A-182 The journey From Conceptualizing, Designing, and Implementing Our Integrated Smart Core Lab at Kokilaben Dhirubhai Ambani Hospital (KDAH) & Medical Research Institute, Mumbai, India
Authors: Vadera V , Singhal S , Manjure A , Das B 
Published: September 2023

Abstract

Background
KDAH established in 2009, is a 550 bedded tertiary care, multispecialty hospital in Mumbai, India. Annually the hospital manages about 300 000 patients, the clinical lab delivers &gt;1 750 000 results with Compound Annual Growth Rate of 18 %. In the last 14 years, the clinical lab has expanded; increasing the test services, adding equipment, recruiting staff, and requesting for more space.
There is increasing pressure to improve speed of service to impact early patient outcomes keeping an awareness on cost, non-availability of space for expansion. There is also demand to bring in new clinical tests and increase outreach beyond the hospital.
In October 2018, the laboratory and hospital management decided to apply principles of Lean and design thinking to laboratory processes.
The Smart Core Laboratory conceptualized was an outcome of this work and is focused on delivering results in the most efficient way, in terms of quality, cost, and speed.

Methods
The team of experts from various lab disciplines and lean consultants, started evaluating the end-to-end process from sample received at the central station to results review, reporting and sample disposal
1. Process Map: The process steps are classified and evaluated by the core team as value added (VA) and non-value added (NVA) & business-value added or necessary waste.
Process Maps charts were generated for the following sample flow.
a. Central Sample Receipt to Section. Verification, Registration & Distribution Process.b.In Lab preanalytical, analytical, post analytical processes: Clinical Chemistry, Immunoassay, Infectious Serology. (Serum, Plasma Fluoride / Heparin)Hematology (EDTA Whole Blood)Hemostasis (Citrate Plasma)
1. Value Stream Map
A detailed Value Stream Map of all the actions for the above processes was generated to determine VA and NVA process steps
3. Spaghetti Mapping: Motion Study
Observation and analysis of the Spaghetti mapping diagrams exposed inefficient layouts and identified areas with a lot of unnecessary movement. This helped to decide optimization of the flow and re-organization of the entire lab section

Results & Discussion
Based on the analysis of the data generated from the lean tools and identifying process waste and non-value added steps the following immediate improvements were implemented a. Combining steps extra-processing at centrifugation at each lab sectionb.Decreasing sample vacutainers by reducing number of sample drawsc.Eliminating Overproduction by removing extra barcode printing and registersd.Using Staff Creatively: Reorganize IQC, Calibration and maintenance to off peak hourse.Space Optimization.

Conclusion
This consolidation approach has enabled us to free up at least 341 sq ft prime lab space (≈14 % reduction), decrease staff motion & sample transportation. Approximately 50% simplification in overall processes is achieved. It also allowed reduction in additional patient sample draws by at least 40 %.
The team could use this lean analysis to conceptualize and design a multidisciplinary Automation solution that would consolidate 5 sections namely Clinical Chemistry, Immunoassay, Infectious Serology, Hematology and Hemostasis in the Smart Core Laboratory.