Dr. Thomas Rieger,
laboratory director

Consolidation Pays Off
Merging Analyzer Platforms and Adding Closed-Tube Aliquotting Help Germany’s Evangelisches Krankenhaus Streamline Testing, Improve Results

In Oberhausen, Germany, the Institute for Laboratory Medicine and Clinical Microbiology at the Evangelisches Krankenhaus (English translation: Lutheran Hospital) performs more than 600,000 clinical chemistry tests a year. This lab serves a 580-bed university hospital, as well as five external hospitals, which now direct all their immunoassay testing to the Oberhausen lab. In September 2007, it became the first hospital laboratory in the world to install one of the most advanced integrated workstations—and has been quantifying impressive improvements ever since.

The lab’s efforts are indicative of several trends taking place in European laboratories today. First, more and more hospitals are concentrating their diagnostics services in a single location; and second, they’re separating their resources between a core laboratory and specialized analytics. Not surprisingly, these trends are affecting lab equipment choices—since newly centralized labs must now have the capacity to handle the workloads of all contributing hospitals.

“Fast and consistent throughput for high-volume workloads becomes an immediate requirement—followed closely by the need to consolidate clinical chemistry and immunoassay platforms,” says Dr. Thomas Rieger, laboratory director.

“At Oberhausen, we have a high proportion of emergency testing—and speeding the delivery of these results is particularly crucial when handling urgent tests requests from the other hospitals in our network,” he adds. “Therefore, we decided to install an integrated system so that we could deliver considerably faster results together with greater and more consistent analytical quality.”

Prioritizing Consistent, Quality Throughput
Before consolidating platforms, the lab conducted a careful assessment of its workflow needs. The lab analyzed five key areas—preanalytics, the quantity and type of testing requests, storing, transport and maintenance. The results were telling.

“At the time, our lab was spending 65 percent of its time on preanalytics, including mainly manual processes, and only 15 percent on the actual testing,” says Dr. Rieger. “Our existing clinical chemistry system was taking 108 minutes—far too long when we needed to analyze 600 tubes a day with an average of 12.5 tests per tube. And three percent of these tubes also required additional testing.”

The lab’s overall turnaround time (TAT) was further impacted by manual processes. Some immunoassay samples, for example, required as many as three aliquots—a time-consuming process that negatively affected overall TAT. The plan to consolidate all the immunoassay testing from multiple sister hospitals made this a serious concern for the Oberhausen lab.

“Improving throughput became an immediate priority and an important selection criterion for our new analyzers,” says Dr. Rieger. “For chemistry, we selected Beckman Coulter’s UniCel® DxC 800 Synchron® Clinical System with a throughput of up to 1,440 tests per hour and chose the UniCel® DxI 800 Access® Immunoassay System with a throughput up to 400 tests per hour for our immunoassay needs.”

Drastic Reductions in TAT
Once the new systems were in place, the lab witnessed immediate results. Its overall TAT for clinical chemistry dropped by approximately two-thirds and about one-third for immunoassay.

“The UniCel DxI was now delivering 90 percent of our test results within 49 minutes, and the UniCel DxC within 35 minutes,” says Dr. Rieger. “Even so, we believed we could make further improvements by integrating our clinical chemistry and immunoassay analyzers into a single platform.”

“Alongside throughput, we had other challenges to consider: existing staff resources; the need to further reduce manual processing time, particularly the high requirement for aliquotting; improving STAT and routine handling and the need for a more comprehensive testing menu,” he explains.

The Addition of Closed-Tube Technology
The lab decided to further upgrade its equipment, this time to Beckman Coulter’s newest integrated platform (UniCel DxC 880i Synchron® Access® Clinical System) by installing the company’s UniCel Closed-Tube Aliquotter module. Designed to fit between existing analyzers, this module links the two systems, thereby creating a single integrated platform and providing a single entry point for samples.

“Immediately, we eliminated our need to manually aliquot samples and automated 90 percent of our other manual processes,” says Dr. Rieger. “We can use one tube without needing to decap and split the sample, saving time and removing the risk of error or contamination. For example, with the UniCel DxC 880i we can run Troponin I in tandem with any chemistry tests—without having to move the samples onto a separate system.

“Closed-tube aliquotting also provides added protection for our staff, particularly when they’re under pressure from the emergency departments,” adds Dr. Rieger. “Having an integrated system also means we can now access a menu of more than 150 tests for both chemistry and immunoassay—with 120 onboard.* The UniCel DxC 880i also gives us the option to load reagents while the system is running, without wasting valuable time shutting the system down.”

Enhanced Working Environment Benefits Staff
As far as the lab staff is concerned, adopting an integrated system has enabled the lab to make even better use of these valuable but limited resources.

“We redeployed some technicians to carry out essential quality control procedures, and our scientists can now better focus on specialty immunoassay testing, which will always require manual involvement,” says Dr. Rieger.

To confirm the UniCel DxC 880i’s consistency and efficiency, the lab conducted another evaluation across routine and STAT tests. It also checked for carryover by running Beta hCG, Ferritin, PSA and HBS Ag in different scenarios. The good news? The results couldn’t have been better. Regardless of whether a technologist loaded the samples via the UniCel Closed-Tube Aliquotter, loaded samples directly onto the system or requested add-on tests after chemistry analysis was completed, no carryover was detected.

Finally, the lab compared its (already improved) performance from the high-throughput analyzers to the new-found performance of the integrated UniCel DxC 800i. By using the integrated UniCel DxC 880i system, the lab witnessed an additional 20 percent reduction in overall TAT—with no additional preparation required.

“Our evaluations show that the immediate benefits of integrated, automated laboratory systems, capable of maintaining the high throughput of component units, are significant,” concludes Dr. Rieger. “At Oberhausen, we believe this will enable us to deliver improved efficiency with greater reliability of results, handle larger workloads, maintain health and safety standards and ensure quality patient care long-term.”

* Not all tests are available in all countries.