ACHIEVING more from less is the challenge facing today’s pathology service. Laboratories have responded by assessing their own processes and workflow to identify areas where efficiency can be improved. Automating manual tasks is a key aspect. Diagnostics manufacturers have also risen to the challenge, developing a range of solutions that can be tailored to suit laboratories’ individual needs. One group of products to emerge is integrated systems - consolidating clinical chemistry and immunoassay into a single analyser. The subsequent move to a single sample tube is a clear advantage. Not only does it reduce trauma for the patient, but also it results in many benefits for the lab including increased efficiency and space saving in the archive.

Here we examine the technology that makes this possible. In addition, John Mansley, biochemistry service manager for the Pennine Acute Hospitals NHS Trust, and Dr Mark Lynch, consultant clinical biochemist at Altnagelvin Hospital, discuss the benefits that such integrated systems have brought to workflow processing and throughput in their laboratories.

Following consolidation of four Trusts to form the Pennine Acute Hospitals NHS Trust - which handles approximately 7,200,000 tests annually - integrated systems were installed. Mr Mansley explains their adoption of a consolidated approach. “Integrated analysers reduce the number of instruments around the laboratory and avoid excessive sample handling. Single sample handling is particularly effective in reducing workloads and minimising the risks associated with manual handling, such as incomplete testing. Reduction in manual sample handling increases the efficiency and effectiveness of laboratory workflow.”

Dr Lynch adds: “Integrated instruments are very helpful, particularly in smaller labs where it is very hard to justify the expense of a system with automated sample transfer from one instrument to another. By selecting a single, integrated system our need to transfer samples has been removed.”

An integrated analyser equipped with an effective sample handler not only significantly reduces manual handling demands but also releases samples quickly for transfer to the next part of the process.

Efficient transport of samples within the analyser itself further helps to achieve the high analytical throughput required. This is where a Multi-Dimensional Sampling approach comes in, such as that used on Abbott’s ARCHITECT family of analysers.

Ideally, analysers should allow for prioritisation of STAT samples, reflex testing and dilutions, dealing with them immediately as they arise. ARCHITECT, for example, has dedicated priority bays for loading up to 35 samples which will be tested immediately, bypassing any waiting routine samples.

Dr Lynch said: “We use the separate priority bays a lot at Altnagelvin Hospital for urgent samples, QC samples and calibration, but in general the instrument is so fast we find that samples anywhere on the instrument are processed within our tight timelines and faster than any other analyser we have used.”

While current demands on pathology services necessitate faster turnaround times, it is vital that the integrity of results is preserved. Laboratories need to be able to consolidate testing and remain confident that data produced is still robust.

By failing to minimise sample-to-sample carryover, many analysers disappoint when integrating clinical chemistry and immunoassay. Critical variables such as equipment design and alignment and wash volume sequencing must be balanced to minimise carryover without requiring excessive washing, eliminating unnecessary use of costly consumables.

“The ARCHITECT system incorporates a number of SmartWash technologies which go on unnoticed in the background,” explains Dr Lynch. “These are automated processes so we can forget about them and remain confident in our results. Errors due to washing problems are extremely rare.”

With such low sample-to-sample carryover, either clinical chemistry or immunoassay testing can be performed first without risk of contamination. “The RSH processes samples more effectively by selecting the testing order based on the most efficient final throughput of results. This generally speeds up whole process,” said Mansley.

A laboratory’s choice of analyser is key to both workflow throughput and analytical integrity. Integrated systems can offer significant benefit to laboratories in terms of efficiency.

References
Ravalico T, Wilson C, Ingram H & Alonzo D. Abbott Laboratories. Optimised sample probe wash on the Abbott ARCHITECT ci8200 analyser. Present at the 18th International Congress of Clinical Chemistry and Laboratory Medicine. 2002.

By Carla Deakin. Carla is Senior Business Development Manager for Immuno/Chemistry Systems & Automation at Abbott Diagnostics UK.