Success During the SARS Outbreak
In early 2003, when Singapore was struck by Severe Acute Respiratory Syndrome (SARS), TTSH was designated as the sole treatment hospital for all suspect cases of SARS—and immediately closed itself off from all other admissions.
The pandemic forced the lab to balance the clinical needs of the SARS patients with the safety needs of its staff, who were operating in an environment of uncertainty and fear. Juggling the demands of these potentially high-risk specimens presented a real challenge—especially since the lab was working without closed tube sampling.
Fortunately, the laboratory had no cases of acquired infections during the outbreak; although the scare did heighten the management’s attention to safety concerns and desire for closed-tube sampling.
Mounting Problems
By the end of 2004, the lab was facing additional challenges that demanded attention. Although it was maintaining a satisfactory turnaround time, it was often inconsistent—and vulnerable to even slight variations in equipment or staffing. Plus, the lab was anticipating an increase in workload (with no increase in manpower) and responding to demands for faster turnaround time and same-session results on outpatients.
To meet the demands on the hematology side, lab staff members began seeking manual ways to provide STAT results in less than 60 minutes. However, this led to unnecessary physical handling of specimens, manual centrifugation for coagulation samples and a significant amount of undue stress on workers.
There was also the continued concern for staff safety. Since the current instruments were not equipped with closed-tube sampling, the staff remained at risk for communicable diseases and other infectious outbreaks.
Lastly, the lab was running a wide range of instrument platforms, a fact that made it difficult to consolidate testing.
Clearly, the lab needed a way to increase safety, reduce physical specimen handling and gradually remove the need for STAT testing by providing consistently fast results across the board.
Time for Change
In early 2005, TTSH approached five potential diagnostic partners for help. After initial evaluation of solution functionality, IT considerations and cost, the list was narrowed down to three potential candidates and finally down to one vendor of choice: Beckman Coulter.
"Functionally speaking, Beckman Coulter stood out as the only vendor with closed-tube sampling on their chemistry analyzers, decapping capabilities on the automation system and a large stockyard that allowed the hands-free addition of test requests," says Dr. Robert Hawkins, Senior Consultant Chemical Pathologist.
So the implementation began. The lab chose to maximize their benefits by building two separate automation lines. In the process, it became the first laboratory in Singapore to successfully implement total laboratory automation for chemistry, immunoassay, hematology and coagulation testing.
Today, the lab’s chemistry/immunoassay line consists of a Power Processor automation system, two UniCel® DxI 800 immunoassay systems, one UniCel® DxC 800 system, two SYNCHRON LX®20 Pro systems and a 3,060-tube stockyard.
The hematology line is equally efficient, with a LH1500 hematology automation system, two COULTER® LH 750 hematology systems with automated slidemakers, centrifuge, 200-tube outlet for coagulation samples and a 1,020-tube stockyard.
Together, these systems handle nearly 95% of all the hospital’s biochemistry testing and 70% of all hematology testing—making more than 80 different assays available to clinicians around the clock.
Reaping the Rewards
"There’s no doubt that implementing the Beckman Coulter automation systems have been positive for hospital managers, lab staff and patients," says Dr. Hawkins. "There’s no more batching of immunoassays, which means that all the results clinicians need are available in real time—thus speeding up patient management and potentially resulting in shorter lengths of stay. Plus, the ability to perform closed-tube sampling on the instruments means we can confidently handle infectious samples without risk to our staff."
He adds, "For the staff, the refrigerated stockyard and the ability to add tests with no manual intervention has been a godsend, saving much time and effort chasing down samples for additional testing."
A Turnaround for TAT
When it comes to turnaround time (TAT), TTSH’s significantly improved.
For example, before automation, only 69% of the lab’s STAT full blood count (FBC) results were done in less than 30 minutes; yet after automation, that percentage jumped to 86%. This is especially important because nearly 40% of the lab’s hematology tests are STAT requests. Likewise, only 81% of routine hematology results were completed in less than an hour before automation—a number that jumped to 98% after implementation.
"Because we are getting more consistent results now, we no longer need to separate routine and STAT samples, except in super-STAT situations," says Dr. Ponnudurai Kuperan, Senior Consultant Hematologist for TTSH.
Improvements on the chemistry side were equally notable. Consider the timing of STAT Troponin I results. Before automation, only 41% of these test results were done in less than 45 minutes. But after automation, 93% of them were completed in the same time frame.
Likewise, only 6% of TSH tests were completed in less than two hours before automation; but that figure rose dramatically—to 99%—after automation was in place.
Ironically, the turnaround time for post-automation routine Potassium results was faster than their pre-automation STAT counterparts.
"Turnaround time metrics are the key performance indicators for our department," explains Dr. Hawkins, "So, the improved TAT for all our tests—both STAT and routine—was probably our most important outcome."
"Aside from that, the number of phone calls to our lab has certainly dropped, reflecting the faster TAT. All in all, upper management is pleased that the system implementation was accomplished so speedily and has met all our objectives."
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