Vall d´Hebron Laboratories a territorial integration example

Abstract

The "Laboratoris Clínics Vall d'Hebron" centralise in a single physical space the activity conducted in three laboratories of the Catalan Institute of Health (ICS) of Barcelona until 2014: the Valle de Hebrón Hospital laboratories (Pathology biochemical Genetics, Hematology, Immunology, Microbiology) and the two laboratories of Primary Care Manso and Buen Pastor. To do this, following the current trend of improving the production process by applying Lean and Process Reengineering, a Core Lab has been created with the aim of simplifying the organization and number of tubes to be manipulated, thus enabling continuous work and the use of sample and processing flow control systems. This workflow streamlining has allowed a reduction in response times adapting them to the needs of the Hospital and Primary Care and it has also allowed a redistribution of staff. On the one hand, the staff members have been dedicated to creating new diagnostic areas (genetic and rare diseases), thus facilitating the incorporation of new tests to the catalogue. On the other hand, they have been allocated to existing special areas, enabling more capacity to support the centre and a greater dialogue with clinicians. These changes have allowed the laboratory to be a centre of excellence in some clinical areas becoming a reference centre.

Staff members from different laboratories have been involved throughout the whole process. Various participatory committees have been created, regularly holding meetings with Primary Care and Hospital Services. The information management system had to allow the globalisation of all the laboratory areas, and the integration of the pre-and post-analytical phases and connections between the Hospital Network and Primary Care. It also had to solve the high activity of complex tests (tertiarism) in the laboratory area of the HUVH.

In order to do this, the existing four ( LIS ) computer systems (two in the Laboratory Services of Vall d'Hebron and two in Primary Care) had to be unified on a single LIS which can connect to other Hospital and external computer systems (SAP, ECAP , T-System, IMO, etc.), as well as to different laboratory Middleware. An IT commission was created in order to undertake the whole design and implementation. This process is being done in stages, and the final reports are now being finalised, including those regarding the Genetics Service and other special areas which are difficult to fit into existing computer systems.

A logistics commission was also set up to organize the routes of almost 100 peripheral extraction points and the unification of containers. A Committee of Direction of Laboratories was created from the beginning. This committee coordinates all the services, and it includes the Director of the Laboratory, Heads of Department of Pathology, Biochemistry,

Haematology, Genetics, Immunology and Microbiology, the Director of Technical personnel, representatives of the Hospital Welfare Branch and the Finance Department and representatives of the laboratory personnel.

There is also a weekly monitoring committee responsible for supervising the overall operation and resolving the everyday incidents. This unification has resulted in the largest laboratories in southern Europe, with more than 20,000,000 determinations per year and one of the most complex in Europe.

We have also achieved savings in five years of 23.86%, compared to what was spent when the laboratories were not unified.