Perspective On: A Cancer Diagnostic Lab

Never a Dull Moment

For lab administrator Pramila Sood, teamwork is the only way to get work done.

Its logo—MD Anderson Cancer Center—strikes through the word “Cancer.” Its tagline, “Making Cancer History,” is indicative of its mission: to eliminate cancer in the world. Through research, testing, care, and education, The University of Texas MD Anderson Cancer Center, located in Houston, Texas, Technologist pipetting in the Special Chemistry Labtakes an integrative approach to cancer, a group of diseases that affect millions worldwide.

Pramila Sood works on the clinical side—she is the lab administrator for the Department of Laboratory Medicine, in the division of Pathology and Laboratory Medicine. Sood oversees the operation of seven laboratories.

“Our laboratories provide clinical diagnostic information to our physicians, for treatment of their patients,” she explains. “Thus, as a cancer laboratory, we are not different from other clinical laboratories— what makes us unique is that we do extensive testing compared to non-cancer hospital laboratories.”

“For example, in our Special Chemistry Lab, we do electrophoresis and look for abnormal protein peaks, followed by immunofixation,” Sood continues. “For immunofixation, we identify the immunoglobulin peaks and do dilution studies to tease out the abnormality.”

Sood and her team also test for circulating tumor cells, where they look for epithelial cells produced by metastatic tumors. The test, which provides information on how effective chemotherapy is for the patient—along with analyses such as one that looks for optimal levels of chemotherapeutic agents to prevent organ damage—helps physicians determine the proper course of action for cancer patients.

Lab structure

Sood administers the CORE, Microbiology, Transfusion Services, Donor Center, Histocompatibility (HLA), Specimen Processing, and Point of Care (POC) testing labs.

Each lab specializes in one aspect of cancer research. The CORE lab is dedicated to hematology and chemistries. In the Microbiology lab, technologists identify aerobic and anaerobic microorganisms and perform susceptibilities, with a specialization in mycology, mycobacteriology, and virology.

At the Transfusion Services lab, technologists type and screen blood to provide for transfusion. At the Donor Center, researchers collect blood and manufacture blood products— MD Anderson has the largest hospital-based transfusion and donor center in Texas. Specimen Processing is responsible for receiving all specimens in the laboratory, aliquoting samples, and distributing the samples to other laboratories.

The technologists provide histocompatibility testing in the HLA laboratory. The high volume of HLA testing utilizes liquid handling automation for each of the testing steps, with database management tools that include built-in quality control and quality assurance programs.

“All our laboratories provide excellent client service to bone marrow and stem cell transplant programs and cord blood banks,” Sood explains. “We have more than 15 sites in the hospital where we provide POC testing. We train over 1,200 nursing staff to do POC testing and maintain quality control and instruments. POC testing is the fastestgrowing service in our hospital.”

Each of the seven labs occupies approximately 3,000 to 5,000 square feet of space and is run by its own manager, except for the CORE lab and Special Chemistry lab, which are run by the same person. Sood oversees all the managers, who supervise some 270 employees.

“I report to the chair of the department, the division administrator, and the director of operations,” she says. “Six managers report to me—they provide supervision and guidance to lab coordinators and supervisors. Medical technologists and laboratory technicians receive direct supervision from supervisors, who also work side by side on the bench with the technologists and technicians.”

Sood is a microbiologist. Her staff comprises chemists, hematologists, microbiologists, and virologists, among others. Together, her highly specialized team processes about nine million tests each year.

Instrumentation

The staff at the Department of Laboratory Medicine utilize a variety of instruments typically used in hospital labs, such as Vitros, Sysmex, PRISM, and STAGO, among others. In each lab, the equipment is set up to achieve maximum efficiency.

“We have to look at the workflow and how we’re going to get our results out as quickly as possible,” Sood says.

Another aspect of maximizing output is keeping up with advances in technology. One way to achieve this is to ensure that instruments are upgraded as equipment changes are made in the market.

Sood and her managers try to upgrade instrumentation every five to seven years. But this is not a hard-and-fast rule; it depends on the instrumentation and technology.

Technologist working at a scope.

“We keep some instruments for 10 to 15 years because they work well,” Sood says. “For example, we haven’t upgraded Vitros in 10 to 12 years. If the technology doesn’t change or the methodology is pretty steady, then we keep that instrument as long as we can.”

Automation is another aspect of improving workflow and efficiency. The CORE lab is entirely automated, while the other labs are approximately 50 percent automated.

“There’s always been automation in the CORE lab,” Sood explains. “It’s just that over the years, it has gotten more sophisticated: Instruments are performing at a higher capacity, and turnaround times are getting better and better.”

MD Anderson Cancer Center - HoustonOther labs, such as Microbiology, are still not fully automated, because they require more human involvement. Still, tasks such as streaking plates, which some years ago would have been performed by a person, are now automated.

“Today we can streak using an instrument called an Isoplater, which saves us time by allowing the personnel to focus on other tasks while the plates are being streaked by the instrument.”

Such automation also improves turnaround times—the team’s biggest challenge.

“Today, turnaround times are very important,” Sood says. “Physicians in any hospital want their results within an hour and a half from the time the blood is drawn. We have to be very effective and very efficient to get that work out, and you do that through automation.”

“For example, we recently installed middleware for our Sysmex instruments,” she adds. “This has allowed us to improve our turnaround time for complete blood count (CBC) results to within 15 to 30 minutes from the time the sample is received in the lab.”

To ensure that all instrumentation and equipment are properly working, lab administrators have contracted service technicians from instrument vendors for routine maintenance and emergency repairs.

Inventory and hiring

The seven labs need to be resupplied regularly to ensure that a lack of supplies doesn’t halt workflow. The task of taking inventory is the responsibility of designated personnel. Once they take stock of what needs to be replenished, they notify a member of the administrative support staff, who will then place orders.

“Supplies are received by the supervisors or designated staff,” Sood explains. “We would like to move to an electronic inventory system and are currently exploring an inventory system that will work for us.”

With so many tasks to be completed and hundreds of employees working together at the various labs, it’s important for each individual to fit in within the organization. For this reason, finding the appropriate personnel is key. Individual lab managers, therefore, need to evaluate their team’s requirements and decide what kind of expertise would complement their laboratory.

“Each manager takes care of hiring for his or her laboratory,” Sood says. “Our Human Resources department takes care of the recruiting; managers interview applicants and hire the best candidate.”

Fortunately, the lab managers often don’t have to look too far to find the right fit.

“We have a medical technology school in our institution, and we fill our vacant positions with graduating students,” says Sood.

Nonetheless, as at other institutions, the labs managed by Sood face short-staffing and budgetary constraints, among other challenges. But a good workforce allows the team members to get through the hard times. “We work together and support each other to meet these challenges,” she says.

“Laboratory work is challenging, overwhelming, and stressful,” Sood adds. “We are successful when we seek help from direct reports, peers, and superiors. Teamwork is rewarding and is the only way to get the work done and face the challenges of the workplace.”

To keep her workforce motivated, Sood and others in administrative positions reward employees with monetary performance awards.

“Quarterly, we have a Service Awards ceremony, where we present Service Awards for the number of years that the employee has worked,” she says. “We also present awards to our outstanding employees from each laboratory and welcome our new employees.”

“For National Laboratory Week (NLW), we participate in fun games, and [there is] an outdoor hot dog party for the Fourth of July,” Sood says. “[Also], the institution has an Employee Recognition Day, and we are invited to an ice cream social by our division.”

For the winter holidays, Sood’s department hosts a dinner and dance party, sponsored and funded by the department chair, giving the labs’ personnel a chance to enjoy one another’s company outside of the work environment.

Number one

Sood works hard, wears many hats, and at times spends long hours at the institution. In addition to attending meetings with managers and staff, she is constantly working to solve both administrative and technical problems.

“There is never a dull moment. I work in a very dynamic institution,” she says. “My day involves making sure that I am available for my managers, to help them when needed.”

It’s not an easy job, but the overarching goal—to provide first-rate care for the institution’s patients—gets Sood out of bed each day to come to work.

“We do excellent work in our laboratories, and we provide the best care for our patients,” Sood says. “We are proud to be one of the top hospitals in the nation. To remain number one is what makes me come to work every day.”

Top Instruments

Vitros • Sysmex • TOSOH • STAGO • Vitek II BacTec FX • BacTAlert • IRIS • Roche COBAS Galileo • PRISM • Tigris