By Leonard K. Dunikoski, PhD, DABCC, and Robert Parson, MS, CHE

LE01.jpg (9227 bytes)Today’s pressure-driven and cost-conscious health care environment is prompting greater demands for clinical laboratories to deliver improvements in efficiency, profitability, and safety. Yet often the ability to deliver those improvements is right under our noses.

Case in point: Closed-tube sampling (CTS) technology—or cap piercing—is a mainstay in most hematology labs, enabling analyzers to pierce specimen tube caps and extract blood samples automatically. For years this innovative technology has helped laboratories increase productivity, lower costs, and improve worker safety. But the capabilities of CTS don’t begin and end with hematology testing. In fact, it may surprise many laboratorians to learn that this technology is now available on chemistry instruments. And it may surprise them more to learn that even greater opportunities exist for improvements in efficiency, profitability, safety and patient care.
Improving Efficiency, Turnaround Time.

Raritan Bay Medical Center (RBMC) in Perth Amboy, NJ, was among the first institutions to deploy CTS technology on the SYNCHRON LX®20 PRO clinical system (Beckman Coulter, Fullerton, Calif). Since that time, the technology has delivered measurable improvements in efficiency and test turnaround time (TAT).

Individually manually decapping and recapping a sample tube may not seem like a time-consuming endeavor. But when you consider that it takes anywhere from 5 to 10 seconds to remove a cap and prepare a single tube for testing and another 5 to 10 seconds to recap a specimen tube for storage after testing, and that the average lab processes literally hundreds of chemistry tubes each day, those seconds accumulate quickly.

At RBMC, laboratorians process upward of 500 samples per day on the chemistry analyzers. By eliminating the manual process of decapping and recapping specimen tubes, up to 500 hours per year have been saved, allowing laboratorians to devote their time to more important activities, such as interpreting results.

It also means that the laboratory has improved TAT and delivers results much faster to clinicians. Using CTS, the laboratorians at RBMC simply set the tube on the analyzer and walk away. The analyzer automatically draws the specimen, runs the test, and then delivers the tube for storage. Without the manual steps, the process is streamlined and uninterrupted.

In addition, CTS protects against time-consuming accidents such as spills and cross-contamination. When these incidents occur, lab technologists are pulled away to respond. This can delay the delivery of test results. By erasing these risks, CTS keeps workflow moving at a rapid clip.

Eliminating Medical Errors
Laboratories are not immune to recent efforts by regulatory agencies, activists, and hospitals to reduce medical errors and improve patient safety. According to a report by the Institute of Medicine, medical errors lead to as many as 98,000 deaths and up to 1 million injuries per year in the United States. The report concluded that diagnostic errors are the second-leading type of preventable error and can include delays in diagnosis, failure to employ indicated tests and use of outmoded tests—activities that are tied directly to the laboratory.

Automated technologies such as CTS can curb these risks. In addition, they can improve the reliability of test results. This is critical because the laboratory provides up to 80% of the information doctors use to make important medical decisions.

For example, because CTS allows the specimen caps to stay firmly affixed to the tube at all times, opportunity for sample cross-contamination is reduced significantly. The integrity of the sample is also protected since it is not exposed to evaporation—a situation that could compromise the reliability of test results.

The deployment of CTS also reduces opportunities for specimen tube spills or breakages—an accident that might require the phlebotomist to draw another sample from the patient.

Benefits of Closed-Tube Sampling

Low Mid High
Test Volume / Shift 200 300 400
Annual Test Volume 163,800 245,700 327,600
Average Time to Decap, Recap Tubes/Year (10 seconds each) 455 hours saved 683 hours saved 910 hours saved
Annual Cost for Staff to Decap, Recap Tubes/Year $13,650 saved $20,475 saved $27,300 saved

Reducing Carpal Tunnel Injuries
Nearly every lab has experienced injuries from carpal tunnel syndrome—and statistics show that the problem is indeed large. A 1998 study estimated that between 7% and 16% of the US population experience carpal tunnel syndrome. According to the US Occupational Safety & Health Administration (OSHA), repetitive motion injuries cost between $15 billion and $20 billion in workers’ compensation settlements each year. Indirect costs, such as time off work, can push the total to $60 billion a year.

Laboratory technologists are particularly at risk due to the repetitive nature of their work. Tasks such as capping and decapping sample tubes can irritate tendons and ligaments in the wrist. Over time, these motions take their toll and could permanently damage nerves in the hand.

Treating this type of injury is costly, to say the least. The estimated tab for nonsurgical carpal tunnel treatment is $3,500. Surgery brings the total closer to $20,000. For a long-term disability, the expense could reach $100,000.

By employing CTS technology in chemistry testing, however, labs can take a proactive approach to this problem. Eliminating just one manual task can go a long way toward relieving the pressure on tendons and nerves—and this is especially true for wrist-twisting tasks such as decapping and recapping specimen tubes.

Minimizing Exposure to Biohazards
Accidents in the laboratory may not be likely, but the consequences can be catastrophic.

According to the Exposure Prevention Information Network, clinical lab workers account for 20% of all health care–worker HIV cases. And OSHA estimates that nearly 5.6 million US health care workers are at risk for exposure to bloodborne pathogens such as HIV and hepatitis B. In addition, the National Institute for Occupational Safety and Health says that between 600,000 and 800,000 needlestick injuries and other percutaneous injuries occur among health-care workers each year.

Even the simplest lab operations carry an infection risk. For instance, when a test tube is uncapped, a lab worker can accidentally get splashed. While careful technique can avoid most splashes, what if the cap fits a little more tightly than usual? Or the technologist sneezes or is bumped? Lab workers are also exposed to aerosols when tubes are uncapped, and, since they normally are colorless and odorless, they may pose an even more insidious risk.

The good news: Safer medical devices can prevent anywhere from 62% to 88% of exposures. Because of this, OSHA’s newly revised Bloodborne Pathogens Standard states that health organizations should use the safest devices possible and continually evaluate new technology.

CTS is one of these safety-enhancing technologies. At Raritan Bay Medical Center, this type of automation has significantly reduced accidental biohazard exposure in the lab. As a result, worker satisfaction levels are high because laboratorians feel more secure about their daily safety.

The Costs of Doing Business
Average Number of Days Lost Due to Work Injury 1
Average Cost for Blood Exposure Due to Damaged Tubes $4,600
Average Cost for Short-Term Treatment of Carpal Tunnel Syndrome $5,000
Average Cost for Long-Term Treatment of Carpal Tunnel Syndrome $100,000
Source: Raritan Bay Medical Center

Lowering Cost
But CTS is not just a technology of efficiency, convenience, and safety. It also generates measurable cost savings.

According to one economic analysis, CTS technology deployed on chemistry analyzers can save laboratories up to approximately $30,000 per year. The figures account for capital equipment expenditures as well as efficiency savings and cost savings associated with damaged equipment, lost productivity, and lost workdays due to biohazard exposures or repetitive motion injuries.

That means labs can often recoup the initial cost of CTS in roughly one and a half years. In the case of a high-volume lab, the break-even point could be less than a year.

For instance, the cost of one biohazard exposure can total $4,600. This includes time away from work, tests for the laboratorian and source patient, antiviral medication, and related counseling services. By guarding against this type of accident, CTS protects labs from this, and other, unforeseen costs.

A Growing Trend to Automate
CTS represents a natural path for laboratories that want to automate manual processes—and offers a solution to the competing problems of increasing workloads and fewer staff members. The shortage of qualified laboratorians is very real—and it will not be resolved soon. It is estimated that there are up to 8,000 vacant positions a year in the United States.

By automating the most tedious tasks, laboratories can help offset the impact of the labor shortage, as well as process more tests, shorten turnaround time, reduce the risk of error, and save money—all with fewer people. Most important, automating these tasks allows laboratorians to focus on the work that requires their expertise, such as interpreting test results.

In short, by using cap-piercing instruments, labs not only can meet the latest industry safety standards, but they also run a far more efficient workplace. This is certainly the case at RBMC, where CTS technology is one of the reasons the laboratory can manage an increasing workload without negatively impacting safety, reliability, or costs.

For laboratories that do not employ CTS technology, it is time to take a closer look. Otherwise, they risk missing out on one of the most striking advancements in diagnostic testing to come along in a long time—and that could be a costly mistake on many fronts.

Leonard K. Dunikoski, PhD, DABCC, is director of operations at Raritan Bay Medical Center in Perth Amboy, NJ. Robert Parson, MS, CHE, is a senior staff scientist and biostatistician for Beckman Coulter Inc in San Diego and a certified health care executive.