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.
One of the first considerations was to look closely at the existing protocols for sample analysis, to see where and how automation would best fit. This coincided with the implementation of a new order-communications package (Sunquest ICE) for the pathology services in the trust. Entering patient information is very time-consuming and often leads to bottlenecks, so this development proved to have a significant impact and has helped to facilitate workflow. There was also the unexpected benefit of pathology personnel building better relationships with GPs while training them on the new ordering system.
As far as automation was concerned, one of the first targets for change in microbiology was TB testing, which previously had been contracted out to a laboratory in Cardiff. The demographics at Slough had changed quite considerably in the intervening years since testing was first outsourced, and now included quite a high proportion of Asian inhabitants who regularly travelled to and from areas where TB is prevalent. As a consequence, levels of the disease in the area increased and it was no longer a cost-effective option to send work away. Furthermore, the team had no control over testing and, most importantly, turnaround of results was very poor. There was a clear business case to bring TB testing in-house and reduce costs. An automated system was chosen, and clinicians and patients alike are very happy with the service they now receive.
Cost-effective and easy analysis
After this initial success, the next candidate for automation was urine analysis. Incumbent methods were based largely on repetitive manual tasks, and the urine bench would often succumb to backlogs of predominantly negative results, especially at times of staff shortage. Urine microscopy was read, results were written on the forms and, although the tests were effectively complete, it could be some time before the results reached the GP. Understandably, the department would receive frequent call asking for results, and the delays had a huge knock-on effect.
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