2.  Efficiency

Efficiency is driven by reducing the amount of input relative to a fixed output. Therefore, any procedural change that reduces steps taken, whether walking around the lab or setting up a daily run, will directly impact efficiency. The efficiency gains, in turn, reduce the time required to perform the testing, whether it is hands-on time, turnaround time, or time to first result. The implications for MCA were dramatic: The efficiency gains translated to reduced turnaround time and reduced labor.

Turnaround Time (TAT)

Automation reduces the turnaround time required to report results through several areas. In the instance of this study, the TAT decreased to less than 1 day for 96% of the workload. Every request arriving prior to 4:00 PM is now completed same day. Previously, accessions coming in after 1:00 PM would not be done until the following day.

Improved productivity is defined as increasing output relative to a fixed input, such as labor or resources. Productivity is measured from the individual technologist’s perspective, the overall lab’s perspective, and the Relative Productivity Index (RPI).

Increasing productivity for the technologist means increasing the number of tests that each technologist produces; therefore, reducing the number of FTEs while holding test volume constant reflects increased technologist productivity. Conversely, increasing the number of tests while holding the number of FTEs constant also results in increased FTE productivity. Reportables/FTE is the metric: In this instance the number of reportables that each FTE produces (i.e. the productivity of each FTE) has increased by 24%. Hands-on labor (minutes/reportable) fell from 0.21 to 0.08 on the IMMULITE.

System productivity is driven by capacity utilization. The greater the available capacity, the greater the ability to increase production.

It is key to recognize that if automation reduces the amount of time each FTE spends on producing tests, but the volume of tests each FTE produces remains constant, then there is no increase in productivity; only an increase in efficiency. If that extra time is used to go on coffee breaks, there is no net benefit to the lab.

For the serology lab overall, cumulative savings in labor will amount to €95,526.

                                PRE-VERSACELL   POST-VERSACELL     SAVINGS

ANNUAL                          21123                 5202                        15921

6 YEARS                        126738               31212                        95526

While reagent costs were held static, the lab increased its capacity to perform additional testing.
Assuming the same test mix and utilizing the spare capacity could achieve at 65% increase in test volume in an eight hour shift. This increase would yield a cost-savings of €19552, or 0.5 FTE.
The lab utilized this capacity to bring 40% incremental testing in-house though consolidation of three other hospitals.
Total annual cost per reportable is apportioned:
Costs

Supplies                             2%

Instrument                        i%

Labor                                11%

Reagents                         85%

SUMMARY

The implementation of micro-automation in the serology lab can bring significant improvements in efficiency, productivity, quality and cost to operations. While traditional automation schemes are not practical in most serology lab settings, the combined effect of high volume immunoassay platforms with large ID portfolios in addition to the unique front-end and sample management capabilities of the VersaCell System, enable labs to achieve dramatic improvements in their operations.

Automation delivers predictable and consistent service coupled with a reduction in staff. Walk-away time is increased with the VersaCell, enabling staff to perform other duties.

In the typical menu mix of infectious disease, the VersaCell offers the maximum menu consolidation.

Case Study Background

Medical Center Alkmaar (MCA) is a 900-bed institution in the Netherlands that employs nearly 3,100 people. Its microbiology laboratory serves not only the MCA facility, but also Gemini Hospital, a 300-bed hospital in Den Helder, plus outpatient testing for about 300 local physicians. Each year the lab receives about 40,000 serology samples and runs about 82,000 infectious disease (ID) serology tests on these specimens.
As with most ID testing, MCA traditionally relied on tried-and-true manual methods. Fortunately, new technological developments in methodologies, robotics, and computerization are rapidly advancing in the field of ID serology. Until 2000, MCA’s initial shift to automation depended primarily on its Dynex™ micro-titer plate and Vidas® analyzers, while syphilis tests were processed manually. This approach worked well for nearly a decade, but the need for more technological advancement provided an opportunity.
After recognizing the shortage of highly trained technicians, along with the need to improve efficiency and productivity in the lab, MCA connected an IMMULITE® 2000 XPi System and an ADVIA Centaur® XP Immunoassay System with the VersaCell System and doubled the percentage of ID serology tests run and reported in one day while significantly reducing the number of technicians required to operate the system.
The IMMULITE 2000 XPi and the ADVIA Centaur XP menus best matched the testing needs of the lab. In 2000, MCA acquired an IMMULITE 2000 system, which was upgraded to an IMMULITE 2000 XPi System in 2009 consolidating syphilis, ToRCH, and EBV testing onboard. At the end of 2008, MCA added the ADVIA Centaur XP system to add the full range of hepatitis, HIV, and pregnancy testing.

The VersaCell System, installed in the MCA lab in July 2009, completed the consolidation and automation of processes for the institution’s ID serology testing. The VersaCell system links the ADVIA Centaur XP and the IMMULITE 2000 XPi instruments to form one consolidated ID serology testing system. In an effort to quantify the impact the VersaCell System had on laboratory operations, we conducted Time/Motion studies before the VersaCell System was installed and compared the data to workflow after installation.
Significant improvements were seen in the following areas:

• 96% of the ID serology results reported the same day
• VersaCell consolidates 96% of all samples onboard
• One FTE’s reduction for the ID serology workload
• Reduced manual errors
• More efficient laboratory workflow
• Effective resource utilization
• Improved diagnostic service / patient care to the clinic
• Increased capacity for future growth

Methodology

In order to ensure that a direct comparison was made of activity and other workflow metrics, a standardized protocol was used to collect data on two occasions for 2 days. 

Data collection

A standard protocol for data collection was used; the same technical staff and data collector was used. Data was collected on days with representative processing volumes and no account was taken for monthly or unscheduled maintenance. All hands-on labor time to run the work, time taken to process and complete the tests including reruns, reflex, and add-on testing was collected and test numbers were also counted. The same operator collected the timing data across both measuring periods and test numbers were collated from the LIS data sheets and analyzer logs.

Results

The results obtained from the study have been incorporated throughout the white paper as demonstrative of the impact of micro-automation in the serology lab.

Dr. Ferdinand Vlaspolder, MD, PhD, is a Consultant Microbiologist who serves as Head of the Medical Microbiology Laboratory at Medical Center Alkmaar (MCA) in the Netherlands.
Dr. Vlaspolder was born in Rotterdam in1952, where he also received his laboratory training. After military service he studied medicine at the Erasmus University in Rotterdam and became a medical doctor in 1981. Before he started his specialization in medical microbiology at Utrecht in1984 he worked as a public health physician. During this time (1984-1989) he started his scientific work, completing his thesis in 1990. He worked for three years in three hospitals in The Hague as a consultant microbiologist. In 1992 he joined Medical Centre Alkmaar and Gemini hospital in Den Helder.
Dr. Vlaspolder is head of the laboratory for medical microbiology, the department of hygiene and infection control, and the outdoor clinic for travelers. He is published widely on different subjects in medical microbiology.
Patricia Glasius, Ing, is a senior technician in Medical Microbiology Laboratory at Medical Center, Alkmaar, The Netherlands.
We would like to acknowledge Alastair Gammie, PhD, and Dr. Hans IJpelaar of Siemens Healthcare Diagnostics for providing support for the time and motion studies.

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Medical Center Alkmaar (MCA) is a 900-bed institution in the Netherlands that employs nearly 3,100 people. Its microbiology laboratory serves not only the MCA facility, but also Gemini Hospital, a 300-bed hospital in Den Helder, plus outpatient testing for about 300 local physicians. Each year the lab receives about 40,000 serology samples and runs about 82,000 infectious disease (ID) serology tests on these specimens.

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Each year, a carefully selected line-up of laboratory leaders and innovators tell the story of how their laboratories are solving problems, tackling the toughest challenges in lab medicine and seizing opportunities to improve clinical care and boost financial performance. The Executive War College is the place to get practical advice and solutions for the toughest lab management challenges. A unique case study format brings participants face-to-face with their most successful peers. They tell, first hand, how their laboratory solved intractable problems and successfully used new technology.
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Sue has over 30 years’ experience in the hospital diagnostics industry, including clinical chemistry, immunochemistry, and plasma proteins. This experience includes hospital, marketing management, health economics, marketing communications and consulting. She has consulted with over 50 clients globally, including Siemens, Dade Behring, J&J, DuPont, and others, and has generated over $17 million in sales for critical health networks.
As president of Labsim, Inc., she leads development of custom software applications for laboratory cost accounting in addition to strategic marketing and marketing communications consulting in the healthcare sector.
She has been cited in articles in Advance, Clinical Research and Management Review, and College of American Pathologists. Her expertise is in laboratory workflow simulation, cost accounting, and decision modeling, leading the development of laboratory simulation software for multiple product lines. She served on the NCCLS Subcommittee on Total Cost Management in the Laboratory.  Sue has a BA and MA from the University of North Carolina, Chapel Hill.