Integrating Chemistry and Immunochemistry Platforms on a Single Line - How Dynacare Kasper Medical Labs Overhauled the Core Lab With An Automation System
From rural community hospitals to sophisticated tertiary care, teaching hospitals, the Dynacare Kasper Medical Labs in Edmonton, Alberta, Canada serves a vast and diverse area in the central and northern reaches of this province. Managing 17 hospital laboratories serving 1.5 million Canadians, Dynacare Kasper was turning out a prodigious volume yearly - averaging 5.5 to 6 million test results, but the need to accommodate the core laboratory's growth could not be met with existing equipment and its projected needs assessment called for an ambitious plan to integrate its instruments.
As the laboratory's administration considered new integrated options to their stand-alone chemistry and immunochemistry instruments, they turned to a trusted partner that had served them well over decades of operation, the Bayer HealthCare Diagnostics Division. "We knew that as we tried to develop the capability of providing a greater volume of tests that it would become harder to find well-trained medical laboratory technologists because of the shortage that exists here," said Thomas Higa, MD, retired President and CEO of Dynacare Kasper.
Turnaround times are excellent - averaging less than 6 hours from the time a specimen enters the building because the ADVIA® LabCell® system is directly interfaced with the information system.
Since there was no need to switch vendors, the administration consulted with Bayer to come up with a plan to optimize their laboratory operations by implementing an ADVIA LabCell system. The ADVIA LabCell system enabled the laboratory to boost productivity and throughput to the point where the laboratory is processing about 4,000 tubes per day. In addition, 80% of the testing in the Chemistry Department is done by the instrumentation on the ADVIA Lab Cell system. "The new system also allowed us to combine both our chemistry and immunochemistry platforms on a single line. That meant there were fewer tubes that we had to collect, store, and dispose of," added Dr Higa. "This was a substantial factor for us as well. We probably saved about 800 tubes a day by installing the new automation system."
Another objective in opting for the ADVIA LabCell system was the long-term expected amortization of the system, and the administration is pleased with the projected results. "When you make that type of capital investment you hope to achieve savings over the long term. Part of the reason for going to the ADVIA LabCell system and negotiating a long-term contract with Bayer was to allow us some predictability in our cost structure. Although the system has only been installed since 2002, we are achieving this predictability," said Dr Higa.
Because the instruments and automation system operate as one integrated system that is directly interfaced through ADVIA CentraLink® data management and networking solution with the laboratory's information system, the entire operation allows for a high degree of accuracy of test results once they have been reviewed and confirmed by a senior technologist and clinical chemist. The automated track system was installed in 2002 at the same time that Dynacare Kasper moved from another building into its new facility.
"This significant reduction in the number of tubes required was noticed by our phlebotomists and by our patients," said Gloria Shukalek, Manager of Chemistry. "We started the implementation of the ADVIA LabCell system in November 2002. At this point, we put 2 ADVIA Centaur® systems on the line. An additional sample manager was added early in 2003 and the implementation of automation was completed in April 2003 when we added 2 ADVIA® 1650 systems to the line."
Nevertheless, there were some growing pains in getting started and making the transition to the new system and processes. "The installation was complex and we were one of the first laboratories in North America to have the ADVIA LabCell system installed," said Dr Higa. "Bayer was very committed to providing the support services to do that. They did everything they could to mollify the complications." Another benefit to the upgrade is that staffing essentially has not changed at Dynacare Kasper in the last few years, remaining stable at about 40 staff members. The only changes have been what ordinarily might be expected as staff moves from one department to another. "With an organization of 1200, there's always room for people to move around." The biggest problem was in the shortage of trained technologists in the Edmonton area, and the automated features of the ADVIA LabCell system helped address the problem of providing increased productivity without hiring more staff.
Turnaround times are excellent - averaging less than 6 hours from the time a specimen enters the building because the ADVIA LabCell system is directly interfaced with the information system. The reference laboratory includes the following configuration: the 8-meter ADVIA LabCell track, 2 sample managers, 2 ADVIA 1650 systems, and 2 ADVIA Centaur systems. A workflow study performed by Bayer Diagnostics indicated that volume increased 15% from 5,728,008 in 2002 to 6,568,278 in 2004 while the number of tubes per day decreased from 5,132 to 4,197 per day or 18%.
Working through an implementation period of 5-6 months before the system was fully operational, the laboratory initiated a cross-training program that enabled some staff "to work on both chemistry and immunochemistry analyzers and become familiar with both instruments as opposed to being keyed to one of them," said Dr Higa.
"We have not reduced our staffing in the Chemistry area. We have retained essentially the same number of staff but we have gained capacity for growth. Unlike other laboratories, we did workstation consolidation (reduction in number of testing platforms) prior to implementation of automation. The ADVIA 1650 system and the ADVIA Centaur system were already established within our laboratory operations. If a site has multiple testing platforms performing the tests that are available on the ADVIA 1650 system and the ADVIA Centaur system, they would be more likely to realize staff savings with the implementation of an automation solution," said Shukalek.
Implementation support from Bayer, along with a dedicated workforce, has enabled Dynacare to successfully overhaul its Core Laboratory and greatly improve efficiency and productivity while significantly growing its business.
Thomas Higa, MD
Retired President and CEO of Dynacare Kasper
Edmonton, Alberta, Canada
*System performance and staffing requirements may vary from laboratory to laboratory.