COVID-19 testing at Purdue gets streamlined with application of lean tools

Wednesday, November 11 2020

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An internal improvement team took Purdue University’s COVID-19 testing up a notch to improve patient safety, improve patient flow and maximize staff time.

In order to manage the large volume of tests, Purdue controls all tests and processing in-house. Saliva tests are labeled and sent to the Animal Disease Diagnostic Laboratory (ADDL), and data is captured real-time. But waves of increased demand were impacting patient wait times and social distancing, and prompting the need for overflow testing.

Last month, the College of Pharmacy asked experts in lean process improvement from Purdue Healthcare Advisors (PHA) and the Purdue Manufacturing Extension Partnership to consult with the ADDL where the tests are being processed; outside contractor One-to-One Health, which runs the Protect Purdue Health Center and is responsible for all on-campus testing; and the Turf Recreation Exercise Center (TREC) where all the testing is conducted.

The team was to observe how the approximately 900 students and staff per day make their way through the testing process at the TREC, and then apply lean thinking to make the process better. “Lean” is a methodology whereby practitioners strive to minimize waste in every process, procedure and task through an ongoing system of improvement.

After a half day of observing the process and cycle times, then mapping out the current processes and redesigning them, the team provided their feedback. The first and most obvious issue affecting flow, according to PHA Assistant Director Jack Fenton, was the allocation of space and staff dedicated to symptomatic versus asymptomatic testing. Almost 50% of the building was dedicated to symptomatic testing, which constituted only 20% of the volume. This needed to be addressed by “right-sizing” the testing facility (i.e. changing the layout) to better utilize the asymptomatic side.

“We recommended the center decrease the size of the symptomatic testing footprint,” Fenton said. “By doing this, the process allows for appropriate physical distancing while bringing patients in out of the inclement weather where they were waiting in line.”

Other changes included shifting the patient flow/entry to the opposite side of the building; allocating staff to the areas of longer cycle times (i.e. longer times to complete the process); eliminating overflow testing; avoiding the need for patients to wait outside; especially as inclement weather approaches; and establishing physical barriers to ensure patients could not walk to close to each other.

“The small cones placed on the floor to guide patients were not doing their job as patients were passing directly beside or crossing in front of one another at less than six feet,” Fenton said. “We recommended replacing the cones with rope dividers or cubical type walls to improve safety and flow.”

By observing cycle times at each stage, the team observed the stages that were “constraining” the process (i.e. stages that were the slowest). To improve flow, they recommended adding more signage to direct patients while in que. Fenton said, “We observed one patient digging through his pockets to find his Purdue ID card while other patients were waiting. Even though signage was on the check-in table, improved flow demands earlier prompts.”

The team’s recommendations were implemented the following weekend to great success. According to Kyle E. Hultgren, PharmD, Director of Purdue’s Center for Medication Safety Advancement, effects from the improved flow have kept staffing constant at all stations and decreased the high amounts of variability in the lab collection process and delivery to the testing facility. “Lab deliveries have been standardized, occur routinely and on-time, and our utilization of overflow testing has been eliminated,” Hultgren said.

After this experience, Fenton has some advice for other universities and companies doing testing during the pandemic:

1. Observe, observe, observe! Watch how the process is unfolding, time the flow of patients through each stage, and document issues impeding the flow of patients and causing rework or other waste in the process. Develop solutions around those problems and then implement.
2. Anticipate areas for delay. For example, one patient walked up to the check-in table and was asked to show a Purdue ID Card. The patient spent time digging through his pockets to find it while other patients were waiting. Signage was on the table he walked up to but he needed an earlier prompt.
3. Maximize the layout. Ensure the facility’s layout and patient flow are maximized for the correct patient volume.
4. Staff appropriately. Remember the Theory of Constraints, which states that the process will only move as fast as the slowest process step. Ensure the appropriate number of staff members are allocated at each stage of testing to establish an even flow of patients and prevent bottlenecks.
5. Erect barriers. Use rope lines, cubical walls and/or other physical barriers to ensure that physical distancing is maintained. People tend to “float” or wander without real barriers.
6. Map the process. Draw out the current state process and then redraw and redesign it to match the true need by including proposed solutions. Do several iterations of this, as new designs may yield new/innovative ideas that were not thought of before.

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Tags: Process & Cost Improvement (LEAN)