In the cover story of the June print edition of ADVANCE for Administrators of the Laboratory, the author discusses the growing trend to integrate traditional clinical laboratory testing platforms onto one system or unit-most commonly, chemistry and immunoassay. A similar movement in the hematology area is taking a test previously batched on a dedicated testing platform (HPLC A1c) and moving it to a hematology automation system. With this capability laboratories can more efficiently perform multiple tests from a single lavender top EDTA tube (>90%) and isolate and divert these sample tubes away from serum-based chemistry automation lines to an EDTA-based testing line in the hematology department.
A number of benefits can be derived by putting HPLC A1c testing on the hematology line. Faster results back to the physician will be realized because the A1c assay no longer has to be held for batch testing. On an updated, automated hematology line, A1c analysis can be performed on demand via random access for faster assessment of the patient's condition and treatment decisions by the clinician. Skilled medical technologists can then perform more labor-intensive tests.
Managers are seeking creative ways to minimize "test tube touch-points" while maximizing the number of tests and information available from each tube across the enterprise. By isolating and diverting lavender tubes, which typically make up 25-30 percent of all tubes, serum line sample tube throughputs also will be enhanced. There will be fewer manual staff interventions in re-routing lavender top tubes, and rack/track space for serum tubes will be maximized.
The pairing of decision logic (intelligent) software within the integrated lavender top automation platform provides yet another level of efficiency. Intelligent software automates both sample routing and data decisions through the use of decision logic rules. This further integrates the A1c workstation, introduces comprehensive data review (both CBC and A1c) and further maximizes use of staffing (single dedicated operator for lavender top line). The application of the user-defined rules further improves consistency and effectiveness in the data review process by adding a level of standardization among staff and shifts and introducing autovalidation. Autovalidation further maximizes result turnaround as 70-80 percent of hematology results and 70-90 percent of A1c results can be charted without manual technical review. A library of system rules drives sample analyses and improves efficiencies in laboratory operations. Rules can be simple or complex based on the laboratory's best practices and unique workflow. For instance, rules can be written to include non-numeric as well as patient demographics data and in the absence of a test order, can drive the automatic addition of another test.
The impact of integrated lavender top system in consolidating testing and result standardization can be realized in multiple laboratory environments. Integrated Delivery Network (IDN) laboratories and hospital networks will see a benefit from the standardized sample and data handling processes that this integrated solution can bring.
Data review and decisions related to release is a time-consuming, paper-laden and error-prone process, especially with HPLC A1c testing. This new integrated automation provides relief and eliminates the waste and error from manual data review and decision processes.
The integrated lavender top automation system will allow more testing from a single EDTA tube and less draw volume from patient. Some of these tests include the high volume hematology profiles (CBC, Retic, Diff, sickle, ESR) as well as diabetes testing (A1c). This integration provides a greater level of efficiency in processes associated with pre- and post- analytical sample management. Dedicated lavender top sample testing and management means reduction in draw volume from patients and fewer tubes getting lost in the process of testing
Quality control is the essence of assuring quality results and clinical information. The inclusion of quality control logic rules within the intelligent software provides yet another level of efficiency. This software can evaluate QC across all labs, shifts, and technologists. It also standardizes QC qualification, enabling the measurement of instrument precision across the integrated system. This information provides the ability to quickly identify QC trends (proactively versus retrospectively) to minimize risk to patient reporting.
By standardizing instrument platforms, clinical and quality control information integration, and advanced technologies, clinical laboratories can achieve unexpected levels of optimization for laboratory operations that literally transform their productivity. This transformation can include improved testing, optimized workflow through waste reduction and building capacity for future laboratory growth.
Nilam Patel, senior product manager, Laboratory Automation Solutions, oversees Sysmex America's laboratory-automation product line and Lavender Top Management initiatives.