Economic prosperity has led to increasing population in Almeria, Spain and this is reflected in the ever-expanding workload of the laboratory at the area’s El Poniente Hospital in El Ejido
Dr Cristóbal Avivar
Director of the Integrated
Biotechnology Management Area,
El Poniente Hospital, El Ejido,
The regional government of Andalusia began an ambitious programme more than five years ago to revolutionise its healthcare system, establishing 22 ‘high resolution’ hospital centres within the region.
The staff and laboratory management at El Poniente hospital have been responsible for supporting what is seen as a groundbreaking collaboration in the diagnostics field – the integration of Olympus Diagnostics clinical chemistry and automation products into the Beckman Coulter portfolio.
El Poniente Hospital Public Trust is responsible for managing five of the region’s new ‘high resolution’ medical centres. Also two new hospitals have recently opened. In Spain, ‘high resolution’ denotes a comprehensive, fast-track medical service in a centre of excellence, offering patients the fullest range of treatments in one location, as quickly and efficiently as possible.
As a high resolution medical centre, El Poniente’s laboratory is required to provide analytical results services to more than 240 different medical teams, all generating substantial complexity in both pre- and postanalytical processes. The increased demand
comes from El Poniente hospital and from the widely-dispersed primary health care centres, for which El Poniente and the other two hospitals have responsibility. The El Poniente laboratory
performs most of this activity.
Preliminary analysis of laboratory activity for 2009, across all three hospital centres, shows
the lab handled 500,000 patient requests (about 2,100 requests per day) involving:
- 5.4 million individual tests.
- 40,000 decentralised anti-coagulant controls.
- 16,000 biopsies and 15,000 cytologies.
- Extensive blood bank activity.
The lab’s workload has doubled over the past five years due to the expansion of the hospital. In the past 12 months Poniente may have dealt with the highest volume of activity of all the regional Andalusian hospitals. At a national level, its productivity and workflow are superior to many leading urban hospitals. This is made possible by the innovative approach taken in automating the laboratory. El Poniente is now known as a
European reference site, to demonstrate to others how this level of automation can be achieved.
The increase in activity, together with the organisational complexity of the three hospital centres, has demanded significant changes in all areas of the laboratory. When El Poniente started reorganisation in 2008, several important goals were set. Among these were to automate and streamline manual processes and to integrate different analytical areas into a combined blood service facility.
To achieve consolidation and integration of the various analytical areas, the El Poniente lab required the most advanced technology available, with particular importance placed on
improving sample management and laboratory processes, without increasing costs. Key selection criteria focused on analyser speed, technological and reagent quality (both chemistry and immunoassay), high pre-analytical capacity
and an overall improvement in organisational efficiency.
After a competitive tendering process, it was decided that the most suitable systems were offered not by one, but two companies – Beckman Coulter, for its automation and immunoassay expertise, and Olympus Diagnostics, known
for its reliable high-volume clinical chemistry platform. Both vendors were invited to work together to deliver a ‘best of breed’ total automation solution.
This joint effort worked out very well for El Poniente. The institution’s challenge to automate over 90% of its manual processes has been achieved and laboratory services have transformed into a fully integrated biotechnological management unit. Poniente now has the capacity to handle the specialties of clinical analysis, biochemistry, haematology and haemotherapy, microbiology and pathology. New models of laboratory management have been created and put into practice, enabling the lab to further adapt and streamline work practices.
Beckman Coulter’s acquisition of the Olympus clinical chemistry systems was officially announced not long after the new lab services were opened, in February 2009. This collaboration demonstrates the benefits that this move should bring.
Increased flexibility and fast sample sorting
From the moment the samples enter the El Poniente laboratory, the technology is able to provide a fast and consistent response to test requests, regardless of workload pressure.
The biotechnology department’s sample management unit is equipped with two preanalytical sorters, an AutoMate 2550 and an AutoMate 1250 (both with aliquot capability) – completely automating the reception and distribution of samples.
The high-speed capacity of the AutoMate 2550, with its capability of handling 1,200 samples per hour, provides the crucial first step in helping the lab successfully achieve its current performance levels. When additional support is
required, the AutoMate 1250 is engaged, which can handle 800 samples an hour.
Automating the pre-analytical tasks of sample tube decapping, preparation of selected aliquots, and sorting and distributing of samples to the required work area or analyser, has minimised sample handling and eliminated associated errors. This contributes to the successful achievement of overall high-speed sample processing targets. It has provided increased flexibility in tackling new and challenging tasks and satisfied the differing needs of both the El Poniente hospital and the external centres.
Once sorted, most of the samples are sent to the fully automated core lab where the Beckman Coulter Power Processor system transports the samples along a continuously moving track to the interconnected chemistry and immunoassay platforms.
PrepLink, the computer management software for track automation, controls all of the system’s functions and it shares information with the laboratory information system (LIS), enabling the lab to track the progression of each sample and the action being taken, in real time.
High-speed, high-volume analysers
The Power Processor automates routine, timeconsuming manual tasks – such as initial sample entry onto the system (via an inlet module), centrifugation and cap removal. It presents samples to the analysers and transfers them for the next processing step. Two high-speed centrifugation systems are linked to the track, each with 40-tube capacities, capable of spinning 450 tubes per hour.
Automated sample storage was also a key requirement. As test requests are completed and tubes are automatically recapped, the track directs them – again without manual intervention
– to the new 3,060-capacity refrigerated storage unit. PrepLink is also able to quickly locate samples needed for add-ons, reruns and reflex testing. It automatically identifies the patient via
barcode, retrieving the sample within seconds so that it can be directed to the appropriate analyser. This time-saving feature of automation has been particularly welcomed by laboratory staff, who are now no longer under pressure from the
medical teams to locate samples.
The track links with two Beckman Coulter UniCel DxI 800 immunoassay analysers, which are able to run up to 400 tests an hour for high-speed chemiluminiscent analysis. The DxI 800 is backed by a menu – which includes hormone studies, anaemia and cardiac tests and tumour markers – as well as the expanded range of general immunoassay analysis the lab requires on a daily basis. Test turnaround targets are maintained because staff can replenish reagent levels while the analysers are running. Bottlenecks are reduced with STAT and routine tests handled at the same time.
Beckman Coulter was chosen to provide the flexible, total laboratory automation solution and immunoassay expertise but the lab had specific high-volume clinical chemistry requirements. It needed an overall system with a moderate
footprint but this had to be capable of delivering an hourly maximum throughput of about 8,000 tests, when all the analysers were connected to the Power Processor.
The AU5420 and AU2700 systems more than meet these requirements and link seamlessly to the Power Processor. As a result of the acquisition of Olympus Diagnostics, these systems are now part of the Beckman Coulter family of products.
Staff adapt to new working practices
Automating and integrating different laboratory processes and disciplines in this way required a more flexible working approach from staff at all levels. Initially this involved investment in retraining staff to ensure they were able to adapt quickly to this new model for laboratory work. They now multi-task – working across several areas.
The response has been optimistic, with colleagues recognising that automation reduces the time spent on unproductive manual tasks. These frustrations have been replaced by new working challenges and opportunities, offering increased job satisfaction.
Key automation and consolidation successes
- Quality and safety improvements.
- Elimination of handling errors both before and after sample analysis.
- Reduction of work risks caused by sample handling.
- Reduction of turnaround time (TAT).
- Reduction of manual tasks.
- Simplification of processes.
- Consolidation of parameters.
- Fast and accurate location of samples.
- Increased analytical productivity and coordination of work.
- Improved working practices and job satisfaction.
For El Poniente staff, implementing this ‘best of breed’ total lab solution has been a pioneering experience and has had a marked impact on the professional team. Poniente laboratory
now has a principal, combined blood services unit that compares favourably with many in larger European cities. Working practices and performance targets have been enhanced, and the hospital is able to play a significant role in the region’s new healthcare structure – transforming the quality of medical treatment and patient care for all who live in the areas it serves.