Dark Daily gets tour of clinical lab and anatomic pathology activities

DATELINE: Omaha, Nebraska—This city may be in America’s heartland and best-known for corn-fed beef and billionaire-investor Warren Buffet, but its premier academic center clinical pathology laboratory is breaking new ground in several important ways.

Last Thursday, your Dark Daily editor was hosted for a site visit by the Department of Pathology and Microbiology at the University of Nebraska-Omaha (UNO). From adoption of digital pathology solutions to assertive use of Lean and Six Sigma techniques across the span of clinical laboratory and histology laboratory operations, advanced use of latest-generation medical laboratory testing technology was on display.

Using Lean and Value Process Maps in the Clinical Laboratory

Across the United States, every academic center Department of Pathology has activities and goals which distinguish it in specific ways when compared to other pathology departments. During this site visit, Dark Daily recognized three distinct laboratory management activities taking place in the clinical pathology laboratory at the 525-bed University of Nebraska Medical Center laboratory.

One noteworthy attribute is this Pathology Department’s use of Lean, Six Sigma, and similar performance improvement methods across several medical laboratory testing departments. For example, four years ago, the UNMC laboratory engaged the consultants of Ortho-Clinical DiagnosticsValuMetrix consultancy to help it prepare for a major remodel of the high-volume automated chemistry and hematology core laboratory.

In the core laboratory at the University of Nebraska-Omaha, from left: Robert Michel, Editor of Dark Daily; David Muirhead, Laboratory Manager; James Wisecarver, M.D., Ph.D., Vice Chair, during Dark Daily’s site visit to the Department of Pathology

Faced with limited square footage and serious constraints because of existing walls, UNMC’s lab team needed to optimize use of existing space in a manner that would support enhanced use of laboratory automation. The goal was to achieve substantial and ongoing improvements in clinical laboratory testing turnaround time and quality within the core laboratory.

The fruits of this work were visible during a visit to the high-volume core laboratory. It incorporates a blend of advanced analytical systems and targeted lab automation solutions from Beckman Coulter, Inc., and Sysmex America. According to pathologist James L. Wisecarver, M.D., Ph.D., Professor and Vice Chair for Clinical Affairs, value process mapping and Lean work flow design helped the lab team fit the new core laboratory in a much-reduced footprint that currently performs more than three million billable tests per year.

In the designated core lab space, the extra square footage made available by Lean planning techniques made it possible to bring other related testing functions—which had been located outside the core lab—into the same physical space with high-volume chemistry and hematology testing.

Same Day Specimen Processing in Histology Laboratory

It was a similar story in the histology laboratory. Pathologists and the technical team at UNMC regularly use Lean and value process mapping in tandem with advanced histology automation solutions to support the academic mission of the pathology department in both patient care and clinical research.

Tour guide and laboratory manager David Muirfield explained that the anatomic pathology department is now capable of reporting a significant number of cases on a same-day basis. The ongoing quality improvement program is delivering continual improvements in turnaround time and quality. The increased productivity also produces worthwhile cost savings.

UNMC’s histology laboratory is well-equipped with the latest generation automated systems. A best-of-breed preference can be seen. Systems from such histology vendors as Dako, Milestone Medical, Sakura Finetek, and Ventana Medical Systems all are in daily use in the histology laboratory.

As a beta site, UNMC’s histology laboratory is also evaluating next-generation products currently undergoing FDA review. This gives its pathologists and technical team an early look at next-generation histology technology.

Another new technology initiative at UNMC’s Department of Pathology is digital pathology systems. To this end, the pathology department has acquired multiple digital pathology systems from BioImagene. This equipment is being installed and validated. Pathologists expect to initially use digital pathology images for teaching and for handling referral cases.

Looking forward, the pathologists at UNMC point out that digital pathology will allow them to provide sub-specialist pathology support to rural hospitals in Nebraska, which has many thinly-populated agricultural counties.

Support for Public Health Laboratories

Another noteworthy activity that distinguishes the Department of Pathology at the University of Nebraska-Omaha from many other academic pathology programs is its support of public health laboratories. Steven H. Hinrichs, M.D., is the Chairman of the Department of Pathology and Microbiology at UNMC. He also serves as Director of the Center for Biosecurity, and Director of the Nebraska Public Health Laboratory.

Dr. Hinrichs is active at the state and national levels in the operation of public health laboratories. On the UNMC campus is located a new, post—9-11 public health laboratory, chock-full of latest-generation lab testing technology.

This public health laboratory is capable of evaluating specimens that represent the gamut of biological agents that would threaten public health. Included are capabilities to detect and identify natural disease outbreaks, as well as the dangerous materials that might be used by terrorists.

The three examples of innovative activity profiled in this Dark Daily e-briefing only describe a few of the many projects and research efforts taking place at UNMC’s Department of Pathology and Microbiology. Pathologists and clinical laboratory managers should keep in mind that similar efforts are happening in more than 200 other major academic center pathology and clinical laboratory departments across the United States. It is one major reason why pathology and laboratory medicine is in the forefront of genetic and diagnostic medicine.

Related Information:

UNMC, Canadian researchers make discovery; may render Staphylococcus harmless

UNMC- Durham Research Center II – Nebraska Public Health Laboratories

Meet ‘Distinguished Scientist Steven Hinrichs, M.D.

Lab Quality Confab’s “Lean Bootcamp”

The Dark Report’s Audio Conference – Achieving World-Class Performance: New Ways Your Lab Can Use Lean Six Sigma to Stop Bad Outcomes and Boost Financial Performance