The Lab of the Future – Now

Growth and evolution are important aspects to embrace in science – and they’re vitally important when it comes to the laboratories behind cancer testing. When Memorial Sloan Kettering Cancer Center (MSK) wanted to grow their laboratory to accommodate more staff and facilities, they saw an opportunity to review their approach to creating a lab and decided to build one from the ground up to make a space that could adapt to their needs as they grow and evolve.

Laying a foundation

The groundwork for the new building began nearly six years ago with supporting future growth at the top of MSK’s priority list. The facility in use at the time was a challenge to remodel, so the decision to relocate led them to a spacious building – formerly an old garage. That construction posed quite a few challenges – digging into the ground uncovered an ancient creek bed – but as the rebuilding began, the team’s ideas of what the lab could be grew more complex. MSK’s Chair in Laboratory Medicine, Melissa Pessin, says,  “We were starting almost from scratch, so why not push the possibilities as far as they could go?” The ambitious project came at the cost of time. The initial completion date was planned for 2015, but ended up being 2017. The results, however, seemed well worth the wait. “What we now have is a uniquely engineered building that is tailored not just for our current needs, but for what we anticipate needing in the future as well,” says Pessin.

MSK’s new lab is also the first in the United States to feature an automated line with a vertical transport module, which allows medical laboratory assistants (MLAs) to load specimens onto the system, transport them to another floor, and have the samples immediately transferred to an instrument, greatly reducing turnaround time. Pessin adds, “Here in crowded New York City, we’re quite space-constrained, so the vertical transport module allows us to spread our workspaces across several floors without losing efficiency. It’s a lot faster than having someone carry samples to another floor or using our ETV (elevating transfer vehicle) to send up batches. With the automated line, samples get to the floor they need to be in seconds.”

The concept and execution of the building has been such a success that MSK’s anatomic pathology colleagues are looking at the lab as a model for the planned expansion of their molecular facilities.

Design for collaboration

MSK has a number of locations in and around Manhattan, but also receives samples from Long Island, New Jersey, and Westchester. Those satellite locations conduct basic chemistry and hematology tests on site, but samples for other tests are sent to the new facility. “With cancer care moving more and more toward the outpatient model, it’s important for us to turn results around rapidly and get them back to the requesting clinicians so that they can select and administer treatments quickly and efficiently,” says Pessin.

The new building is currently up and running with services that include blood banking, clinical hematology, clinical chemistry, microbiology, cell immunology, flow cytometry, and a cell therapy laboratory (the first section to open in the building). And, alongside their plan for adaptation, the space has the capacity to expand into other areas.

When designing the layout, the staff working in different labs were invited to provide input into their respective setups.

The microbiologists have lab automation equipment to speed up processes that have largely been manual – at least for bacteriology – and, in the future, MSK plans on adding a human leukocyte antigen laboratory to the facility.

By focusing on flexibility and having the additional room to grow, CAR T therapy – which has become a prominent research topic since the early days of the building design – was easily accommodated. What happens now? When the cell therapy lab receives patient blood cells from the MSK donor room, the cell immunology laboratory characterizes those cells to ensure there are sufficient T cells prior to sending them on to various companies or an MSK lab for engineering. When the CAR T-cells are received, the lab makes sure that they are prepared for infusion before they are administered to patients.

Another example of flexibility: the lights, power, water, and air are channeled through the ceiling, which means that certain lab areas can be shifted in size and position, depending on what tests or services are needed at any time.

Pessin also notes that the work life of the pathologists has improved. There are no more cubicles (but to allow for the privacy required by HIPAA, there are real offices), and the new open plan structure has allowed more conversations across specialties, resulting in new ideas and great collaborations. Sometimes, when designing a lab, the comfort of the scientists working there takes a backseat to function – but that’s a pitfall MSK made a strong effort to avoid when designing the building. “We provide terraces they can use when the weather permits, food areas if people don’t want to eat off-site, showers in the basement, and – something I think the staff really appreciate – natural light. That can be a rarity for laboratory medicine professionals, because many places have labs in the basement. We wanted our staff to see the sun!”

Looking to the future

Currently, the teams are still working to further optimize their processes. Although the lab was designed with efficiency in mind, Pessin says, “It’s difficult to plan the most optimal workflow in advance – especially in a space as unique as ours.” Despite this challenge, they have already seen a great improvement in turnaround times, and, once microbiology automation is fully implemented, they expect to see tremendous further progress. With that system in place, they’ll be able to obtain automatic, real-time readouts instead of manually checking on each bacterial culture every day – an upgrade that could save at least 12 hours. Among other improvements, they hope this will make a big difference to the length-of-stay for patients.

Pessin concludes, “We’re all very excited to be in this building. And we are grateful to MSK for recognizing the value of its clinical laboratories and investing to help make things better for our patients. I hope that sharing our approach to workflow and lab design will help other hospitals and other laboratories optimize their own processes, so that we are all able to help our patients to the best of our abilities.”

Melissa Pessin is Pathologist and Chair in the Department of Laboratory Medicine at Memorial Sloan Kettering Cancer Center, New York, USA.