Hematology laboratories around the world face similar operational and organizational challenges. A shrinking workforce, increasing testing volumes and case complexity, and manual processes are among the virtually universal barriers to efficiency and quality service.
So what are clinical labs doing to overcome these challenges? What strategies are effective and sustainable?
Increasingly, the answer is digitization. Digital workflows provide cost-effective and time-saving solutions to the most common bottlenecks in the hematology lab today. Here’s a closer look at seven of those solutions.
Serious staff shortages are well documented in the clinical laboratory space, and the problem has grown more severe in recent years. This trend is seen across many industries, and the U.S. Bureau of Labor Statistics cited a record 4.5 million workers quitting or changing jobs in November 2021. Workforce shortages are affecting the entire healthcare ecosystem, and there’s a particular strain being felt in hematology laboratories. Staff shortages and rising workloads are taking a toll on hematology labs everywhere, and a key bottleneck is microscopy, where manual processes and limited digital workflows remain slow and labor-intensive.
The British Society of Hematology found many vacancies in the hematology workforce due to a variety of factors, including higher rates of retirement combined with fewer people entering the field. This nets a negative influx of trained personnel available to cover shifts and share their expertise. The loss of experienced personnel without a sufficient number of graduates creates a greater workload for existing personnel, leading to burnout.
In the face of limited ability to add personnel to relieve workloads, digitization is filling the gap. Digital processes make everyone on the lab team more efficient and effective, reducing workload pressures and the need for extra staff.
With the latest full-field digital technologies, PBS reviews are faster, slides don’t need transport, and consultations can happen remotely and instantly. Workloads can be easily balanced across sites and shifts because once a digital PBS scan is complete, the images can be reviewed anywhere. By optimizing utilization, backlogs disappear without the need for additional staff.
Digital workflows create efficiency that both relieves the need for new staff and the low morale that goes with it.
At the Center for Laboratory Medicine in Switzerland (ZLM), converting manual workflows to a digital system immediately saved about .10 FTE per day in the lab by speeding reviews and opening up capacity through remote work.
With Scopio Full-Field imaging, ZLM was able to eliminate travel time by digitally replicating remotely everything lab teams can see and do with a manual microscope.
With a digital workflow, remote staff can pan and zoom on any area or cell on the slide exactly as they would in the lab. The system provides AI decision support to quickly count and analyze cells of interest, and staff can annotate observation and share images with experts anywhere. As a result, the most frequent tests in the hematology lab take half the time. Teams complete analyses faster, with more confidence and consistency, and they consult and collaborate remotely. In the digital age, this is how every lab and lab network should operate.
A second contributing factor to the strain placed on hematology labs is the increased demand for services. With the advancement of diagnostic and therapeutic techniques in hematology, more people are being diagnosed with cancer and other blood-related diseases. The world population is also expanding and aging. This means people are living longer and developing complex conditions with comorbidities. Consequently, labs are faced with a difficult question – how to maintain the standard of care and provide long-term treatment and disease management with limited qualified staff and more complex patients?
With manual microscopy, a sample is smeared onto a slide and viewed manually by an expert in the lab. This requires an expert to be physically present in the laboratory to conduct the analysis. It also means that there is no way to share slides easily between laboratories – whether for collaboration, consultation, or teaching purposes. Slides must be physically sent to another laboratory, or another expert must be invited to the original lab. This often hinders the diagnostic process.
Covid-19 showed the world the importance of remote work capabilities. Having laboratory experts review and analyze slides through the secure hospital network can decrease sample review time and help patients receive a diagnosis sooner, leading to faster initiation of treatment.
To speed throughput, digitization is the solution. Eliminating manual microscopy, slide transport, and the need for on-site consultants accelerates every PBS review and diagnosis.
A head-to-head study at Tel-Aviv Sourasky Medical Center revealed dramatic decreases in turnaround time for PBS using digital processes. Under clinical study settings, where each examiner reported on a 200‐WBC differential, complete RBC morphology evaluation. and platelet estimation based on 10 FOVs, the median time for manual review was 20:00 minutes per case.
The median time for Scopio’s Full-Field PBS review, on the other hand, was just 7:46 minutes, a 60% improvement in workflow efficiency.
In addition, simply reducing the need to physically transport slides is transformative in the lab setting.
As with many networked labs with a limited number of specialist experts, ZLM centralizes its expertise at its hub location, where the most experienced staff are available to review anomalous samples. Before digitization, if a PBS review at a satellite lab required a secondary consultation, the slide had to be physically transported to the main lab, which could take anywhere from one to 18 hours.
After hours, the problem was even more complex. When experts were not on-site to manually review slides, the final report would frequently be delayed until the next day. This was the case even for PBS reviews originating at the main lab, where lab staff would have to email a snapshot of the slide image to the expert on-call, adding about 35 minutes to the slide turnaround process. Often, the image did not provide enough information for the reviewer to make a confident report, so would wait until they could manually review the scan back in the lab.
With full-field digital workflows, analysis takes half the time and none of the travel. Transmission of full-field images is instantaneous, and the reviewer has all the information required to make a confident diagnosis and report.
Yet another longstanding challenge in the hematology lab is establishing standardization of results. This is a serious quality issue that can impact patient outcomes, and the increasing complexity and volume of cases is adding to the risk.
In traditional hematology laboratories that rely on manual instruments, there is considerable variability of test results. Inconsistencies in every stage of the testing process can affect the results. Improper handling or storage of the sample before testing, analytical errors, type and quality of instruments used, and errors in interpretation or reporting of the results can all lead to the variability of reported results. What’s more, not every member of the lab team has the same level of expertise.
But digital processes supported by artificial intelligence are helping to bring new standardization to even the busiest lab environment. Scopio’s AI-guided decision support helps every technician rapidly count and analyze cells in a consistent, repeatable, and traceable way that is always human-affirmed. Staff can analyze millions of cells at once and use AI for instant cell detection, pre-classification, and suggested cell counts.
Not only does this support speed reviews, it means every review at every lab site can start at the same standardized baseline with highly accurate AI decision support for detection, classification, and estimation. AI does the heavy lifting at digital speed, so humans can make assessments efficiently and in a consistent and repeatable way.
Around the world, laboratory directors are charged with reducing costs and maximizing product and instrument lifespan. Finding technological solutions that meet the needs of the lab, improve workflow, and help the lab reduce costs benefit hospitals and hematology laboratories and leave room for strategic investments.
Efficient digital workflows reduce costs in unexpected ways. Full-field imaging and AI decision support have shown to cut time for slide reviews in half, which allows the lab to do more with fewer resources. In addition, reviews and consultations can take place remotely and workloads can be more easily balanced across sites and shifts.
Sourasky Medical Center simultaneously reduced staff costs and backlogs. By optimizing its weekend workflow to allow for remote digital microscopy for PBS analysis, the hematology laboratory at Tel-Aviv Sourasky Medical Center saw dramatic reductions in TAT throughout the weekend and virtually eliminated the backlog of samples on the first weekday.
Simply reducing the weekend backlog enabled the lab to eliminate one eight-hour shift at the beginning of each week. Even accounting for the added overtime hours accrued over the weekends, the laboratory saw a net cost benefit and a net reduction in staff hours.
To make meaningful progress toward efficiency and quality, labs must fundamentally change how they work. That creates a human hurdle. Digitization requires new mindsets, skill sets, and comfort zones for valued laboratory staff.
Remarkably, in the hematology lab, this change has shown to be welcome — not only by digital-native staff, but also by the most experienced professionals with careers built on manual microscopy. At ZLM, where processes went from manual to 100% digital in a very short amount of time, approval rates among lab staff were overwhelmingly (90%) positive.
“People are often reluctant when you try to implement a new system, but with Scopio it was different,” says Lukas Graf, Head of Clinical Chemistry, Hematology, Immunology and Consultant Hematologist at ZLM. “As soon as we had the first machine in the lab, everyone wanted to try it. They were so excited and still are. They all see the value and how easy it is to handle.”
Across industries, the pandemic changed forever the definition of the workplace. Now that employees know they can work productively from home, few want to go back to the traditional office.
Until now, laboratory staff have not been able to benefit from this new reality, because manual microscopy made physical presence in the lab mandatory. But thanks to full-field technology, 100% remote workflows are now possible, creating enormous competitive advantages for labs that can provide this flexibility to their staff. A remote-enabled hematology lab can offer its technicians and experts important work-life advantages that conventional labs cannot:
Hematology, like many fields of medicine, is moving towards a digital transformation where data is the key to diagnostic insights and building an effective plan of treatment. While this is an exciting evolution that brings with it incredible opportunities for improved clinical capabilities and improved patient outcomes, labs must be willing to adopt digital technologies and workflows. The rewards for doing so are clear.
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