The evolution of specimen accessioning and delivery
The first test specimens (blood, urine, and tissue samples) began coming into Mayo Clinic Laboratories around 1971, and the lab was officially launched on March 17 of that year. Back then, it was known as the Regional Laboratory because the two men charged with its operation, Jerry Wollner, chief administrator, and Michael O’Sullivan, M.D., medical director, wanted to start small and smooth out any “wrinkles” before expanding into a national reference lab. Initial clients were made up of regional hospitals and solo pathology practices. Client specimens were received in a back room on the first floor of the Plumber Building, the lab’s initial operating headquarters.
“At the time, our receiving area amounted to a small card table because we really didn’t need a lot of room yet,” says Susan Towers, who was the lab’s 11th hire. Towers, along with a handful of other “clerk typists,” would unpack specimens, which arrived by U.S. Postal Service, and match them with the paperwork, a process called “accessioning,” before delivering each one to the lab for testing. “We would then take turns going around to pick up the test results, which were sent off, again by postal service, to the hospitals and clients as quickly as possible.”
An employee sorts specimen requisition forms in the accessioning area of Mayo Clinic Laboratories in the late 1990s.
That first year, an average of 10 to 75 specimens were accessioned per day. Over the month of July 1971, the lab performed 219 tests and had a total of 14 clients. Business grew steadily. By the end of that year, the lab had 83 clients. Dr. O’Sullivan remembers one standout day in March of 1972, when the lab accessioned 100 specimens for the first time. “That evening, my wife and I hosted a little dinner party at our home,” he says. “And we celebrated that first day we hit 100 specimens.”
A group of lab workers sorts specimens at Mayo Clinic Laboratories.
Another landmark day, circa 1973, demanded that Towers and her coworkers accession a “whopping” 175 specimens for the first time, an amount that nearly overwhelmed her office. “We worked like crazy to get those done,” she says. “At the end of the day, when we finally got through them, we were so excited because it was a huge number for us. It was such a big deal that our manager took us out for dinner that night. We went to the nicest restaurant in downtown Rochester at the time. We had steak and lobster, and just celebrated this accomplishment.”
Among his many managerial duties, Wollner was responsible for specimen containers and the delivery process, which meant he had to quickly respond to logistical issues that came up.
“Some specimens could be handled in ambient temperature, and others had to be in a frozen state,” he says. “And I had absolutely no expertise in those areas. But, nonetheless, I had to learn about them. So we built a container out of Styrofoam that would hold three blood specimens and two half-pint containers of urine. We used standard Mayo Clinic materials, and we found that some of them just didn’t stand up in the delivery process. We also found out that when blood samples go through the post office and go on airplanes, they don’t get handled that gingerly.”
Towers chimes in, “Our blood samples came in little twist-top vials, and we would have so much trouble with them. They’d go up in the airplane and the air pressure changes would loosen the cap on the vial and all the liquid would leak out of it. By the time it reached us we couldn’t run the test.”
There were also issues with the initial container for frozen tissue samples. “We had a Styrofoam box made for frozen specimens, and it had a cover on it that wouldn’t seal properly,” says Wollner. “So we had tissue specimens coming in that were thawed. And the laboratory couldn’t use those specimens. Those were always difficult calls to make back to a customer, saying, ‘Sorry, but your specimen thawed in transit, and we need a new one.’”
Wollner continues, “We had a new molded Styrofoam box built for us by a company in Wisconsin. We literally solved the problem as quickly as that box could be made.”
The Regional Laboratory soon expanded into a national reference lab. And because clients were sending specimens from farther and farther away, a faster delivery method was needed. “We switched to a courier service, where we made direct pickups at laboratories and hospitals around the country,” says Wollner, who retired in 1997 after 35 years with Mayo. “And this significantly sped up the whole process of specimen delivery.”
As the lab expanded and operations improved, new clients could be better educated on how to properly prepare their specimens for transport to Mayo Clinic Laboratories. This became part of the responsibility for the sales force, implemented in 1987.
“If a lab manager at a hospital or clinic was interested in having complex tests done by Mayo Clinic Laboratories, the sales rep had to facilitate the entire ordering process, on paper,” says Don Flott, a former sales rep. “We’d have to show them how to load the boxes with an ambient room-temperature specimen, or something that went with a cold-pack, or a specimen that would require dry ice. So we had to train them on how to get those samples to Rochester.”
As the decades passed, the analog era moved into the digital age. By now, the lab had gone from paper to computerized support, had a very large esoteric testing catalog, and implemented a 1-800 customer service line, which was answered in the first 10 seconds by an actual human voice.
“A huge percentage of issues that were called in were solved in a single phone call,” says Marie Brown, who was an education coordinator for the department’s Section of Chemistry early on. “Our shipping and logistics, our ability to track the test sample wherever it was, the computerized ordering and reporting of test results, I think when all those things were implemented, it put us out ahead of some of the other competitive reference labs.”
“There were a lot of things on the service side that were, and continue to be, best practices. Likewise with our sales staff and technology support staff that work with our clients,” says Brown.
Today, Mayo Clinic Laboratories uses FedEx and other delivery services for maximum delivery speed of specimens. Further, the lab has innovated ways to minimize lost specimens.
Scott Beck, senior vice president at Mayo Clinic Laboratories, offers one example: “We support our clients with the required materials to package up their specimens,” he says. “And the containers that we use have evolved over the years. We have some that we call our ‘berry boxes,’ which have a very distinctive raspberry or cranberry color to them. And that is so they don’t look like any other box that might be shipped. They stand out, so it’s easier to sort those boxes out for us and prioritize them for shipping to Rochester.”
The distinctive “berry boxes” stand out to shipping carriers, making it easier to sort and prioritize patient specimens.
During the pandemic year, there were days when some 50,000 specimens were coming in through logistics carriers. Other specimens come through Mayo Clinic Laboratories’ regional laboratory delivery services.
“We try to do whatever we can to make that process as efficient and as high-quality as possible, down to the color of the boxes, to provide that safety for patient specimens that are sent to us,” says Beck. “And the high volume of specimens that comes in to Mayo Clinic Laboratories helps support this level of service from our logistical providers.”
When the little lab first started in 1971, there were only two lab techs doing the testing. Fifty years later, Mayo Clinic Laboratories has over 65 specialty laboratories located in a two-story building of 279,000 square feet in Rochester, Minnesota.
Towers sums up the early climate at the lab this way: “The reason it was so exiting all those years ago is because I was a part of almost everything that was happening in the lab,” she says. “Even things like blood samples and biopsy samples. We continually made improvements on nearly everything, and so as time went along, our overall operations got faster, easier, and better.”
Guided by a patient-centric philosophy, Mayo Clinic Laboratories has a unique internal structure of quality specialists, coordinators, and engineers who constantly evaluate and improve laboratory operations. This structure supports a host of quality assurance activities.
Each day, some 40 to 45 thousand specimens are shipped to Mayo Clinic Laboratories in Rochester, Minnesota, from hospitals and other health care organizations around the world. And for every sample, there’s a patient to whom it belongs, someone on the other end hoping for answers to a challenging, perhaps even life-threatening, condition.