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Niall Firth
Freelance Journalist
Lying in an attractive valley in Lower Saxony, Germany, Osnabruck is one of the largest cities in the area. Its main hospital, the Marienhospital, has to provide services and care well beyond the limits of this medieval city. Dr Michael Heins, medical director of the hospital’s Institute of Laboratory Medicine, Microbiology, Transfusion and Haematology, has almost 20 years of experience in clinical chemistry procedures. The Institute’s latest purchase, combined with a spot of clever reshuffling, means Heins is confident that the Institute can increase its positive impact on this area of northern Germany.
The laboratory covers a wide range of blood testing, ranging from the more common clinical chemistry tests to immune chemistry, blood banking, screening for infectious diseases and haematology. The decision to invest in a new, fully automated laboratory system was the result of a number of different factors, not least an interesting quirk of the German healthcare system. In Germany there is a specific delineation between the doctors who deal with outpatients and those who work elsewhere within the hospital. Outpatients can only be treated by doctors specifically assigned to do so and there is far less crossover than in, for example, the UK.
New working practices
To work around this division of labour Heins has taken the unusual step of reducing his official hours at the Marienhospital by half while, at the same time, opening up a private practice specifically for dealing with outpatients. “We wanted to establish a new laboratory community that works together with outpatient doctors,” explained Heins. One of the results of this change in working practice has been a hugely increased workload – an escalation in testing that often left Heins and his staff completely overloaded with requests. A switch to automation was urgently needed, Heins admits.
A decision was made to purchase LabStation (DPC). In the months leading up to the new system going live, Heins and his team were seriously struggling to keep up with the number of samples that needed processing. It reached the stage where laboratory assistants were often required to stay until 2am to be able to stay on top of the phenomenal new workload. To the relief of the overworked staff the new system went live in July 2005 after a period of extensive testing that allowed laboratory technicians time to set up the system’s specifications and parameters.
Since then, the laboratory has serviced six different hospitals. The team also work with the German Red Cross in Lower Saxony as well as responding to special requests for trauma and cardiac patients. “We had to make a decision that would mean we could cope with this rise in testing without increasing our number of staff during the night and at weekends. At night we only have one technician working for us and at weekends we have two,” said Heins.
Versatile clinical chemistry analysers
Another major consideration in choosing LabStation was the limited amount of space available for such an automated system. Although the biggest room available was only 60m2 in size, a total of seven analysers were squeezed into the space – three clinical chemistry analysers (Konelab 60, Thermo Electron Corp), two immunochemistry analysers (IMMULITE 2500, DPC) and an additional two analysers. Thermo also provided the sophisticated tracking system that moves the samples from analyser to analyser, which Heins described as being key to the system’s overall success.
Konelab uses disposable plastic cuvettes, which – while not as pure as glass or quartz versions – are often used in photometric testing where speed is essential. Inside a 12-cell cuvette, the reagents and the sample are analysed automatically. Electrolytes such as sodium, potassium, ionised calcium and lithium are measured by direct potentiometry.
One of the key advantages of Konelab is that it is a completely open platform. This means that the laboratory is not compelled to only use the reagents developed by Thermo – an important consideration for Heins and his team as it opens up a far wider range of potential tests that can be offered. “While Thermo has many tests, if they do not have the exact one you need then you can take reagents from other companies and adapt it to the analyser. Also, because the cuvettes are disposable there is no carryover or contamination between them,” said Heins.
The combined DPC and Thermo analysers in the LabStation have had a variety of positive knock-on effects on the way the laboratory operates. In the past the laboratory assistants had to move each sample manually between the different analysers, which was not only time-consuming and labour-intensive but also impacted on the department’s ability to provide accurate estimates of turnaround times.
“The only way you can have a defined turnaround time – essential when you are doing lots of different tests – is if you use an automated system,” explained Heins. “You just bring in the sample, put it in the LabStation, choose the test and that’s it. By minimising human input you can say with some accuracy how long it will be before it’s finished.”
Staff suspicions
According to Heins, the system’s touchscreen interface is extremely easy to use, but despite the LabStation’s purported advantages the staff in the department were initially rather suspicious of the system. However, opinion soon changed when the staff saw how much simpler the system made their work. The system also saves crucial time in processing samples for patients who may need urgent treatment, such as a patient presenting with severe chest pain. “You don’t know if s/he has acute myocardial infarction or not,” explains Heins. “There is no point in running lots of expensive tests if the basic test is negative. You can program the system so that if the creatine basic test is within a normal range then no more tests have to be run, but if it is elevated then it runs a more specific test.”
Because the secondary test would be much more expensive than the first, this form of reflex testing not only saves time but also keeps the laboratory’s costs down. Konelab also removes the need to make aliquots of a sample and spread them among different analysers, which also wastes valuable time. Konelab automatically takes an aliquot, sends the sample to the next analyser via the tracking system and processes the results completely autonomously.
Statistically speaking …
The statistics speak volumes about the difference the automated system has made. The laboratory can now process almost twice as many samples and can carry out 1,800 clinical chemistry tests and 400 immune chemistry tests per hour. In 2005 they could only carry out 1,200 clinical chemistry tests and 240 different immune chemistry tests per hour.
The other big gain is in cost. Although the entire system was not a minor investment, Heins estimates that the cost of an additional member of staff, coupled with the additional hours that would have to be worked to cope with the increased workload, means that the system will have paid for itself inside two years.
Heins is hopeful for the future of his reshaped and modernised laboratory. “Even though it is already working very well, as newer instruments are developed and are integrated it will just get better and better. We are very pleased with our decision,” he said.
