A common goal worlds apart: determination to help patients marks MLO's 2008 Medical Laboratory of the Year winners

Medical Laboratory Observer, April, 2008 by Carren Bersch

Each year, MLO sponsors a friendly competition among laboratories in conjunction with National Medical Laboratory Professionals Week (April 20-26, 2008). A three-judge MLO panel selects the winner as well as the first and second runners-up. Our April issue presents these three winning laborataories to MLO readers via some of their professional accomplishments. This year's selections are committed not only to making their laboratories more efficient and customer-friendly but also serving the communities in which they work and for whose citizens they care. To each of these--and to all nominees--thank you for bringing high-quality testing and world-class performance to America's laboratories.

[ILLUSTRATION OMITTED]

Big Texas boots to fill

If Nominator Harvey Jones from the Medical Center Dallas Hospital (MCDH) Laboratory was excited two years ago when he learned that his was MLO's Medical Laboratory of the Year 2nd Runner-Up, we wondered what he would do when we broke the news that his lab had won the 2008 competition.

Jones' response? "We have worked very hard these last three years to improve. I enjoy your friendly competition each year. We use your application as our annual QA effectiveness summary."

Worked very hard? This year's accomplishments--too numerous to list--made our heads swim. Yours might, too, when you consider that the lab was functioning up to speed the entire time it was making major improvements.

In May 2007, just two months after the completion of a 28-month lab renovation, the MCDH lab was very surprised that the upcoming surgery expansion would require each lab section to vacate its area for up to three weeks so contractors could complete asbestos abatement and construction in the ceiling and repair ventilation problems. Where and how could each section relocate temporarily and continue to assure timely and quality results? Quality-control systems were vital to the lab's success. The lab team responded by meeting weekly with engineers and contractors to discuss and plan any lab-associated moves, while each lab area planned its move, validated the moved systems, and completed critical monitoring of QC results. Each section--hematology, imunohistochemistry, chemistry, and blood bank--and each of its shifts monitored QC results, making timely, thorough adjustments using spot coolers and air flow so that temperature-sensitive equipment continued to provide quality patient results.

In addition to all of that, the lab extended AFB and fungus testing to other labs in its integrated network when a reference lab could not provide initial results within 24 hours as recommended by CLSI standards; these two tests had a 95% improved turnaround time (TAT). MRSA testing was begun as part of the lab's HCA corporate initiative, with real-time PCR results 100% faster than CHROMagar culture (within one versus two days). Two other labs chose to send their MRSA screens to MCDH's lab after learning of its outstanding performance. For more rapid implementation of barrier isolation of colonized patients using the more rapid and sensitive molecular test, the lab moved Tacrolimus tests to its primary chemistry analyzer, improving turnaround time 100%. Then, AmniSure testing was implemented in Labor and Delivery to help diagnose rupture of fetal membrane. A bar-code phlebotomy system was installed and implemented for positive patient and patient specimen identification using two patient identifiers and bar-code technology; thus, the number of tests completed by 7 a.m. for the morning run improved from 85% to 96%; similar improvement has been noted for STAT test completion.

Quantitative CMV PCR test TAT suffered after the local esoteric lab was sold to a competitor and moved out of town. MCDH's lab chose to insource these tests, obtaining 1,200 square feet of space, adding two virology and molecular technologists, and purchasing more than $150,000 in equipment for virology and PCR testing. The expanded test menu for CMV, rapid respiratory panel, viral culture, and enterovirus improved turnaround time 100% (from two days to one day), while reducing costs by $100,000 annually. Additionally, the MCDH lab-information-system (LIS) team was responsible for implementing the changes associated with the esoteric lab's closing. The change brought better service and efficiency, especially by providing a new interface to the lab's LIS, and very high efficiency through recovery of lost test charges for the low-volume esoteric tests not previously built into its computer system. The LIS team is now moving on with the same level of dedication and efficiency to new projects for an LIS computer upgrade, ISBT bar-code printer, electronic cross match, and a shared point-of-care computer server.

MCDH's lab serves a system that boasts the Medical City Transplant Center, the first transplant center in Texas and second in the country to meet the new Centers for Medicare and Medicaid Services' guidelines for certification. Medical City was the first hospital in the southwest United States to perform open-heart bypass surgery using robotic technology. Medical City was named an American Society for Metabolic and Bariatric Surgery Center of Excellence in November. Medical City Children's Hospital has one of the top craniofacial programs in the world; more than 15,000 procedures have been performed on children and adults from every state and 75 countries. Medical City continues growth in operating-room (OR) technology where minimally invasive surgery is becoming a mantra, where surgery is expanding from 21 to 30 OR suites with installation of new Storz integrated visualization systems, where LifePort Kidney Transporter is utilized and, last, where expectations are that it will be the first hospital in the nation to use microwave ablation of hepatic tumors. The Emergency Services Clinical Decision Unit at Medical City is recognized by the National Health Care Advisory Board as Best Practice for Observation Medicine; [er.sup.2] also features a completely separate children's emergency room, independent from the adult emergency room.