Special Coagulation Lab Standardizes Testing and Speeds Results Systemwide

Special coagulation testing is a critical tool that helps properly diagnose and treat several conditions that prevent blood from clotting properly. Clinicians who care for patients with complex disorders such as hemophilia, cancer or unexplained severe bleeding rely on receiving precise, easily interpreted results from these tests. However, up until last March, differences in how special coagulation testing was performed across our system sometimes made it difficult to compare results from different Mass General Brigham (MGB) hospitals. 

“MGH did it one way, Brigham had its own approach, and the community hospitals typically sent their tests out to reference labs,” explained Anand Dighe, MD, PhD, vice chair of Clinical Operations for MGB Pathology. “But coagulation testing should be standardized across the entire system, no matter where a patient receives care, so that results are consistent, reliable and easily comparable — ensuring the best possible diagnosis and treatment.” 

This vision propelled an 18-month, multiphase project to create a fully integrated special coagulation laboratory service for all of Mass General Brigham. The integrated Special Coagulation Lab now provides such testing for both academic medical centers, Brigham and Women’s Faulkner Hospital and Newton-Wellesley Hospital, as well as their outpatient clinics. 

The lab is currently working to add Salem Hospital and will eventually support all hospitals and outpatient clinics across Mass General Brigham to deliver standardized testing workflows, faster turnaround times and more consistent interpretation of results. This milestone has been made possible thanks to a collaborative, multidisciplinary team of Pathology, Hematology and Digital leaders and staff from across MGB.

“Asking medical directors and lab experts to develop a combined best practice was challenging due to longstanding, ingrained processes. But with the goal of providing the best care for every patient in the system, the team began working together across sites and debating which processes would be most effective,” Sacha Uljon, MD, PhD, medical director of the MGB Special Coagulation Integrated Laboratory Service. “As new relationships were fostered, the group worked together to design a new service which was better than the service any of the individual labs had before.”

Elisabeth Battinelli, MD, PhD, clinical director of the lab service, agreed.

“The collaboration between the MGH and BWH around the Special Coagulation Laboratory consolidation was a true partnership in integration,” she said. “We clearly had a steep learning curve, given the differences in testing practices and utilization at the two institutions. Together, we built a team that worked hard to find consensus based on best practices for patient care. We emerge from this process stronger and more unified. We are proud of what we have accomplished and excited to keep working together to offer exceptional special coagulation testing for the MGB community.”

Expanded service

Most of the integrated Special Coagulation Lab’s tests are performed at Massachusetts General Hospital (MGH), with one form of testing remaining at Brigham and Women’s Hospital (BWH).

“This wasn’t so much about centralizing everything in one location. It was really about consolidating resources. We had a lot of redundancy between MGH and the Brigham,” Uljon said, explaining that prior to integration, equipment at one lab would sometimes sit unused while it might benefit another hospital in the system.

“Previously, at many of our hospitals, running a special coagulation test on the weekend was a rare and challenging task that often disrupted the workflow. Now, it’s fully integrated into our routine operations,” added Dighe. “Making these kinds of improvements was essential to build trust and confidence, especially when asking staff to change practices they’d followed for more than 30 years.”

Integrating the lab’s operations has meant specimens are processed in a uniform way, including the use of transport on dry ice to maintain integrity during travel. Testing methodologies, reference ranges and reflex protocols for special coagulation tests are now standardized across the system as well.

Another change involved who interpreted lab results. Previously, hematologists did so at BWH, while pathologists did the interpretation at MGH. In the new, integrated model, a completely digital workflow enables both sets of specialists to review and interpret all results from any physical location.

Additionally, the team created a weekly conference for hematologists, hematopathologists, residents, and the attending on service to ensure the most challenging cases are reviewed by multiple specialties.

“It has helped our interpretation a lot because we’re bringing more perspectives,” Uljon said.

A crucial factor enabling this progress is unifying all of Pathology onto a single software platform, Epic Beaker. The software is being implemented across the system, with all MGB clinical labs expected to be on Beaker by November.

Faster turnaround

In addition to the technical considerations, the team paid close attention to operational issues such as transport. With most specimens now being processed at MGH, it meant many samples would be originating from much farther than a few floors away.

To accommodate this, MGB Pathology reallocated resources to increase the frequency of special coagulation testing and build a more robust specimen transport service. Every weekday, a dedicated courier now makes six trips per day between MGH and BWH, as well as three trips per day on the weekends. A separate transport courier makes trips directly between BWFH and MGH, bypassing BWH and the associated traffic around the Longwood Medical Area.

As a result, test turnaround times are faster than they ever have been before. Uljon reflected on the experience of a patient who had their blood drawn at the Mass General Brigham Healthcare Center in Foxborough to rule out von Willebrand disease — a genetic bleeding disorder — the day before their surgery at BWH.

“This wasn't even a STAT specimen, and the turnaround time was less than 24 hours from an outpatient draw in Foxborough,” Uljon said. “Before integration, we ran von Willebrand panels three days a week at MGH, and the average turnaround time for an MGH inpatient was more than 30 hours. We are now routinely offering faster service to sites throughout MGB than we used to offer only to MGH inpatients.”

Achievements like this reflect how integration has pushed the boundaries of what’s possible, Dighe said.

“We’ve built a better service than any of us could do individually, and we’ve done it at a lower cost,” he said. “Knowing that our work positively impacts patient care across the entire Mass General Brigham system, and even throughout New England, makes this effort truly meaningful.”