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Haematology technology and innovation drives quality and productivity

The advanced technology behind Beckman Coulter’s DxH 800 cellular analysis system has helped create significant workflow efficiencies for this UK lab
Martin Langan
Blood Sciences Manager,
Countess of Chester Hospital, UK
The Countess of Chester Hospital NHS Foundation Trust, in the north of England, is one of the most efficiently run in the UK, with an excellent reputation for delivering high quality patient care. It is nationally accredited at the highest levels in many areas, in particular those relating to clinical outcomes and patient safety. 
The hospital has won the prestigious ’40 Top Hospitals Award’ from the NHS for the 12th consecutive year, one of only five Trusts in the UK to achieve this status. With almost 4000 staff, it provides medical services for more than 425,000 patients from Western Cheshire, Ellesmere Port, Neston and North Wales. Our main pathology services are based at the 500-bed, Countess of Chester General Hospital on the outskirts of Chester. 
The trust consistently challenges its teams to think creatively about the way we maximise operational efficiency and productivity. In blood sciences we have been encouraged to rethink and redesign our long-term service provision in line with core lean principles. This approach focuses more on fundamental process improvements than just short-term cost saving. 
As one example of our increased efficiency, our full blood count reporting times to GPs are down by almost 50%, enabling most results to be back within normal hours, reducing any call on National Health Service (NHS) emergency or out-of-hours services.
Quantifiable workflow improvements
We began our partnership with Beckman Coulter more than five years ago to develop one of the first combined blood science units in the NHS. Almost immediately, we demonstrated quantifiable workflow improvements, a consistently reduced turnaround time, increased revenue opportunities, and the prospect of well-trained staff, able to multitask effectively within the new working environment. We now process approximately 3500 samples a day, with a 50/50 split between our internal and external customers.
The investment in our laboratory services was part of a £6 million improvement programme to the hospital’s overall infrastructure and environment, ensuring that more patients could be treated. At the same time, the hospital instigated a process of continuous improvement in all departments, to minimise waste and delay while increasing productivity and efficiency savings. 
Our collaboration with Beckman Coulter is part of that process of continuous improvement and has involved a complete upgrade of all the systems and a lab reconfiguration. With recruitment static and workload escalating, it had also become crucial to use staff time more effectively. An added challenge was our limited floor space. The requirement for handling the ever-increasing demand for haematology was to find a new platform that offered more precise and faster analysis in a compact footprint. 
Small footprint DxH delivers greater analytical precision
The catalyst for further reconfiguration has been Beckman Coulter’s DxH 800 haematology technology and streamlined instrument design. We immediately increased the lab’s capacity by replacing two haematology analysers with three small footprint DxH 800 cellular analysis systems, which combine with a DxH Slidemaker Stainer to automate slide making and staining in one compact module. This upgrade has enabled us to expand our facilities and handle greater workloads, while reducing the overall footprint. The compact and modern design of the DxH analysers has created more space overall, improving the working environment for everyone. 
In addition, the high-definition signal processing and multi-angle light scatter technology of the DxH 800 now provides us with an exceptional ‘first-pass’ throughput. This further reduces the workload pressure on staff, in the face of increases in both GP work and demands from the Accident and Emergency Department (AED). From February 2014, 97% of full blood counts for the AED have been available within one hour, with the average time being 15 minutes. This is an improvement from 20 minutes with the previous automation solution and approximately 45 minutes on our average pre-automation.
One of the most significant improvements since the DxH analysers were fully operational has been reducing to 14 minutes the turnaround time we deliver for more than 85% of leukaemia patients waiting for their haematology results before seeing their consultant. 
This year, workflow efficiencies will further improve when the four modular units are integrated into one connected Workcell, with a single entry point for samples. Chester will be one of the first laboratories in the world to implement this newly released DxH Workcell connectivity. The Workcell will provide us with a two-way sample transport system, automatically diverting samples between the haematology analysers to reduce delays. We will also be able to add critical STAT samples or body fluids while it is running, without holding up routine testing.
High throughput automation and chemistry systems
As part of our upgrade, we wanted all our instruments to be at the forefront of technology, robust and with high throughput. Alongside two DxI 800 immunoassay systems, we have therefore upgraded our clinical chemistry systems to two of Beckman Coulter’s high speed clinical chemistry analysers, AU5800s, together able to handle up to 4000 photometric tests per hour. The lab itself is fully automated by Beckman Coulter’s Power Processor, with high speed tracking conveying clinical chemistry and immunoassay test requests; and then storage of samples in the 3060-tube capacity refrigerated stockyard. 
The impact on our service to the hospital’s AED has been significant. For example, prior to automation, staff did not always know when laboratory results would be available. This could have an impact on the AED meeting critical Department of Health four-hour targets. Automation now ensures the return of 90% of vital marker tests (determining, for example, if a patient has had a cardiac incident) within an average time of 42 minutes. 
With the active and continued involvement of Beckman Coulter’s team, our laboratory has been able to:
  • Consolidate and streamline its complete laboratory testing service
  • Simplify the entire workflow process, not just the analytical phase
  • Reduce variation time in turnaround times 
  • Deliver consistent and sustained improvements
  • Expand its workload capacity
  • Demonstrate its ability to generate additional income
  • Improve cost efficiency levels
  • Reduce the need for extra staff, yet still…
  • Motivate and sustain staff morale 
  • Increase our customer satisfaction.
Unique approach to auto-receiving
The initial manual stages of handling and logging samples can be one of the most time consuming activities, often unpredictable and prone to human error. It can therefore have a negative impact on the consistency of overall turnaround times. While most laboratories do now use some form of electronic order and results system for GPs and hospital wards, the process of receiving the electronically generated requests remains too time-consuming for staff. Sample reception can therefore still represent a bottleneck with tubes sitting in reception while analysers are left idle. 
As part of improving workflow efficiency, we have developed a unique approach to auto-receiving of hospital requests using our Beckman Coulter automation and IT systems. We first involved the Remisol data management system and later the Beckman Coulter sample sorting system, the AutoMate 2500. 
NHS lab staff know that workloads will continue to increase and staffing levels may not. We therefore decided to handle the introduction of auto-receiving in stages to enable staff to see for themselves how the quality of their working day may be improved – and to have the flexibility of learning new ways of managing the workflow and understanding the new system. 
Since December 2013, samples enter the lab and go straight onto the AutoMate  2500 to complete most of the pre-analytical tasks, including auto-receiving requests, sorting and distributing samples to the analyser racks, and detecting labelling issues. Samples with potential problems can be directed into error racks for human checking. The whole process creates a consistent, fast throughput, while reducing error. The AutoMate  also sorts and receives all the samples, handles the retests and all the archiving. The archiving alone saves staff time, as previously we were manually archiving more than several hundred tubes a day.
Using auto receiving can free up approximately 2.5 hours per day of staff time by transmitting the hospital ward orders directly to Remisol, Beckman Coulter’s data handling system. When a sample arrives from a ward it can be put directly onto the Power Processor or AutoMate without the need for a manual receiving process. Since Remisol already has the details for the tests requested, the samples can proceed for analysis on the Beckman Coulter systems. Remisol transmits a received message back to the host computer system, which, in turn, changes the status of the order from ‘pending’ to ‘received’. This immediately enables the lab to more consistently deliver its 90% turnaround time of one hour for all test requests from other hospital departments, especially the AED.
Staff handle increased workloads with less stress
At Chester, we are seeking to use a more creative combination of software and analysers to both automate the processes and improve the quality of the working experience. Our objective is to free-up experienced staff from those manual processes that do not make best of use of their expertise. 
The transitional period when old systems are being removed and new ones installed is especially critical for both the patients we serve and the added pressure on our staff. We have had to demand a great deal of our staff as they adjust to these new work practices and systems, but it has been noticeable how well they have responded – actively supported by Beckman Coulter’s staff training and service support team.
Winning support from the staff was an important step in the successful implementation of this complex lab reconfiguration and upgrading. Laboratory staff clearly understand the benefit that automating processes will have on improving our service for patients. However, with this sort of development it is natural for them to be concerned about the impact on their future. 
These workflow efficiencies are designed to help improve clinical outcomes and patient safety, which are paramount to the overall values and service delivery commitment of the Countess of Chester Hospital. Having invested in the right level of automation, with staff costs contained, the lab is better able to offer customers, both internal and external, an improved level of service and performance. This benefits both the profitability of the laboratory and the overall health of the patients. In turn, its enables Chester to meet, and increasingly exceed, the quality and productivity improvements required by a modern NHS.