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A new approach to pathology

The demands on today's pathology service are driving many Trusts to assess current practices and explore new approaches to ensure enhanced service provision into the future. Here we take a look at how one Trust has gone about achieving its aim of providing an effective and efficient diagnostic service with improvements to clinical users and enhanced care for patients

Two years ago, the Pathology Directorate in what is now the Imperial College Healthcare NHS Trust agreed to centralise much of its acute pathology testing and, together with commercial partners, set about planning and engineering a new automated diagnostic laboratory at Charing Cross Hospital. The new laboratory would provide an unprecedented level of service to the whole Trust with faster delivery of results to the clinicians.

Anne Bradshaw, operations manager for Acute Services at the Imperial College Healthcare NHS Trust explains: "Having made the decision to centralise routine testing, the Trust went out to tender asking potential suppliers 'how can you help us achieve our aims?' Right from the start, Abbott demonstrated a clear understanding of our needs and offered a comprehensive solution that would help us improve both turnaround times of routine testing and efficiency."

The Trust agreed a managed service contract with Abbott Diagnostics as prime contractor. The contract ranges over several pathology disciplines and, for the clinical chemistry service, included the supply of an ACCELERATOR APS and 18 ARCHITECT analysers. Other instrumentation has been provided under subcontracting arrangements, an example of this being Abbott's subcontract with Sysmex (UK) to deliver certain elements of the total solution. The automated laboratory, which also incorporates a newly designed sample reception area, went live in May.

Anne comments: "For our immunochemistry automation we opted for the ACCELERATOR APS. From the first time we saw it in action, it was clear that this was a truly modern approach to moving samples around the lab. Also, the ability to store samples robotically has definitely offered us a significant time saving."

ARCHITECT analysers have been installed across the Trust and at Charing Cross these are connected to the ACCELERATOR APS. In the smaller labs, two combined clinical chemistry and immunoassay ARCHITECTs are used. Anne explains: "Our decision to install these analysers was definitely influenced by the wide menu of assays available with more analytes being launched all the time. This decreases the number of legacy instruments required in the laboratory. Now, with a couple of month's experience of using the analysers, they have proven themselves to be reliable and easy to use."

In order to successfully centralise routine workload from different hospitals, results need to be accessible across the Trust. "We first looked at the Analyser Management System (AMS) in use in Glasgow and were very impressed. Not only can results and relevant QC data be viewed from any hospital in the Trust, but it also adds extra functionality to the analysers including reflex testing and auto-validation."

While the laboratory is still getting to grips with the new automation, it is already a much calmer place. Lean principles have been adopted and samples are being constantly fed onto the ACCELERATOR APS for processing. Turnaround has improved. GP samples, for example, are now all tested same day whereas previously some samples had to be carried over to the following day.

The Charing Cross laboratory has been designed to allow for the analysis of more than 20,000 patient samples per day, including 7,000 blood counts and 15,000 immunochemistry tests. This by far exceeds the current sample numbers, providing what is hoped to be a future-proof solution with adequate capacity to accommodate the expected growth in demand as well as allowing for an expansion of the present test repertoire.

Anne sums up these changes: "What we have is world class, cutting-edge technology. We anticipate that the automation of many routine tasks will enable us to offer an enhanced service to clinicians and patients and also allow the department to focus on an underlying primary objective of the Directorate of Clinical and Investigative Sciences - that is, translational research."

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