these in cost-saving quantities, you must set aside a central storage area for them. This trend will accelerate as automation becomes more common in microbiology and the blood bank.

Traditional work area storage cabinets are usually made as deep as the 30-inch bench tops. This configuration wastes a large amount of space. The shelves are too deep to use efficiently--and so the cupboard stands largely empty or becomes a catchall. A much more sensible storage solution is deep drawers or narrow shelves, which keep supplies close at hand and easy to find.

Although laboratories need less storage at the bench, there is a growing demand for centralized storage space to accommodate large shipping cartons of reagents and consumables. Open shelving keeps the stock visible and expedites taking inventories. Storage of computer-related supplies is another consideration.

Large labs need refrigerator space close to work areas and a larger walk-in cold storage area for supplies purchased in bulk. Small under-the-counter units with drawers rather than shelves provide a maximum of storage space per square foot. Conventional-sized refrigerators can also be ordered with slide-out shelves or drawers from firms supplying the restaurant industry.

Waste disposal has become vastly more complex than before. Various kinds of containers must be readily available for disposing of glass and other sharps, biohazardous waste, and recyclable materials. Waste containers should be conveniently located in work areas where waste is produced, yet must not hinder traffic. The Federal Government and some states require special precautions for handling biohazardous medical waste. Check on any restrictions that may apply in your community and plan accordingly. * Clerical chores. As laboratorians' responsibilities have shifted from purely technical activities to managing complex automated equipment, their tasks have entailed more writing--often on computers. Today's technologist deals with work lists, patient logs, quality control reports, maintenance records, and procedure manuals. Thus the work area must now include space for reading and writing these documents, for analyzing control charts, and for storing the documents. If the lab is computerized, a computer terminal and printer must be accessible. * Specific instruments. Some renovation is usually necessary whenever a lab acquires a major piece of equipment. The instrument's location should be dictated by its mode of use, not by the space freed when its predecessor was removed. Placing high-volume instruments near the specimen-receipt area reduces transport time and distance.

An instrument should be near any other test systems that will analyze the same specimens. If the unit will be run on all shifts, it should be located close to the other systems that operate around the clock.

Besides knowing an instrument's physical dimensions, one must determine whether access is needed to the unit's sides or back for repair, maintenance, or air circulation. Arrange benches so that the workflow is logical and convenient and incorporates clerical space. Other instruments are often used in conjunction with a particular analyzer. Space for such instruments--a centrifuge, mixer, refrigerator, or computer terminal and printer, for example--should be provided as well.

The utilities needed to run an instrument are also an important concern. In addition to the usual electrical and plumbing considerations, remember to plan for computer or data transmission lines and the telephone system. Additionally, some systems must be vented, and others can generate a significant amount of heat, which may alter the lab's air-conditioning requirements. * Working with an architect. If the lab will require extensive renovation, consider consulting an architect. Be advised, though, that few architects have had much experience designing clinical labs. They don't have a clue about the trend away from manual testing and toward today's highly automated laboratory. Without extensive guidance from laboratorians, they will continue to use traditional designs based on past needs and on the casework supplied by laboratory vendors.

Laboratorians can assist the architect by providing a description of each lab instrument. Figure I offers suggestions for guiding your architect. It can also serve as a handy checklist for your own design changes.

With planning, cooperation, and common sense, you can create a laboratory setting that will serve you and your staff well into the next century. If you do the job properly, the new lab layout will be flexible enough to accommodate any advance that looms on the technologic horizon.

PHOTO : Underestimating storage requirements is a common mistake. A good design plans for future

PHOTO : as well as current needs. An efficient work space keeps everything close at hand, but out

PHOTO : of the way. Supplies are neatly organized, and the bench top is clutter free.

Daniel M. Baer, M.D., a member of MLO's Editorial Advisory Board, is chief of laboratory service at the Veterans Administration Medical Center in Portland. Ore., and professor of clinical pathology at Oregon Health Sciences University, Portland.
COPYRIGHT 1989 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Author:Baer, Daniel M.
Publication:Medical Laboratory Observer
Date:Oct 1, 1989
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