BLOOD BANKING 1- BLOOD PRODUCTS 2- AUTOLOGOUS TRANSFUSION M. H. Shaheen Maadi Armed Forces Hospital.
Planning and Designing a Hospital Transfusion Service T and designing a hospital transfusion...
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14 MedicalLab Management • September 2016 Don’t miss out on premium content: www.MedLabMag.com/subscribe BLOOD BANK By Michael J. Lopatka, MS, MT(ASCP)SBB; and Theodore R. Newell, AIA, NCARB, AABB T he opportunity to plan and design a new transfusion service operation may not present itself often, but when it does, applying a full understanding of the scope of required functions will help establish the basis for a comprehensive and efficient transfusion service that meets the near- and long-term needs of the organization. By partnering with experienced health care architectural and design consultants, transfusion service department managers can plan and create a high functioning and workflow-driven transfusion service. In 2012, Geisinger Health System, headquartered in Danville, Pennsylvania, approved the construction of a new, full-service laboratory that included a robust transfusion services opera- tion. Throughout the year-long planning and design process, the transfusion team was integral in providing their essential work- flow knowledge and suggestions for improvement over previous operations, and in advising the architects and designers on de- sired physical layout. During this process, the combined teams developed a common set of functions that assisted in determin- ing the best design to support the various transfusion service workflows. Transfusion Service Functions There is a set of common functions that can be customized to the individual facility when planning and designing a new or reno- vated blood transfusion service. These functions include: Receipt of blood products Storage of blood products Receipt of patient specimens Testing of specimens and products Preparation and distribution of blood products Integration into supply chain Proper management of waste stream These functions are illustrated in greater detail in FIGURE 1 as a process flow diagram. Transfusion blood products includ- ing, but not limited to red blood cells, plasma, and platelets, flow into the transfusion service department from outside sources and must be received, removed from shipping containers, in- processed, and moved to storage. The product flow also includes testing of blood products for proper blood type to verify labeling, and identifying a location to store containers before returning them to vendors. Once in-processed, products are moved to stor- age areas pending the need for preparation and distribution. Patient specimens represent the other incoming process flow. Specimens arrive in the laboratory, preferably to a single loca- tion, and are typically received electronically (ie, using bar code scanning for LIS entry), processed and tested, and resulted. Pro- cessing and testing actions require ample physical workspace for both automated and non-automated tasks. The blood product and specimen flows come together when there is a need for a product for specimen testing, which begins the combined flow of blood product processing and distribu- tion. Orders are received and cross-matched, enabling the blood product to be made ready for distribution, a process that must interface with the blood product user, either at a pick-up window or other distribution point, such as through a pneumatic tube system. Blood product return flow also must be accounted for, which may lead to blood products being placed back in storage or moved to the waste stream if unacceptable upon return. Translating Workflows Into Design Layouts From an architectural standpoint, it is best to begin a project by viewing the operation at a high level in order to gain an under- standing of the fundamental functional parts of the departmental program and strategize how to organize them in order to promote efficiency, regulatory compliance, and create a comfortable sense of place for staff. That said, it is certainly beneficial to be familiar, at least at an intermediate level, with detailed functions and op- erations of transfusion services before finalizing a design concept. The architectural and design team will develop the design concept in part by creating process flow diagrams that identify the steps required in a given activity and propose a way to ac- complish them. By understanding workflows, the architect can design physical space to accomplish the required activities in the sequence suggested or required by the process and workflows. 1 For blood banks and transfusion services, we identify four major functions: 1. Receiving 2. Storage 3. Testing 4. Distribution Planning and Designing a Hospital Transfusion Service
Transcript of Planning and Designing a Hospital Transfusion Service T and designing a hospital transfusion...
14 MedicalLab Management • September 2016 Don’t miss out on premium content: www.MedLabMag.com/subscribe
BLOOD BANK By Michael J. Lopatka, MS, MT(ASCP)SBB; and Theodore R. Newell, AIA, NCARB, AABB
The opportunity to plan and design a new transfusion service operation may not present itself often, but when it does, applying a full understanding of the scope of required functions will help establish the basis for a comprehensive and efficient transfusion service
that meets the near- and long-term needs of the organization. By partnering with experienced health care architectural and design consultants, transfusion service department managers can plan and create a high functioning and workflow-driven transfusion service.
In 2012, Geisinger Health System, headquartered in Danville, Pennsylvania, approved the construction of a new, full-service laboratory that included a robust transfusion services opera-tion. Throughout the year-long planning and design process, the transfusion team was integral in providing their essential work-flow knowledge and suggestions for improvement over previous operations, and in advising the architects and designers on de-sired physical layout. During this process, the combined teams developed a common set of functions that assisted in determin-ing the best design to support the various transfusion service workflows.
Transfusion Service Functions There is a set of common functions that can be customized to the individual facility when planning and designing a new or reno-vated blood transfusion service. These functions include:�Receipt of blood products�Storage of blood products�Receipt of patient specimens�Testing of specimens and products�Preparation and distribution of blood products� Integration into supply chain�Proper management of waste stream
These functions are illustrated in greater detail in FIGURE 1 as a process flow diagram. Transfusion blood products includ-ing, but not limited to red blood cells, plasma, and platelets, flow into the transfusion service department from outside sources and must be received, removed from shipping containers, in-processed, and moved to storage. The product flow also includes testing of blood products for proper blood type to verify labeling,
and identifying a location to store containers before returning them to vendors. Once in-processed, products are moved to stor-age areas pending the need for preparation and distribution.
Patient specimens represent the other incoming process flow. Specimens arrive in the laboratory, preferably to a single loca-tion, and are typically received electronically (ie, using bar code scanning for LIS entry), processed and tested, and resulted. Pro-cessing and testing actions require ample physical workspace for both automated and non-automated tasks.
The blood product and specimen flows come together when there is a need for a product for specimen testing, which begins the combined flow of blood product processing and distribu-tion. Orders are received and cross-matched, enabling the blood product to be made ready for distribution, a process that must interface with the blood product user, either at a pick-up window or other distribution point, such as through a pneumatic tube system. Blood product return flow also must be accounted for, which may lead to blood products being placed back in storage or moved to the waste stream if unacceptable upon return.
Translating Workflows Into Design LayoutsFrom an architectural standpoint, it is best to begin a project by viewing the operation at a high level in order to gain an under-standing of the fundamental functional parts of the departmental program and strategize how to organize them in order to promote efficiency, regulatory compliance, and create a comfortable sense of place for staff. That said, it is certainly beneficial to be familiar, at least at an intermediate level, with detailed functions and op-erations of transfusion services before finalizing a design concept.
The architectural and design team will develop the design concept in part by creating process flow diagrams that identify the steps required in a given activity and propose a way to ac-complish them. By understanding workflows, the architect can design physical space to accomplish the required activities in the sequence suggested or required by the process and workflows.1
For blood banks and transfusion services, we identify four major functions:
1. Receiving
2. Storage
3. Testing
4. Distribution
Planning and Designing a Hospital Transfusion Service
www.MedLabMag.com September 2016 • MedicalLab Management 15
Storage of supplies, the supply chain restock process, and the waste stream are the final considerations in the overall flow of the facility. Once the process flows are identified, they must be converted into the design layouts.
An analysis of workflow diagrams can aid in the develop-ment of proper adjacencies and relationships between the ma-jor functions.
Receiving: a. Areas are designated for receiving blood and blood prod-
ucts from couriers or pneumatic tube stations with donor segments, products are logged in, routing to product stor-age or to ABO testing area is designated, transport con-tainer coolant and waste are disposed, and empty contain-ers are routed back to the entry area
b. To encourage lean, efficient operations, the receiving area is best located adjacent to product storage and testing areas
Product Storage: a. Workspace is allotted for in-processing activities related to
product storage
b. Products are placed in refrigerators, freezers, and platelet incubator/rotators expeditiously for storage under proper conditions
Testing:
a. Ideally, testing areas are adjacent to test preparation areas and proximate to product storage areas
b. Initial testing is completed using automated instruments when possible
i: If additional testing is not required, specimens are stored (refrigeration)
ii: If additional testing is required, specimens are transported to non-automated testing areas
FIGURE 1
Hospital Transfusion Services Process Flow
All figures courtesy of the authors
Hospital Transfusion Services Process Flow
U1: Receive Blood Products in Coolers or Boxes
U2: Remove Products, Coolant &
Packing Materials
U3: Scan Units into LIS
Storage/InventoryRBC to 1ºC to 6ºC
Refrigerator
Storage/InventoryPlasma to -30ºC
Freezer
Storage/InventoryPlatelets to Rm Temp
Incubator/Agitator
Units
Specimen
Supplies
Bio Waste
Dispose of Wet Ice, Store Dry Ice & Coolant
StoreCoolers& Boxes
U4: Remove Segments
S1: Receive Specimen Tubes in Single Stream
S3: Segregate into Urgent &
Routine
S2: Scan Tubes into LIS
D2 & D3: Assess CompatibilityCrossmatch
Ret
rieve
Pro
duct
s fro
m In
vent
ory
Pat
ient
Spe
cim
en T
est R
esul
ts
D1: Receive OrdersD4: Fill OrdersD5: Distribute
Units
Blood Products Returned
Products Specimen Testing
Distribution
Bio Waste
Bio Waste
Retention Seg to Ref
S4: Type & Screen Testing on Auto Instr
S5: Positive ABY Screen
U5: Product Re-Typing
D6: Assess
Storage
Testing
S6: Antibody Work Ups
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BLOOD BANK
Distribution: a. Blood product orders are submitted from critical locations
in the hospital, such as surgery and the ED, to the blood bank through the LIS
b. Crossmatch testing is performedc. Compatible units are retrieved from blood product storage
and are labeled for distributiond. Distribution is acknowledged in the LISe. Blood products are provided to the customer through a
service window, pneumatic tube station, or other method
With the understanding of the functions and adjacency re-lationships, the architect develops a block concept plan (see FIGURE 2). Finally, a written program is used to develop a func-tions checklist and determine the proper size of each area.
Instituting the Design ConceptAn additional layer of information embedded in the design is an understanding of the context of transfusion services within the larger lab and facility structure (see FIGURE 3). The following functions are part of this context, and therefore should be visual-ized and understood: �Where blood products arrive in the facility� Where specimens arrive and where pneumatic tube sta-
tions are located� Where staff members arrive to pick up blood products for
distribution� The path for routing trash and bio-hazard waste material
out of the transfusion services department� The path for interfacing with the supply chain and routing
supplies to the area� Blood bank and transfusion services connectivity to the
hospital information system and how staff moves to andfrom the area on each shift
The concept diagram helps to visualize the geometry and scale of a specific blood bank or transfusion services department. This detailed layout plan identifies departmental entry points con-necting the hospital to the transfusion service and blood bank, and provides the best routes for receiving blood products and specimens, as well as establishes direct connections to the clini-cal core lab, supply chain, and waste management functions.
Detailed LayoutsArchitectural floor plan layouts are developed by following the workflow diagrams to provide a series of defined spaces for each activity in the sequence of the workflow. In reviewing a detailed plan of the receiving workplace, for example (see FIGURE 4), blood products are received at the Log In workstation on an In Cart, are scanned into the computer and are placed on an Out Cart moving from right to left. This attention to process helps meet regulatory
FIGURE 2
Block Concept Functional Relationships
3.bTesting
1. Receiving
2. Storage
3a. Prep
Distribution
Testing
Receiving
Storage
Patient & Donor Specimen
Blood Products In
Prep
BloodProductsOut
Flow Diagram
Block Concept
4. Distribution
1. Receiving
2. Storage
Functions
3. Testing
4a.Orders
4c. DistributionOrders
Dist Prep4b. Prep
FIGURE 3
Concept Diagram
4c. Distribution
3b. Testing
1. Receiving
2.Storage
3a. Testing Prep
4a. Orders
Main Street
Secondary
4b. Cross Match & Distribution Prep
5.S
uppo
rt
Bio Waste Holding
Waste
Staff Offices
IncomingBlood
Products
Specimens from RAP &
Pneumatic Tubes
ToHospitalLab
Waste
To Hospital ED & ORs
Mai
n St
reet
Entry
Mai
n St
reet
Blood Bank
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BLOOD BANK
requirements to prevent mix ups and errors.1,2,3 A similar approach is used for testing and distribution.
As each detailed layout is carefully located back into the concept plan, attention to the connections to the other parts of the plan is required to ensure the integrity of the overall concept (see FIGURE 5).
ConclusionDesigning and planning a transfusion service from scratch offers the opportunity to create efficient layouts based on well-defined workflow diagrams that describe each activity in the process and organize the workplace. Understanding the context, the regulatory environment, and the notion of providing a comfortable and enlightening place to work also are required for a successful transfusion service envi-ronment. A concept can be developed and used to organize and fuse all the parts together into a transfusion service that relates all its necessary functions to each other, as well as the greater hospital environment. Future transfusion service planners can utilize the process described herein to success-fully plan and design lean and efficient facilities as a team with transfusion service input and architectural expertise. ■
References1. US Food and Drug Administration. Code of Federal Regulations.
Title 21, Vol 4: Part 211; Subpart C—Buildings and Facilities.2. Fung MK, Grossman BJ, Hillyer CD, Westhoff CM, eds. Technical
Manual. 18th ed. Bethesda, MD: AABB Press; 2014.3. World Health Organization. Design Guidelines for Blood Centers.
Facility Design and Construction Standards. Accessed: 8.24.16 http://www.who.int/bloodsafety/publications/DesignGuideBlood-Centres.pdf
Michael J. Lopatka, MS, MT(ASCP)SBB, is the system manager of transfusion services at Geisinger Health System in central and northeastern Penn-sylvania. He received his BS in medical technology
from the University of Scranton and MS in Immunohematology from The George Washington University in Washington DC. Hav-ing spent 22 years in the Army as a laboratory and blood bank manager, Michael specializes in transfusion services operations. He is a voluntary transfusion services assessor for AABB and laboratory inspector for CAP.
Theodore R. Newell, AIA, NCARB, AABB, is an Ar-chitect and Principal at EwingCole, Architects and Planners in Philadelphia. He is a laboratory design innovator with over 30 years of experience and
leadership in the programming, planning and design of complex facilities for blood processing, testing, and transfusion services. Ted interacts extensively with each client to formulate design concepts and provide detailed space planning to meet the needs and objectives of each project.
FIGURE 4
Receiving Detail Layout
BloodProductsDelivered
Placeproduct
Boxes onto Cart
PRODUCTS IN
Move ProductBoxes to
Log IN Area
OpenProductBoxes
Log In Units Pack Bin Move Cart To Inventory
RemoveUnits
Move Segments to
Refrig
Move Cart to Wet Station
RemoveSegments
Wet Ice to Sink
Dry Ice to Sto
Rm TempPacks
Move Cart to Delivery
Area
RECEIVING & INVENTORY
SkDryIceBin
Bio Trash
PC
Pass Thru
OutCart
InCart
PC
SpecimensPrep Bench
Log In
Inventory
InCart
Testing Area
BoxCart
WASTE
PRODUCTSDELIVEREDLOG INWASTE
INVENTORY
SPECIMENDELIVERED
BoxCart
ToDistribution
Place Empty Boxes
Boxes onto The Delivery
Cart
FIGURE 5
Floor Plan
TestPrep
Cross Match & Distribution Prep
Distribution
Initial Panel Testing
ABY Work Ups
Orders
1. Receiving
2. In-Processing& Storage (Inventory)
3. Receipt, Prep & Testing of Samples
4. Preparation & Distribution of Products
Waste
Sup
port
Sup
port
