Non-Stop Traffic in the Hospital Lab
As part of efforts to improve quality, reliability, and flexibility, Adjunct Professor Dr. Dr. Hans Günter Wahl, MD, subjected his medical lab to a major system switch. In 2011, all clinical chemistry and immunology were automated. The new implementation is built around a Siemens lab automation solution, made up of systems from the ADVIA® family.
The Wahl Medical Lab in Lüdenscheid (Germany) offers 24-hour service. Dr. Wahl and his team process almost 100 percent of their analyses in his own lab so customers benefit from results received without delay. Senders currently include seven clinics and 40 medical offices. Before the introduction of a new lab automation solution, Wahl Medical relied on stand-alone systems that required a relatively high degree of manual work. The systems helped the lab to simplify and accelerate workflow, thus creating substantially more capacity for the night shift, high-specimen volume or special diagnostics. In addition, quality control options have improved. Centrifugation, specimen opening, transportation, and archiving now take place automatically. Everything is centrally controlled via a workstation, where the information channels of the lab’s EDP, the individual pieces, and the control of automation converge. Automation has contributed to increased employee satisfaction and made a 40 percent increase in the number of customers possible.
Text: Matthias Manych
Photos: Thekla Ehling
Positioned on the loader, the robot arm grasps one of dozens of tubes containing a patient’s specimen and places it on a conveyor belt. For the specimen, a short trip to an automated diagnostic process – in which approximately 10 requested laboratory values out of 100 are determined – has just begun. In an average 24-hour day, the hospital lab handles approximately 1,300 patient specimens and up to 12,000 analyzed parameters.
100 percent adjustment
“It was naturally very exciting,” admits Sabrina Schwarzer, medical-technical lab assistant (MTLA) and head of the Hematology Division, when referring to the big adjustment in the year 2011. Will everything operate as planned? The switch from the current systems used by various manufacturers to the new Siemens system had to take place without interrupting operations. In addition, extensive structural changes were necessary, as Carina Jonescheit, also a MLTA and head of the Serology and Protein Chemistry Division, explains: “Where the hospital lab now stands, there were two rooms for serology and protein biochemistry. Partitions were taken down to set up the hospital lab.” Once everything was in place, things had to be done quickly, because the current specimens still had to undergo further processing. “The switch from the old installations to the Siemens hospital lab had to be completed within two hours,” remembers Schwarzer.
Anything But Back to Normal
The transition was successful almost immediately, without customers noticing that anything had changed. And yet nothing was back to normal: It was a radical adjustment accompanied by Siemens’ preparatory measures and training sessions. “At first, our MTLAs visited other labs where such systems were already operating,” says Dr. Wahl. “We received the first equipment as individual pieces so we could already start training before integrating everything into the hospital lab. Then, a management seminar for all employees was offered, and it was very well received.” The user friendliness of the equipment helped everyone involved to become productive users quickly.
Volumes Increased by 40 Percent
The centerpiece of lab automation is the conveyor belt to which several systems for clinical chemistry, two centrifuges, and two specimen managers have been connected. Immunochemistry is also integrated. Thus, the entire analytics solution is interconnected in one single system. The diagnostic spectrum of up to 100 parameters is indispensable because: “In principle, our customers request everything related to analytics and we process 98 percent of it ourselves,” explains Dr. Wahl. Seven clinics and 40 medical offices are already sending specimens, and volume has increased by 40 percent since automation was installed. Most of the practicing physicians sending specimens are gynecologists and urologists, followed by general practitioners and internists. There is also close cooperation with a rheumatology office. The combined number of beds in all clinics amounts to 1800 and there can be up to 80 patient visits per sending office per day.
Safe, accelerated, and simplified – the new workflow
Dr. Wahl, the former senior physician of the Lüdenscheid Medical Center, invested in the future when he decided to start an independent lab in 2007. He introduced more staff, new equipment, a larger diagnostic spectrum, as well as more service and workflow optimizations. Automation in 2011 was the next logical step. “Since we offer 24-hour service and only one MTLA works here at night, a high degree of automation was essential for us,” according to Dr. Wahl, head of the lab. For the night shifts in particular, reliability was essential, and redundant systems were put in place as back-up in case of failure. In this way, frequently requested values can also be distributed to two pieces of equipment so that “working speed is not affected even when there’s a lot of volume,” says Dr. Wahl. That the entire workflow has become considerably faster and easier is also confirmed by Carina Jonescheit and Sabrina Schwarzer. Contrary to the way it used to be, the tubes with specimens are now automatically centrifuged, opened, archived, and transported to the individual wards. The integration of special diagnostics, such as those for hepatitis, HIV or homocysteine testing, simplifies work.
Easier Information Transfer to the Lab’s Clients
“Before, we had separate equipment for special analyses; the specimens were collected first and then measured,” says Jonescheit. MTLAs find the implementation especially advantageous when there are frequent additional requests, when hospital wards need values from a patient specimen already analyzed again. The related information is now forwarded directly from the lab’s EDP via the control software to the hospital lab so that the specimens automatically return to the diagnostic process from their archiving position. Owing to the speed of the hospital lab, specimens no longer need to be processed separately for medical emergencies. In spite of the increase in specimen throughput, the high degree of automation allows concentrated and flexible work adapted to the need. Asked whether the current, around-the-clock level of service could have been possible before switching to the hospital lab, the two assistants emphatically answered: “No”.
Setting the Course for the Future
Based on the experiences that he has had so far, Dr. Wahl relies 90 percent on Siemens products in his lab. “For me, it’s about having a contact that keeps looking after the automation once the sale has been completed. It is important for service and support to be just right,” he says. Since the current diagnostic lab has already reached its capacity limit, new solution approaches for next year are already on the agenda. At the same time, an outpatient clinic for coagulation disorders is being planned. Additionally, software for providing a quick overview of the workload of individual analytical devices is needed so there can be an early reaction to irregularities. And the ordering system already online is to be systematically automated with radio frequency identification (RFID). Although use of this technology is not commonplace in the medical sector yet, Dr. Wahl has nonetheless already taken the first steps in that direction with Siemens.
Matthias Manych, a biologist, is a freelance scientific journalist, editor, and author specializing in medicine. His work appears primarily in specialized journals, but also in newspapers and online.
The outcomes achieved by the Siemens customers described herein were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption), there can be no guarantee that others will achieve the same results.