Healthcare Design - April 2020 - 34

In Focus

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with limited space can configure docks with
"swim lanes" painted on the floor, with each type
of material staged in its own lane and then delivered separately to a specific lab.
The lab floor plate itself also raises multiple
questions of priority with regard to the flows of
samples, personnel, equipment, and waste. One
approach is to map current flows within and
between all functional areas to determine what
makes the most sense operationally, prior to delineating possible floorplan arrangements that
support those functional flows.

K E Y L A B S PA C E S

Depending on the lab's setting, scale, and function, a clinical diagnostic
testing lab often includes varying densities of automated equipment for
sample accessioning, processing, and testing, along with manual labs that
support lower-volume test assays. Labs will also require space for a freezer, refrigerator, tissue storage, and, potentially, conveyance equipment to
support the storage of retained samples and specimens. Interviews with
lab technicians and operators are extremely insightful to ensure that sufficient program space is provided and readily accessible.
Additionally, staff offices and support areas in or near the lab to support
functions such as test results review, reading and release, specimen slide
review, quality assurance, and assay-development functions also need to
be considered. The program needs for lab support areas are informed by
staff load, equipment needs, on-hand supplies, sample/specimen storage,
and lab throughput. As good practice, the location of these functions and
their interrelationship to the overall lab layout should be vetted during
pre-design programming meetings with lab users where work streams are
mapped out.
Quantifying the number and types of tests that will be performed in a lab
will also go a long way toward determining the staffing/shift model and,
therefore, the scale of the lab. In the case of an existing lab, the scale and
square footage should be informed by analyzing the existing lab arrangement for space compression and/or underutilization, while space for
new labs may be informed by industry benchmarks from peer facilities.
High-volume tests such as electrolyte profiles, chemistry profiles, complete blood counts, urinalysis, and immunoassays can be performed on
connected automated clinical laboratory equipment platforms, and, thus,
lend themselves to a modular lab footprint. On the other hand, high-complexity assays as designated by the U.S. Food and Drug Administration-
including cytology, immunohistochemistry, peripheral smears, and most
molecular diagnostic tests-often require more space to accommodate
pre- and post-sample and specimen testing and preparation activities,
including more sophisticated equipment and increased staffing needs.

S T R AT E G I C P L A N N I N G

As a lab plan comes into focus, there are three
major considerations planners should address.
For high-throughput, high-volume, rapidturnaround lab assays, single-floor lab arrangements with expansive continuous modular
space should be sought out. Operationally, this
approach has several benefits including space to
accommodate automated sample sorting, equipment lines, and retained sample stockyards.
Adjacencies should also be prioritized, to enhance Lean flow and to optimize the lab's overall
testing enterprise. If 70 percent of the samples
are being processed using automated platforms,
those functions should be placed as close to the
incoming docks, de-boxing equipment, sample
receipt, and accessioning as possible. Optimizing adjacencies and workflows will create efficiencies in labor and increased throughput.
Finally, lab flows must be evaluated to ensure
samples and specimens are tracked via a laboratory information system to enable and conform
with chain of custody as well as the efficacy of
sample and specimen results and findings. During the lab programming and design phases, it's
important to ensure barcodes on samples and
specimens are scanned at each prep and analytical step in processing. Too often in large-scale
lab operations, significant time is incurred
tracking down misplaced items, causing unnecessary labor burden and delays in processing.
At both an enterprise and individual lab level,
early program collaboration with lab staff to
confirm and right-size lab program area and environmental and operational needs will result
in a lab design with operational flows that enhance throughput, support regulatory conformance, and, most importantly, corroborate the
efficacy of sample and specimen results. 

U N D E R S TA N D I N G F L O W

Regardless of lab type, the testing process begins with the arrival of samples and specimens. In a patient care setting, materials sent from an emergency or surgery department, for example, might be delivered by a lab tech
or courier, with the only lab design consideration being the location of the
primary lab entrance and/or stat window drop-off. A clinical testing lab,
meanwhile, will receive specimen shipments from physicians' offices or
airports, via multiple express delivery services. Therefore, the first flow
that must be accommodated is vehicular. Facilities should set aside space
to accommodate convenient vehicular-based drop-off, taking into consideration access routes, long- and short-term parking, and quantity and location of loading docks.
In addition to sample delivery, movement of kits, buffers, and reagents
that are used to support analytical equipment test platforms; personal
protective equipment; and on-hand lab support materials will be among
the materials coming into the lab that need to be planned for. Additionally, multiple waste streams, including office, recyclable, nonhazardous
lab, and red bag/biohazard, will account for the outbound flows. To minimize cross-contamination, ideally, materials and support streams won't be
commingled with incoming samples and specimens. Among the decisions
that will need to be made are whether separate docks will be designated for
specimens and non-specimens, or incoming and outgoing materials. Labs

APRIL 2020

Paul Hansen is an architect and principal with Flad
Architects (Madison, Wis.). He can be reached at
PHANSEN@FLAD.COM.

HCDMAGAZINE.COM

http://www.HCDMAGAZINE.COM

Healthcare Design - April 2020

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