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June 2016

The Journey of a Specimen Starts in SMS


MPAHave you ever wondered what happens to blood, urine, or other types of patient specimens after they are collected?

Specimen Management Services, or SMS, is a 24-7 operation of UR Medicine Labs. Its main headquarters is located on the ground floor of Strong Memorial Hospital, down the hall from the Emergency Department and Wilmot Cancer Center where patients are waiting on lab test results.

In addition to inpatient specimens processed at Strong, SMS receives many samples from outpatient facilities that include area nursing homes and 29 patient service centers across the Greater Rochester region.

Lab couriers pick up samples from these various outpatient sites and transport them to SMS collection points that include the SMS lab at Strong, a smaller SMS lab at the Ridgeland Road facility, Surgical Pathology, and Microbiology.

SMS, which includes Surgical Pathology, Accessioning, and Cytology, is the first point of contact for incoming specimens ranging from blood to urine, stool, spinal fluid, pap smears, and patient tissue samples.  

Millions of specimens pass through SMS collection points each year. The lab at Strong processes over 8,000 specimens every day, with another 3,500 outpatient-only specimens delivered to Ridgeland Road.

The Microbiology specimen receiving area also receives specimens of all types for culture, while Surgical Pathology receives 465 surgical specimens – many directly from the operating room – on a daily basis.

“We’re the front end,” said Sue Hurlbutt, chief supervisor of SMS. “We’re the pre-analytical operations. We tell our staff to think about getting that sample out to the labs as if it belonged to you or your loved one.”

windowOnce they arrive at SMS, each specimen sample is scanned by barcode and entered into an electronic database to be tracked.

The SMS lab in Strong is a beehive of activity with about 90 full-time-equivalent employees. On any given day, you will see technologists in white lab coats moving briskly with specimens in hand.  

SMS technicians are non-licensed and cannot release final test results (these must come from a physician). Nevertheless, they play a key role in preparing each sample for final diagnosis.

“There’s a very technical aspect to the job,” said Scott Musial day shift supervisor. “There is a lot of work that goes into getting a specimen resulted.”

In order to be analyzed, most blood samples are put through an instrument called a modular pre-analytics system, or MPA. This spins each blood sample at high speed, separating it into its component serum and plasma.

Next, the samples are labeled, capped, sorted, and transported to another lab area for testing. Those that stay in the SMH laboratory for testing are strategically sorted and taken to another instrument to be analyzed.

Not all blood samples start at the MPA. Others needed for certain testing – hematology, coagulation, or toxicology, for example, will be delivered to the appropriate testing area and/or stabilized according to protocol for each laboratory. 

Once logged and sorted, courier staff known as “scouriers” are responsible for taking samples to various in-house laboratories, like Microbiology, Flow Cytometry, or Cytogenetics, for specialized testing.

Many steps in specimen processing are high priority and time sensitive in nature. When Blue 100, Urgent or Stat tests come to the lab from Emergency and/or Cancer Center, turnaround time is extremely critical to ensure results are reported back as soon as possible so that patient treatment can be determined.

Outpatient testing is generally more routine, although healthcare providers will often ask for additional tests, known as add-ons, to tests that had been done previously.

As you might imagine, the workload for SMS is always a heavy lift. The team at Strong has managed to form its own sense of community through different efforts.

For example, SMS has a staff newsletter and large whiteboard where workers draw pictures, or start writing a story that’s continued by the next person.

Their “Ever Better Board,” or “E.B.B.” is a place where staff can share suggestions or offer feedback. The board was also featured in a university-wide training video as an example of best workplace practices, and staff celebrated the 200th E.B.B. post with a party.

“I think everyone works really well together,” said Musial. “Our group is relatively tight-knit. And although the lab seems big, you’re in a relatively confined space. You move through the same area and are working together each and every day.”  

And by “every day,” he means just that. Even if the hospital loses power or extreme weather hits Rochester, SMS will stay open. They still need to service Emergency at Strong, and in inclement weather, that need is often greater than ever.

The fast pace is something Nathan Giles, a senior tech at Strong SMS, has grown accustomed to. Explaining the work of “the lab” to others can sometimes be difficult, he says, largely due to misconceptions about what happens to patient specimens.

When you see fictional doctors running their own lab tests on TV shows, it can seem like lab technologists are obsolete. The opposite is true. For doctors and nurses to start with the best information possible, it all starts in the lab.

“It’s not often that patients think about this part,” said Giles. “If I’d want them to know anything, it’s that we exist and that we’re a huge part of their treatment every day.”

In photos

Top: A technician prepares to place blood samples onto the modular pre-analytics system, or MPA, which spins the samples at high speed to separate them into serum and plasma.

Middle: Specimens arrive at the SMS lab at Strong Memorial Hospital via courier. Each sample is scanned by barcode into an electronic database so it can be tracked.


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