Laura J. McCloskey, PhD
The lab at Thomas Jefferson University Hospital (TJUH), Philadelphia, a high-volume clinical lab undergoing a structural reorganization, aimed to standardize its workflow operations. When it was time to outfit the lab with new laboratory testing services, an automated solution from Roche—including the Roche MODULAR PRE-ANALYTICS sample handling system, the cobas 6000 analyzer series, which includes the cobas c 501 and cobas e 601 modular chemistry and immunochemistry analyzers, and the cobas p 701 postanalytical sample storage and retrieval unit—fit the bill.
“We started our quest back in the end of 2008,” says Laura J. McCloskey, PhD, assistant professor, Department of Pathology, Anatomy, and Cell Biology; associate director, Clinical Laboratories, director, JHN, IC, Immunology, Specimen Processing and Referral Testing, TJUH. “We were on a 5-year contract cycle wherein we would start the search again to replace these high-volume analyzers. The difference this time was that over the course of the previous 5 years, we had consolidated and acquired different locations and had a great need to standardize practice at every location. So we decided that we would combine this acquisition with a big rollout of standardization across campuses.”
The lab at TJUH performs approximately 3.5 million to 4 million tests a year. The Roche solution allows the lab to quickly and accurately accommodate the increasing number of diagnostic tests funneled through the facility. McCloskey estimates the lab sees a 10% increase in volume annually.
“This is our first fully connected and fully automated system,” McCloskey says, adding, “That makes us somewhat unique in this day and age. A lot of laboratories, especially of our size in hospitals of similar acuity level, had gone to a total laboratory automated system before we chose to.”
Roche’s cobas c 501 and cobas e 601 modular chemistry and immunochemistry analyzers.
Roche’s cobas p 701 postanalytical sample storage and retrieval unit.
Prior to adopting the automated system, the lab effectively completed all incoming tests, McCloskey says. However, as with any high-volume lab, the equipment eventually began to lag. After near-constant use for 5-plus years, an overhaul was warranted.
TJUH worked through significant space constraints in the process. The lab now includes Roche analytics configured in the shape of an “E” with an extra “arm” for the preanalytical portion. The arms support different analyzer combinations: two connected chemistry analyzers; two connected immunoassay analyzers; and two chemistry, plus one immunoassay analyzer, respectively.
“That configuration allows us to be extremely flexible,” McCloskey says. “We can have all seven analyzers running at the same time. We can take down any of those arms—any of the multiple forms of the configuration—and mask it on our system so that the software knows to load balance and send the work to the other platforms.”
The setup facilitates maintenance and assures redundancy for any type of instrument malfunction. “It gives us a lot of capacity for high-volume times of the day,” she says, noting that, as in any tertiary care hospital setting, distinct peaks and valleys of incoming work are not always predictable.
The samples are put into a bar-coded, five-position rack and placed on the input buffer, McCloskey says. The system reads the rack bar codes and the sample bar codes, and then takes over and decides what needs to happen to the sample.
“If it’s testing that’s going to be performed on the analyzers—either immunoassay or chemistry—it will most likely centrifuge those samples,” she says. “It will then remove the samples from the centrifuge and pipette them into cups, recap the primary samples, and send it off to be stored, while the aliquoted sample in the cup will be sent down the line specifically to the analyzer where the testing will be take place.”
Making such a significant workflow overhaul was bound to cause at least some minor issues. Emphasis on bar codes was one. The lab must often remind its clients to only submit samples with properly bar-coded labels. Also, the ongoing transition to a paperless hospital environment sometimes proves challenging as the new system is integrated.
No big surprises materialized, and McCloskey says the transition was solidly where she expected it to be. “It wasn’t without some hiccups,” she admits. “We were asking the majority of our staff to change their workflow and habits in ways that they had not previously been able to imagine.
“But all in all, going live was very smooth,” she says of the stepwise approach. TJUH brought the analytics live first, while Roche connected the analyzers to the track and the preanalytical equipment. Then the preanalytical portion went live, which enabled the technologists to understand all of the nuances that were particular to the Roche systems. “Ultimately, the move to the automated Roche system has helped bring the capabilities and technology at the TJUH laboratory up to date. For a lab that is not only seeing an increasing workload but also dealing with the transition of hospitals to a paperless environment, this technological step forward is invaluable.”
“This is really the first step for us in being able to grow further and be on the cutting edge of where diagnostic laboratory medicine is these days,” McCloskey says. “We also have a very active molecular diagnostics area that continues to expand. This frees up our skilled technologist labor force to be able to do bigger and better things: more development work, an expanded repertoire, and handle more volume. It’s very exciting.”
Chris Gaerig is CLP‘s associate editor.
