Chang Gung Memorial Hospital Linkou (CGMH Linkou) is one of Taiwan’s largest hospitals, serving millions of patients annually. It also operates one of the country’s busiest clinical labs. The hospital plans to expand this lab in the coming years, but in the meantime, it’s constantly working to improve performance and increase offerings in the existing facilities.

As part of these efforts, the lab managers recently completed a workflow optimisation project designed to balance uneven workflows for immunohistochemistry, clear up traffic congestion in peak testing hours, and boost efficiency in the lab. Their results, which were published in a poster presentation at a meeting of the Taiwan Society for Laboratory Medicine [1], demonstrate that even small changes can make a big difference in streamlining operations.

New efficiencies can also facilitate the expansion of test menus, as demonstrated by CGMH Linkou’s decision to add PIVKA-II, a biomarker used to aid the diagnosis of hepatocellular carcinoma, not long after the workflow optimisation project.

This effort focused on two tracks for immunohistochemistry testing, which were roughly separated into a routine testing track and an urgent testing track, though that distinction was not always followed. Collectively, the tracks supported 33 clinical tests.  The team had noticed that samples built up during peak testing hours, creating a congestion issue that delayed their ability to report results to clinical partners.

“One module could be running more tests than the other, with one completely full with more samples waiting while the other was empty,” said Po-Wen Gu, Supervisor Technologist of Laboratory Medicine at CGMH. “We wanted to optimise so we could manage operations more easily and report more clearly to other departments.”

A detailed analysis of several months’ worth of testing data revealed a significant imbalance between the two tracks: one processed 30% more tests per month than the other, leading to the congestion problem. The first track handled more types of tests than the second, not only contributing to the imbalance but also creating a more complex situation for laboratory management. In addition, the lab had experienced significantly increased sample volume for a vitamin D test run only on the first track; the assay reaction took 27 minutes and helped explain the lag in sample processing.

To improve the situation, the team worked with its vendors and carefully reviewed test demand, assay reaction times, and loading operations. They redistributed tests across the tracks more evenly, and added a vitamin D testing capability to the second track that could be used during peak testing hours to ease the load on the first track.

The optimisation initiative was a success. After assay redistribution, the difference in sample workloads between the two tracks dropped from 30% to 10%. While achieving balance and efficiency was the primary goal, the optimisation also tightened up turnaround times, reducing peak-hour test turnaround from 98 minutes to 72 minutes.

“In the beginning the goal wasn’t changing turnaround times, it really was about improving efficiency,” said Dr Chia-Ni Lin, Technical Director at the CGMH Linkou lab. “But when we increased efficiency, we could put more assays on the instruments. In fact, we already added PIVKA-II after the optimisation and are currently thinking about what else is possible.”

In addition, sample loading is now handled differently for each track, giving staff members more flexibility in how they process tests. The team also took the opportunity to identify technical parts that need to be changed more often than manufacturers’ recommendations. These parts are now slated for change annually, which should increase uptime for the instruments in the testing workflows.

Overall, clinical throughput of the testing platforms improved, enabling the laboratory to process more samples and overcome the previous congestion problems while reducing operational complexity and easing workflow management.

For now, this optimisation exercise has given the lab greater flexibility to manage rising demand for tests and even expand its test menu. Looking ahead, the team is already planning for the new facility that should be opened within five years to address anticipated increases in patient load and testing volumes.

References:

[1] Optimization of reagent-loading manner for Automated Immunohistochemistry modules to improve testing turnaround time (Yu Wang, Po-Wen Gu, Chia-Ni Lin, 2022).