Avera McKennan Laboratory: Leo Serrano, Director of Laboratory Services

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Hospitals are feeling more and more pressure to streamline and become more efficient. Many are implementing Lean techniques to improve productivity. Laboratory Services at Avera Health, a health system serving five states in the Midwest, has made enormous strides in becoming more efficient.

The lab is located at Avera McKennan Hospital, a tertiary care center with more than 540 beds. The lab is full service and offers all major specialties, including an extensive analysis section with immunology testing.  Avera’s Laboratory Services strives to be the best in quality and service and has received multiple recognitions for its efforts.

“We have been strong proponents of Lean since 2004,” said Leo Serrano, director of Laboratory Services.  “Because of our Lean efforts, our turnaround times and testing error rates are exceptional. Our average turnaround time from collection of specimen until results are available on the EMR is 35 minutes or less. We are hitting that 95 percent of the time. “

In recognition of its efforts, Laboratory Services was the first hospital in the United States to receive ISO 15189 accreditation; it was also the first lab in the country to complete the entire three-year cycle of the accreditation. Avera McKennan has an active transplant enter, and the lab is a full-service blood bank. The lab has received FACT (Foundation for the Accreditation of Cellular Therapy) accreditation and accreditation by the Association of Blood Banks and the American College of Pathology.

Streamlining process

Serrano said the lab is looking toward expanding molecular testing, particularly infectious disease. Recently the lab updated its microbiology infrastructure and stem cell testing. The lab is also bringing histocompatibility testing in-house.

“Our hospital is a large Center of Excellence for gastrointestinal disease, and celiac testing is a major component. We are doing a lot of work in that area,” he said. “Because we are a tertiary referral center, we have a lot of specialists who request esoteric testing, and we want to be able to do it in-house.”

Avera is in a rural area, serving five states. Most patients travel a long distance to receive services at the hospital, some as many as 200 miles. This increases pressure for the lab to perform tests and get results to patients before they leave.

“Our goal is for patients to go home and resume therapeutics as dictated by their physician with a minimal amount of trips,” Serrano said. “We have worked hard to have processes in place to have specimens drawn just before the physician visits and have results available while the physician is still with the patient.”

To accomplish this, the Lean processes have been extremely important. Serrano said the lab is organized along the lines of functionality rather than discipline, and it spends capital dollars on equipment that is versatile to meet the needs of specialists requesting esoteric tests.

The lab continues working to consolidate processes and meet the needs of all its patients. The largest example of success has been in the emergency room. The main lab also provides services to the ER, and turnaround times are phenomenal.

“From the time the patient enters the door to the ER until they are discharged or admitted is under two hours,” Serrano said. “From the time a patient enters until they see a physician is less than 20 minutes. That is a result of cooperative Lean ventures between the ER and the lab and the utilization of Lead design in both departments. It has been extremely helpful to us as an organization.”

Building the next generation

Laboratory Services and Avera McKennan as a whole has made significant investments in building the next generation of healthcare providers. Everyone on the management team has at least one or two people in a succession plan, Serrano said. He also noted that Laboratory Services has many young employees, with the average age being 30 years old. This has come about by working with South Dakota State University.

“About five years ago, we had difficulty trying to recruit qualified personnel because of the rural nature of South Dakota,” Serrano said. Avera worked with the university to develop an accredited Medical Laboratory Sciences program. The health system donated $50 million to build an allied health building that would support MLS, nursing and pharmacy.

“Through this program, we are able to meet the needs of Avera, the region and students,” he said. “We serve as the clinical site for three MLS programs in the region. We remain actively involved in education.”

The MLS program graduated its first class in 2010 with 100 percent of graduates passing their board exams and 100 percent placement.

-by Patricia Chaney

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