The Leaflet Article
Easy Access: Designing Flexible Core Labs
Every healthcare and research institution wants a flexible clinical laboratory that blends innovative technologies with LEAN principles, increasing the efficiency and quality of the work. The ideal core lab promotes collaboration and the exchange of knowledge, and is flexible and easily modified.
While clinical labs frequently face changes in instrumentation, assays, volume and balance between in-house testing and outsourcing, they don’t adjust easily.
“In the past, every time we needed to add a new piece of laboratory equipment, it turned into a major construction project,” says Myra Wilkerson, MD, vice chair for Laboratory Medicine at Geisinger Medical System in Danville, Pennsylvania.
SERVED AND SERVANT
New alternatives are being developed by design firms to make the core lab adapt to the changing world of clinical pathology. One of the most challenging issues with flexibility in the core lab is positioning services and utilities. Utilities and services routed down from the ceiling typically lead to service columns that obstruct the open lab space, while horizontal distribution through the casework prevents flexibility on the floor. One option for new and renovated labs is ceiling-mounted service and utility carriers that float above the lab. Perhaps the most desirable option is to use lab grade access flooring.
An access floor eliminates the need for fixed casework cores to distribute services and utilities. This permits an easy exchange of benches or floor-mounted equipment. Free-standing instruments and equipment as well as countertop instruments and equipment from floor boxes and fittings can go through the floor. The arrangement allows technicians to quickly and economically reorganize casework benches or exchange benches and floor-mounted equipment to meet new needs.
This system was used successfully at the Geisinger Medical Laboratory building. The floor was raised eighteen inches so that lines for plumbing, deionized water, power and data could be brought to the instruments in a variety of layouts. Instruments can be rearranged without moving walls, disturbing ceilings, or moving piped utilities out of casework.
With this system, casework is simplified because it is not needed to distribute services and utilities to various locations in the lab. The mobile casework manufactured in the past can again be useful, as formerly expensive instrument benches become simple tables, both moveable and adjustable. Access flooring allowed Geisinger, whose labs had been occupied for a century, to roll easily into the next millennium.
When working with patient specimens or caustic chemicals there is always a concern for materials inadvertently spilled on the floor. With the appropriate access floor, when accidents do happen, leaked fluids will not move more than one millimeter beyond the floor’s seam. The tiles can be removed, cleaned and decontaminated. The system becomes a biohazard containment system as well.
Naturally, standard safety requirements should be embedded in the planning and design of the lab. At the Geisinger Laboratory Medicine building, the design followed safety guidelines from the Clinical Laboratory Standards Institute, College of American Pathologists, FDA Code of Federal Regulations and National Institute of Health. Access flooring meets or exceeds these standards.
Utilizing an access floor also provides a real opportunity for a visually and spatially open lab environment to promote collaboration and sharing of staff as well as expansion/contraction of lab functions. Testing is typically categorized as either a closed or open system; it is not unusual for an open system to become closed, forcing the addition of instrumentation and support in the core lab. These changes can sometimes be handled with an adjustment to the benchwork configuration, but often involve a costly re-organization of the lab.
At Geisinger, the original design supported the existing automated equipment. During construction, it was realized that the final equipment Geisinger purchased required a significant change to the layout of the core lab, including automated, semi-automated and manual testing, where the orientation was revised from east-west to north-south. Because they had an access floor, layouts were revised and updated allowing the equipment to be installed in new locations with minor adjustments, and plugged back into the utility systems in the floor. Unlike in the past, there was no change to the construction schedule and a less than 2% increase to the construction budget.
Frequently, lab design is driven by LEAN principles resulting in a configuration and set of relationships based on efficiency and optimum turn-around-times. When LEAN is incorporated in the initial design the lab performs well, but as soon as new assays are added or volumes change, the existing layout may not be optimum and LEAN efficiency could be lost or compromised. A truly flexible lab can better accommodate re-LEANing. The geometric placement of the floor boxes (utility access) accommodates the five most common lab bench patterns. Diagrams 1A – 1E show several bench configurations and the accompanying service availability without changing any below-floor service connections or minimal changes to floor services.
The lab grade access floor and low-rise access floor may very well be the future direction of clinical core lab design for new construction as well as renovations. With this kind of flexibility, technologists and pathologist won’t have to start on the ground floor.