Description
Laboratory facilities have a very low level of direct patient involvement. Samples are taken in many different locations and sophisticated transport systems enable the central laboratory department to be located far away from the sample collection facilities. While the technical integration of multiple analysis sequences has been the focus of innovation for the past few decades, the actual processing pattern has remained largely the same, with the following workflow: 1) sample taking; 2) sample analysis; 3) analysis report; 4) discharge of sample (waste). However, laboratory facilities are today on the brink of a fundamental paradigm change, which will move them from retrospective analysis toward prospective patient intervention and treatment.
Trends
Future laboratory services will have to form part of a highly interactive patient interface, since these services will change from simply providing diagnoses to participating in genetic cell treatment and the reintroduction of adapted cells into the patient’s body. The provision of facilities enabling the reintroduction of live cells may require intense cooperation with the intervention cluster, which will be a room equipped to carry out the full range of procedures, from diagnostics to operations. The paradigm change toward laboratory-driven, individually focused cell treatment will elevate the laboratory department from a service provider to a strategically important treatment facility with interfaces to a broad range of medical specialties.
Functional Perspective
The paradigm shift toward proactive cell treatment will lead to changes in laboratory department design even more substantial than those resulting from the introduction of the PCA (perchloric-acid-precipitable) cell detection method in the 1990s. Just as PCA today has become part of various detection methods, so the attached room sequences and work procedures associated with them have become basic elements of laboratory design. Laboratory spaces have to accommodate the new work sequence: 1) sample taking (cells); 2) cell analysis; 3) cell separation (selection of desirable cells); 4) genetic treatment of the selected cells; 5) augmentation of genetically adapted cells; 6) reintroduction of adapted cells to the patient’s body, maintaining high-quality hygiene standards; 7) monitoring of newly introduced cells with regard to integration, multiplication and behavior (healing).
Challenges for Future Design
In recent years there has been a trend toward outsourcing laboratory facilities, mainly in smaller and medium size hospitals — up to approximately the district hospital level in many countries. Considering the expected paradigm change described above, the outsourcing of laboratory facilities and the reduction of laboratory specialist staff may therefore prove to be a strategic mistake.
While the treatment of certain forms of hematological cancer, along with some cell treatments in cardiology and general oncology, looks promising, it is still a long way before these treatments will become part of the standard case compensation scheme. Thus, decision makers and hospital planners find themselves in a particularly difficult situation, since it is impossible to finance spaces which are not yet part of a financial compensation scheme. The best advice would be to maintain the existing diagnostic laboratory facilities and allow for their gradual transformation in tandem with the evolution of the new techniques.
Among the most significant design changes in this context will no doubt be those needed in the high security S1-, S2-, S3-laboratories in order to provide sufficient safety to allow for a reintroduction of live cells into the patient’s body without exposure to infections or other risks. Up to now, the safety focus in laboratory facilities has been on protection from hazards arising from the conditions of the cell samples. In the new treatment environment, the main safety concern will be to protect the selected and adapted cells from outside contamination.
Originally published in: Cor Wagenaar, Noor Mens, Guru Manja, Colette Niemeijer, Tom Guthknecht, Hospitals: A Design Manual, Birkhäuser, 2018.