EH 2_2015

Source:Shutterstock/SUWITNGAOKAEW EUROPEAN HOSPITAL Vol 24 Issue 2/15 18 LABORATORY Driving lab testing onto one track Scottish NHS group endorses auto Clinical chemistry is broad ran It’s thumbs up for Siemens Healthcare Diagnostics’ Aptio Automation, following a two-year deployment by Dundee-based National Health Service (NHS) Dundee, the first north European healthcare organi- sation to use the system to consoli- date formerly siloed biochemistry, immunology, haematology and hae- mostasis testing onto a single auto- mation track. Tayside now processes 7,000 tubes per day – a 20% increase in its main laboratory workload, with no additional staff. Total decreased turnaround time (TAT) brought a 61% improvement in TAT for add-on tests – all with high-quality results. Three labs into one Serving 480,000 people through 22 hospitals/infirmaries and 69 gener- al-practices, Tayside relies on two laboratories. In the Blood Sciences Laboratory at the 900-bed Ninewells teaching hospital, Aptio Automation merged three former individual labs onto a single track, fully providing pre- and post-analytical sample-pro- cessing modules along with com- prehensive analytics. By crossing traditional discipli- nary boundaries and standardis- The discipline of clinical chemis- try in Switzerland comprises the biochemical and immunological analyses of substrates, hormones, metabolites, proteins, drugs and drugs of abuse in blood and other body fluids, mostly using highly automated instruments. In bigger laboratories more sophisticated chemical techniques are also used, such as atomic absorption spectros- copy to quantify heavy metals in blood, urine and tissues, chromatog- raphy coupled to mass spectrometry e.g. to quantify drugs, and electro- phoresis to separate proteins. Unlike other countries, coagulation tests, blood cell count and blood smears, are not part of clinical chemistry. A Masters degree in medical and pharmaceutical sciences, biology, biochemistry, chemistry or a com- parable natural science is needed to become a clinical chemist. The Swiss Academy of Medical Sciences issues the curriculum to specialise in laboratory medicine. The Swiss Association of Medical Laboratories, FAHM, represents the commercial labs that perform over 1,500 differ- ent analyses of blood, urine, stool or other patient samples, for doctors and hospitals, and it also organises education in clinical chemistry. After passing an entrance exam that covers all disciplines of labora- tory medicine (clinical chemistry, haematology, immunology, medical microbiology and human genetics) the course to qualify as a clini- cal chemist lasts four years, during which FAMH candidates work in a routine laboratory and attend sev- eral block courses in topics such as ing and streamlining flow of infor- mation, samples and data back to patients, Dr Bill Bartlett, NHS Tayside Joint Clinical Director of Diagnostics, concludes, lab services are transformed from cost centre to value investment. ‘The new system can track and manage 3,600 specimens an hour just in circulation. At the touch of man management, quality manage- ment and change management etc. At least one of the four practical years must be spent in a public hos- pital laboratory. After the final oral examination, the clinical chemist can take full responsibility in a lab. The Swiss Federal Office of Health regulates reimbursement for laboratory tests, including all clinical chemistry tests. One list of analyses is positive, containing all lab tests reimbursed by the health insurers linked to one price. Since autumn, there has been one excep- tion to this general rule: point- of-care (POC) tests performed in doctors’ offices have higher prices than the same test performed in professional laboratories. The price of a lab test is a so-called technical activity. Therefore, lab directors usu- ally don’t have any private income for performing medical activities, for example for patients with pri- vate insurance. This contrasts with German laboratories. Due to these circumstances, and a common education, pharmacists and natural scientists have equal a CentraLink system screen, we can also retrieve and drive testing on up to 15,000 more samples stored in the Aptio refrigeration module.’ Thus Ninewells lab could take on 73% of testing formerly conducted at the 260-bed Perth Royal Infirmary (PRI), enabling that smaller labora- tory to focus on acute admissions and in-patient testing. Ninewells rights to bring lab tests to account. Each test has one or several suffixes, which indicate its laboratory medi- cine discipline. If a lab wants to be reimbursed for analytes that belong to different disciplines it needs a FAMH lab medicine specialist for each discipline. In 2012, Switzerland had 206 acute somatic hospitals and special- ised clinics, according to H+, the organisation that represents Swiss hospitals. The Swiss health system is organised in a non-centralised man- ner and each of the cantons has its own health law and hospitals. The size of the 26 cantons varies consid- erably (~16,000 – 1,425,000 inhabit- ants) and consequently also hospital sizes vary substantially. Depending on that size, their laboratory has a few point-of-care instruments; small automated devices for clinical chem- istry, immunology and haematol- ogy, or offers the full spectrum of analysis. Swiss law allows small hospital laboratories that perform only in-house lab tests to be headed by a technician with a superior edu- cation. A physician having passed a two-day-course in laboratory medi- cine can take over supervision of these labs. As soon as samples from outside the hospital are analysed, a FAMH now handles 100% of the general- practice testing in the entire region. Results The Ninewells Blood Sciences Laboratory processes up to 7,000 tubes a day on the Aptio Automation track, 1,700 tubes an hour at peak times. Despite volume increases of around 5% per year since 2012, samples no longer back up. Median TAT is 41 minutes, with 95% of the work completed in 67 minutes. ‘Our input potential has increased 246%, without the additional capacity of the Input Output Module, which is reserved for STAT samples and used heavily for sorting,’ Bartlett points out. The 75-foot track employs a vari- ety of modules to reduce manual samples handling, ease test re-runs and add-on testing, and speed all TAT, all enabling Tayside to up-level biomedical and clinical scientists responsibilities. Customising workflow management The CentraLink Data Management System drives Aptio Automation. With end-to-end touch points, the CentraLink system consolidates laboratory medicine specialist is needed, as already mentioned. There are also several private laboratories responsible for lab testing, mostly in smaller public or private hospitals. Private laboratories always need FAMH laboratory medicine special- ists for each discipline performed in their premises. Switzerland’s five big medical fac- ulties are all linked to a university hospital with a clinical chemistry laboratory. Unfortunately, there are only three ordinary professors for clinical chemistry (Zurich and Geneva) or Biomedicine (Lausanne) appointed to the respective medi- cal faculties. Basel and Berne uni- versity hospitals, and the Zurich’s Children’s University Hospital, have associate professors. Nevertheless, with their co-workers, they are heav- ily engaged in teaching medical and pharmaceutical or natural science students. In all university hospitals MD and/or PhD students perform lab work to gain a doctoral degree from the respective faculty. Highly specialised medicine is offered in all university hospitals in different areas of expertise. Usually, different research groups of clini- cal colleagues carry out research on these fields and often also the clinical chemistry department has research activities in these topics, to allow specialised and unique pro- gression in diagnosis and/or moni- toring of therapy or disease progres- sion/remission. Ten years ago, the different disci- plines in laboratory medicine were mostly separated in the big hospi- tals, but since then organisational units have been created or are in development. They usually consist at least of clinical chemistry, diagnostic haematology and clinical immunol- ogy. The clinical chemist is usu- ally experienced in managing a very high number of patient samples, covering a wide diversity of analyti- information from the LIS, track, and instruments to automate workflows in a lean, multidisciplinary labora- tory that can handle routine and emergency testing on one track. The CentraLink system custom- ises and standardises workflows across automation, analysers and IT. Additionally, when add-on orders arrive, the CentraLink system finds the tube on the track or in refriger- ated storage, coordinates de-cap- ping and/or aliquoting, sends it to the right analyser and uploads results. Shirley McKay, associate ser- vices manager at the Ninewells lab: ‘We can drill down and look at each individual sample, the route it takes, and re-route as needed.’ The lab can also use auto-veri- fication for approximately 90% of its workload, she adds; such high volumes could not be processed if validating everything manually. Logic rules in the CentraLink system can be test- and site-dependent, for example, so that renal ward rules can differ from those of the paedi- atric ward. Bartlett recalls that, after a 90-minute fire drill, staff returned to find the Aptio Automation Rack Input Module and track empty, with cal techniques. Therefore, in many hospitals, the clinical chemist has taken over the position of head of these organisational units and therefore is finally responsible for the organisation of most, if not all, of the laboratory tests performed in his hospital. In Switzerland the number of young scientists studying clinical chemistry is small, perhaps because the profession is not publicly vis- ible – adolescents are not usually aware that the profession exists and medical and natural science students rarely have contact with those from this profession. In Switzerland only pharmacists have mandatory cours- es in laboratory medicine, mostly given by a clinical chemist. To offer positions for a Master or PhD theses for all these university courses is therefore an absolute need, because this is the best chance to draw stu- dents into the laboratories. In my opinion clinical chemistry is the most fascinating discipline of laboratory medicine. Many different analytical techniques are used for patients from all medical disciplines. The discipline is so broad that a young, active clinical chemist can choose a field of expertise. This might be on a more organisational level if he’s interested in automation processes, or lab organisation or, on a basic research level, focusing on a very specialised topic. The expertise of Swiss clinical chemistry research- ers lies in biomarker research, car- diovascular research, metabolomics and toxicology. Besides being active in the Swiss Society of Clinical Chemistry, they are all very actively involved in national and interna- tional scientific societies. Nevertheless, in daily routine we are all confronted with different aspects of lab work that demands a broad knowledge of medicine, besides experience in organising processes to optimise lab turn- Aptio Automation is a unified solution developed expressly for the changing workload and expanding needs of today’s clinical laboratory. It provides unlimited potential for lab optimisation by combining peak performance, adaptability, and intelligent technology with Siemens’ signature automation workflow expertise. With Aptio Automation, labs of all sizes can transform their operations to harness change and drive maximum performance and efficiency The field is neither tedious nor monotonous; it’s fascinating every day, Professor Katharina Rentsch emphasises, when explaining the need to attract students to this often overlooked but intreguing and varied discipline

EH 2_2015

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