Robust testing is only as effective as the speed at which it is performed, and the Utah Public Health Laboratory (UPHL) is doing its part to improve testing in Utah. Due to a short incubation period before a COVID-positive individual becomes infectious, the more quickly an individual is tested and his/her test processed, the more likely we are to limit the spread of the virus.

After applying the SUCCESS framework to its operations under the leadership of Dr. Andy Rohrwasser and Dr. Alessandro Rossi, UPHL reduced testing backlog from 3,732 to 0 in just 16 days, reduced average test turnaround time from 2.9 days to 1.1 days, and increased the number of samples that could be tested per day from 930 to 1,209 without adding additional resources. Additionally, the state lab has set ambitious targets to double its test processing capacity and decrease turnaround time for highest priority tests to 18 hours.

Initially, key stakeholders wanted to purchase new lab equipment in an effort to increase processing capacity and decrease turnaround time. However, maximizing existing equipment enabled the state lab to avoid this purchase, saving taxpayers hundreds of thousands of dollars.

To describe the process and capture the situation initially, the state lab established a daily situation report that “publishes” and shares daily testing volumes at UPHL as well as backlog information with key stakeholders. Using concepts from the SUCCESS framework, UPHL dissected receiving and testing workflows and identified major constraints (or the weakest parts of the system that hold up the rest).

The state lab discovered that major constraints were not in the laboratory with testing equipment but instead resided in sample receiving (SR). Two major bottlenecks were identified in SR: data entry and racking (or the process when samples are removed from a containment bag and placed in a rack for testing).

To streamline the sample collection and sample receiving process, UPHL implemented a barcoding process that reduced data entry time from an average of four minutes per sample to an average of four minutes per entire collection event (or the number of samples collected from a location at once, typically ranging from 60-250 samples per event). In other words, where it would have taken roughly 30 hours to complete data entry for 500 tests using the previous process, it now takes only minutes. The racking process was strengthened by reassigning team members from testing sections, interns, and National Guard members.

Additionally, the lab optimized the process of fixing “problem samples” that either lacked patient information, contained discrepant information, or were defined by untestable specimens. This freed up valuable time for staff to focus on core processes.

To continue to decrease overall turnaround time, UPHL is introducing a two-shift operational model that is expected to double the number of tests processed without requiring any new equipment.

Congratulations and a genuine thank you to the employees and leadership at UPHL for achieving these breakthrough improvements. Their hard work is key to keeping the economy open and protecting those at risk, ultimately saving lives and livelihoods.