How to Do More With Less: An Answer Is Found in Integrated Platform Technology

It’s a common refrain in today’s clinical diagnostic laboratory: Do more with less.

But it isn’t just a suggestion or a “flavor of the month” initiative, it’s a survival strategy. Laboratories are facing a shortage of qualified medical technologists, an increasing volume of samples and pressure to reduce operational costs. Meanwhile, tests have become increasingly complex and new governmental regulations continue to be introduced. The upshot: labs are fighting to preserve the integrity of results and deliver information rapidly, while at the same time struggling with small staff sizes and dwindling resources.

Indeed, since 1980, the number of accredited medical technologist programs has diminished by sixty percent and the number of certified medical technologist graduates has dropped by 70 percent, according to a 2007 Laboratory Industry Report issued by Washington G-2 Reports.

How are laboratories overcoming these challenges? One way is by acquiring integrated workstations (also known as work cells). This emerging technology combines chemistry and immunoassay testing onto a single platform—a move that significantly improves workflow and lab performance.

“Integrated workstations establish a single point of entry for both chemistry and immunoassay analysis,” says Jack Zakowski, director of Scientific Affairs and Professional Relations for Beckman Coulter. “This helps laboratories improve safety, speed turnaround time and minimize the chance of error during analysis.”

The level of productivity and cost savings you experience will vary based on the work cell you select. That’s why it is important to understand what features are offered—and determine which ones will have the most impact in your laboratory.

• A broad on-board menu of chemistry and immunoassay reagents;
• closed-tube sampling;
• parallel sample processing;
• STAT sample recognition, tracking and override;
• non-disruptive reagent loading; and
• scalability.

Broad Menu Helps Improve Patient Care
When you have the ability to run a full menu of both chemistry and immunoassay tests, you can create a single, comprehensive report—delivering all the information a physician needs to properly diagnose a patient and manage a disease state.

“In the future, breadth of menu will be one of the most important features of work cell technology,” says Kerri Weinert, president of Boston Biomedical Consultants and an expert on the in vitro diagnostic (IVD) industry. “A broad menu is of course necessary for true workstation consolidation, negating the need to run samples on secondary analyzers and ostensibly reducing turnaround time and improving labor productivity and patient results.”

A broad test menu can also help accelerate patient results by eliminating the need to outsource certain tests. Since installing Beckman Coulter’s mid-volume workstation, the UniCel® DxC 600i Synchron® Access® Clinical System, Martha Tenan, lab supervisor at University of Missouri Health Care (UMHC) in Columbia, has seen an increase in the number of tests performed in-house. She attributes the growth primarily to the broad menu of tests available on the system.

Stephanie Swanson, MT (ASCP), lab manager at Kernodle Clinic in North Carolina, agrees that expanded testing is one of the key benefits of integrated testing. “There are a number of tests that we’ve wanted to bring in-house, such as Free T4, Direct LDL and Lipase,” says Swanson, whose lab uses the UniCel DxC 600i. “We couldn’t do it before because the technologists simply couldn’t process any more samples. With the DxC® 600i we can add these tests and even more as the clinic grows.”

Closed Tubes Minimize Errors & Risks to Lab Personnel
With closed-tube sampling (CTS), also referred to as cap-piercing, a special technology enables a needle to pierce through the rubber specimen cap and extract samples automatically. No manual de-capping or re-capping is required.

This feature considerably minimizes exposure to sample splashes, spills and aerosols. It also reduces the risk of repetitive motion injuries and speeds up turnaround time by removing manual steps. “We were able to see immediate results in efficiency,” says Swanson.

Cap-piercing technology has been available on hematology analyzers for a long time. However, it wasn’t until 2000 that the greater value of CTS technology became clear, when it was successfully applied to a chemistry analyzer, the Beckman Coulter Synchron LX®20 PRO. Laboratories using the instrument realized operational efficiencies, ranging from $16,000 - $33,000 (U.S.) annually, as a result of reduced labor hours, consumables and repetitive stress injuries, according to a company-sponsored survey.

In addition to the benefits it offers the lab, CTS can be a strong selling point for potential new hires. When a lab selects analyzers that improve lab productivity and protect the health of lab personnel it sends a signal about what the lab values. And this can be attractive to prospective employees.

“CTS creates a safer work environment for lab technologists by minimizing the risk of biohazards during analysis—and safer is always better, especially when working conditions are the differentiator in deciding to accept a job,” says Martha Tenan of MHC.

Parallel Sample Processing
One of the key benefits of an integrated system is the ability to conduct parallel processing, or the simultaneous processing of chemistry samples and immunoassay samples.

In a modularly configured work cell, technologists load both chemistry and immunoassay samples in one single place: the closed-tube aliquotter (CTA). Samples are then aliquotted according to testing needs. For example, if a test requires both chemistry and immunoassay testing, an aliquot will be created and the sample will be processed on both sides of the system simultaneously. Or, if it only requires chemistry testing, the tube will be routed automatically to the chemistry side of the system.

To add even more value, labs have the option of adding CTS technology into the CTA component. As discussed above, this can greatly enhance lab safety and productivity.

“With integrated testing, everything seems to finish up faster than it did before,” says Swanson. “Our technicians are able to finish all their testing and still leave work on time, instead of saving some samples for the next morning. Our consistency of turnaround time has improved as well.”

Fast Handling for Priority Samples
The ability to recognize, prioritize and track STAT samples is another key feature of integrated work cells. With this capability, laboratories can quickly address the most urgent samples, while also operating in an efficient manner that improves productivity and reduces stress in the lab.

On Beckman Coulter’s newest, high-volume work cell, the UniCel® DxC 880i Synchron® Access® Clinical System, 20 percent of the sample carousel will be dedicated to STAT samples. If the STAT slots on the sample carousel are filled, the system will automatically establish the next open slot for STAT testing, optimizing STAT sample processing.

Reagent Load While Running
Efficiency is the driving concept behind any integrated work cell—and it shapes every design element, including the essential task of loading reagents and consumables.

When it comes to this task, the system’s goal is simple: Be non-disruptive. With Reagent Load While Running, sometimes referred to as “on-the-fly” loading, users can load or unload reagents at any time during a run without disrupting workflow.

“Work cells can run hundreds of tests per hour; some tests are run more frequently than others,” says Monica Rassai, Integrated Systems marketing manager, Chemistry Systems Business Center, Beckman Coulter. “Having to entirely stop the instrument to reload reagents is impractical and wastes time.”

Scalability

As throughput levels change, laboratories must evolve. Choosing a work cell that offers long-term flexibility, one that can be reconfigured according to throughput demands, can be one of the best decisions your lab will make.

For example, if your current level of chemistry testing shifts from mid-volume to high-volume, but your immunoassay testing levels remain the same, it would be impractical to purchase an entirely new work cell to accommodate the change. If the work cell is modular, however, you can easily upgrade your analyzer to meet the changing demands.

Scalability also serves as protection against bottlenecks during maintenance of the instrument.

“Maintenance can differ for different modules on an integrated platform,” says Zakowski. “An innovatively designed work cell will allow each functional aspect to operate independently of the other when necessary, especially during maintenance.”

Clearly, a work cell that requires a complete shutdown for repairs can cripple the lab’s performance, creating backlogs that delay patient results, possibly forcing STAT tests to be run on less efficient systems.

By contrast, minimal maintenance can contribute to lab productivity. Kernodle Clinic technologists have seen this firsthand. When the lab was looking for an integrated system, one of its goals was to decrease the time it takes for daily system start-up. Thanks to a large onboard reagent capability (89 reagents) and auto-generation of quality controls, technologists perform only four minutes of daily maintenance, then get straight back to work.

An Integrated Solution That Addresses Multiple Challenges
A shrinking laboratory workforce, increasing volumes of samples and rigid budgetary constraints are changing the way clinical diagnostic labs operate. In response, manufacturers are designing innovative technologies, founded on the principles of increased efficiency and improved patient care.

“The integrated work cell has given our techs the opportunity to be techs,” says Swanson. “They have time to analyze the data and focus on the abnormal results.”

Though technologies differ from work cell to work cell, choosing a system that is constructed with flexible technologies can prove to be the savviest choice. As Jeff Mc Hugh, Beckman Coulter’s corporate vice president, Chemistry Systems Business Center, sees it, “Regardless of the testing discipline—chemistry, immunoassay or hematology—major advances in laboratory performance will revolve around integrated solutions. The continued focus on connectivity is inevitable.”

Indeed, labs are finding that by integrating their work they are saving time. Reducing costs. Improving patient care. In other words: doing more with less.