FEATURE ARTICLES

Following the incorporation of Beckman Coulter into the Danaher portfolio of companies, and the recent launch of cutting-edge analysers in clinical chemistry and haematology, the company’s UK aim is to improve patient care and reduce costs.

Using examples from Peterborough and Gateshead, Paul Skingley explains how a Roche managed laboratory service partnership can help laboratories deliver the ideals incorporated in the recent reviews of pathology services in England.

Mick Chomyn and Martin Fottles from Path Links Pathology Service illustrate how Lean work cells deliver faster turnaround times, higher productivity and efficiency, increased flexibility, improved space utilisation and quality.

The performance of the haematinics service offered by the Royal Oldham Hospital in Greater Manchester shows how centralising laboratory services can be implemented successfully and cooperatively. Supported by its partnership with Beckman Coulter UK, the Royal Oldham Hospital has been able to run one million tests on just one immunoassay platform – the standalone Beckman Coulter DxI 800 immunoassay analyser – since the haematinics service was centralised over three years ago.

The latest computer-based colony counting technology can reduce the time taken to measure microbial load by two-thirds, and it’s non-destructive, as Mark Williamson explains. Industrial vision is a key technique in the pharmaceutical and food industries for checking a range of parameters, from package integrity to correct labelling. While defective packaging can lead to the contamination of product, there are many other potential sources of contamination (eg bacteria, yeast and mould) in liquids originating from raw materials, manufacturing processes or end products. Therefore, it is essential to test for microbial contamination throughout the manufacturing process in order to monitor product quality effectively.

Consolidation of HbA1c testing on a Siemens chemistry analyser has had a significant impact on staff usage and turnaround time at St George’s Hospital in London. St George’s Healthcare NHS Trust in London has recently consolidated all glycated haemoglobin (HbA1c) testing on its routine Siemens Healthcare Diagnostics ADVIA Chemistry 2400 systems. The move to consolidate a traditionally ‘esoteric’ test into the automated routine chemistry environment resulted from a drive to increase efficiency. Incorporating specialist HbA1c analysis into the routine chemistry laboratory testing environment has delivered significant cost savings. In addition to savings made by eliminating purchasing and maintenance costs involved for a dedicated HbA1c high-performance liquid chromatography (HPLC) system, St George’s has liberated a dedicated operator to provide this service and reduced turnaround time from an average of two days to two hours.

The Royal Wolverhampton Hospitals NHS Trust recently adopted the Roche Training Specialist Service to deliver consistent and high-quality training for its point-of-care testing equipment operators. Tailored to meet the specific needs of The Royal Wolverhampton Hospitals NHS Trust, the Roche Training Specialist Service provides confidence that staff members are trained to a high standard and will help the trust to meet Clinical Pathology Accreditation (CPA) requirements for point-of-care testing (POCT).

Roche blood glucose meters and point-of-care data management solution have allowed Mid Yorkshire Hospitals NHS Trust to meet patient safety and Clinical Pathology Accreditation requirements. The Mid Yorkshire Hospitals NHS Trust has recently installed Roche Accu-Chek Inform II wireless-enabled blood glucose meters in wards, clinics and theatres across all three of its acute hospital sites in Wakefield, Pontefract and Dewsbury. The meters are linked wirelessly to the hospital information system (HIS) via the Roche point-of-care (POC) data management solution, cobas IT 1000, allowing them to be managed centrally in accordance with national guidelines for POC devices.

A three-date meeting of the World HAI Forum, hosted by bioMérieux, took place in June and welcomed speakers from Europe, North America and Australia. Over 70 international experts in medicine, infectious diseases, microbiology and epidemiology, from every continent, gathered at the Fondation Mérieux’s Conference Center for the third meeting of the World HAI Forum on healthcare-associated infections (HAIs), a bioMérieux initiative. During the forum, participants called upon national and international health authorities and policy-makers, the medical and veterinary communities, industry and the general public to take action to avoid an impending public health catastrophe caused by the emergence and spread of bacteria that are resistant to all antibiotics.

Over the past 10 years, DX has become a leading provider of specimen delivery services to laboratories nationwide. In response to changes in regulations, recent high-profile disease outbreaks and an increasing focus on patient confidentiality, it continues to invest in its service portfolio to cater for the needs of health professionals. With a long history of delivering highly important and sensitive documents for the legal and government sectors, DX launched its specimen delivery service in 1999 – recognising a gap in the NHS market for an all-inclusive packaging and transportation service that fulfilled regulatory requirements for compliant packaging and the need for a cost-effective, yet highly secure service.

Telepathology has developed with advances in camera, computer and microscope technology. Now, true-colour, high-definition megapixel imaging in real time with no lag and no delay has arrived.

Roche cobas IT 1000 software improves the quality of patient information, ensures accuracy of testing, and provides immediate access to results for authorised staff in the point-of-care setting. As the National Patient Safety Agency (NPSA) reports more than half a million safety incidents in NHS trusts across England in the first half of this financial year (a rise of 4% over the previous six months),1 Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex has been taking steps to enhance patient safety when it comes to performing point-of-care (POC) diagnostic tests.

For those who may not have been able to attend the recent Joint Congress of the European Society for Clinical Microbiology and Infectious Diseases and the International Society of Chemotherapy in Milan, Oxoid provides a round up of the new products shown on the company’s stand in the associated exhibition. A joint meeting of the European Society for Clinical Microbiology and Infectious Diseases and the International Society of Chemotherapy was held in May in Milan. On offer was an excellent scientific programme, running over four days, with stimulating keynote lectures and symposia on parallel tracks, supported by the involvement of a high number of internationally-renowned experts.

West Suffolk Hospital recently implemented an order communications system for users of its diagnostic services. It is intended to make requesting easier for GPs, to improve pathology laboratory efficiency, reduce duplicate tests, and comply with national policies requiring tracking to ensure that results are actually read and acted upon. West Suffolk Hospital is a 460-bed hospital located on the edge of Bury St Edmunds. Serving an area of 600 square miles, with a population of around 275,000, the hospital has seen significant expansion in recent years and continues to grow to meet the developing healthcare needs of the community.

Customer training and support are both vital to the delivery of quality diagnostics to the pathology community, as transfusion scientist Barry Hill discovered during a recent behind-the-scenes visit to Ortho Clinical Diagnostics’ European Support Centre in Strasbourg. Ortho Clinical Diagnostics (OCD) serves the transfusion medicine community and laboratories around the world by producing total solutions for the screening, diagnosis, monitoring and confirmation of disease. As a result, OCD assists hospitals, transfusion laboratories and blood centres to deliver meaningful and timely results. As a leading provider of immunohaematology reagents and instrumentation such as the Ortho AutoVue Innova (AVI) automated blood grouping analyser and the groundbreaking Ortho BioVue column agglutination technology system, OCD invests heavily in user training and in its customer support network to ensure laboratories gain greater operational efficiency with their own analysers and serological procedures. Fundamental to this service is the OCD European Technical Support Centre based in Strasbourg, France, which provides both the dedicated in-house training and support its customers require in order to deliver the quality results that ultimately support patient safety, treatment and care.

A €3.6 million project co-funded by a European Union Framework Programme is developing a biosensor platform for the point-of-care diagnosis of cerebrovascular disease. The P3SENS (Polymer Photonic multiParametric biochemical SENSor for point-of-care diagnostics) consortium has been formed to develop an immunoassay detection device suitable for use in emergency medicine, whether diagnosis is required in an ambulance, emergency room or as part of a rapid near-patient laboratory test in a hospital environment. The requirement for such a technology to be standalone, without the infrastructure associated with a laboratory, dictates that a number of key processes be completed automatically within the system. The ability of a biosensor platform to manipulate liquid samples and deliver any biomarkers which may be present to the surface of the sensor in a manner which ensures accurate and reliable detection is critical.

Blood Science is the next step on the road to a fully integrated pathology service. Core disciplines of haematology and biochemistry are merged, but many also see the inclusion of immunology in this new super-discipline. Its development is driven by the need for cost reductions, commonality in laboratory processing and by roles in clinical diagnosis and management. The new discipline will demand a new breed of scientist, as Andrew Blann, Ian Jennings and Nessar Ahmed explain. Historically, pathology has evolved into distinct disciplines, and training and practice has reflected this. The past decade has seen the birth and slow development of a new branch of pathology – blood science – which merges aspects of haematology, biochemistry and immunology.

A guidebook on cytogram interpretation, written by Graham Gibbs and published recently, should prove very useful to anyone who uses a haematology analyser. Assessment of blood film morphology following an abnormal full blood count (FBC) is a traditional and fundamental aspect of diagnostic haematology. Nationally, review rates vary from below 5% to as much as 100% in certain specialist laboratories. However, as boundaries between different sections of pathology disappear and workload and skill-mix change, the level of morphology skill often varies among staff members.

In recent years, clinical microbiology has turned to state-of-the-art technologies in order to automate workload. Here, Jamie Laughlin discusses the gradual transformation of his department, from traditional bench-based techniques to the Lean working principles of automation.

The Heatherwood and Wexham Park Hospitals NHS Foundation Trust in Slough serves a wide area of Berkshire from its base at Wexham Park Hospital, with satellite hospitals at the Heatherwood in Ascot and St Mark’s in Maidenhead. Pathology services are centralised at Wexham Park, and the microbiology department processes about 317,000 samples a year received from hospitals and GPs in the trust. Over the past few years, the microbiology department has undergone a programme of automation, taking a thorough look at workflow and the equipment options available, as well as learning from the experiences of other laboratories.

Cardiac and thrombosis testing in accident and emergency in Buckinghamshire has benefited from use of a point-of-care immunoassay system from Radiometer, saving time and resources and improving patient care. Instant bedside immunoassay testing for critical cardiac biomarkers can be crucial to the provision of swift and appropriate treatment in an acute care setting, allowing further assessment or urgent treatment of a patient to be ruled in or ruled out without delay. Buckinghamshire Healthcare NHS Trust has introduced point-of-care immunoassay analysis in the accident and emergency (A&E) department at Stoke Mandeville Hospital, improving turnaround times for troponin I (TnI) and D-dimer, and consequently patient flow. Unnecessary treatment has now been reduced, with corresponding time and cost savings.