The James A. Haley VA Medical Center (JAH) in Tampa, Fla, has been serving the 116,000 veterans living in central Florida since 1972. The hospital has more than 300 beds and sees around 2,000 outpatients per day. The Pathology and Laboratory Medicine Service lab at JAH performs tests not just for hospital patients but also for satellite clinics scattered as far away as Brevard County, located on the state’s opposite coast.

The lab strives to offer not only efficient, speedy turnaround times, but also the most comprehensive and accurate pathology testing available. For basic testing, the team at the JAH microbiology lab primarily use a VITEK 2 automated system, which performs a sizeable amount of its identification and susceptibility testing. Three years ago, however, the team made the decision to invest in the BIOMIC V3 from Giles Scientific, Santa Barbara, Calif, as a secondary system for automating tests that are not run on the VITEK and which were previously performed manually, with the goal of expanding the lab’s capabilities and improving patient care.

While the manual process was working adequately for the lab’s highly experienced team (most of the microbiology techs have been with JAH for more than 25 years), it was extremely time consuming. The lab at JAH sees a lot of recent veterans newly returned from Iraq with atypical and unusual organisms that normally require manual identification using kits and Kirby-Bauer susceptibilities. In cases such as these, a quick turnaround time can make all the difference.

The BIOMIC uses color digital imaging technology to automate the reading, interpretation, and reporting of antibiotic disk-diffusion tests and commercial identification panels including RapID™ (Remel), API® (bioMérieux), and BBL™ Crystal™ (BD). Lab techs follow typical standard plate and panel-preparation techniques, and then submit the sample into the BIOMIC system for analysis. The system’s electric eye reads plate colors and helps provide a more accurate result without the hazard of human error or imprecise interpretation.

First in Line

Narla Fries was the first to work with the new system. Fries has been with the lab for more than 30 years, and has worked her way from drawing blood and answering phones to becoming microbiology/molecular diagnostics supervisor, receiving her CLS degree in the process.

Fries stepped into her post as supervisor a couple of years after the BIOMIC purchasing decision had been made, but in her previous capacity as a bench tech, Fries was charged with installing and implementing the system into the lab. While she was originally nervous about setting up an unfamiliar system, Fries warmed to it immediately, and setting up the system took less time than anyone expected.

For Fries, installation consisted of hooking up a separate PC to the BIOMIC system and following both product manual and on-screen setup instructions. “I was just given the instrument and an instruction booklet, and I set it up all by myself. Once I had everything together, everything was ready to go within hours,” she says.

Fries says the system was workable from the get-go. “I like things very intuitive. If something isn’t intuitive, it’s harder to work with and more difficult to teach,” she says. Fortunately, Fries finds the system both user-friendly and responsive. Its interactive interface prompts users along from sample preparation to results, which is still a novelty for a lab that has spent so many years working with time-consuming kits.

“The process was entirely manual before,” Fries says. “With Kirby-Bauer susceptibilities, you read your sensitivity panels with a ruler and you measure your zone circles (zones of inhibition) with the human eye in millimeters,” she explains. “While with the BIOMIC, I programmed all the panels we have into the system. Now I can just click on whatever panel I want and put the plate in,” she says.

Results process instantly after clicking the read button, an improvement the team has embraced. “Nobody wants to go back to hand measuring sensitivities or looking up in the book your number codes to determine what your identification is,” Fries says.

To Face or Not to Face

Although the BIOMIC has bidirectional LIS/LIMS interface capability, the lab has yet to implement the feature. “We’ve been fine operating the system without interfacing,” she says. “We don’t use LIS for most of our tests, anyway, because they’re actual kits,” she explains. Instead, after a plate has been read, the system produces a printout of the results, which includes the patient’s name, unique identifier, and even the tech working on the sample.

In addition to improving the lab’s workflow, the lab also discovered the BIOMIC’s usefulness as an organizational tool. “It has really streamlined QC and has assisted with inspections,” Fries notes. “You can show inspectors every single antibiotic and every single lot number that you’ve used,” she says. In addition, an antibiotic will not result on the manual Kirby-Bauer susceptibility panel readout if the QC is out of date or range, and all results are stored on the PC for review at any time.

The team is also impressed with the BIOMIC’s ability to store the latest CLSI guidelines right in the system, eliminating the arduous process of searching for them in books. As new guidelines are released, the company sends Fries new updates.

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The support team at Giles also receives high marks from Fries. “They check in with me periodically via e-mail and phone, and if I ever have any trouble installing updates or working with the system, I know I can hop on the phone and they’ll walk me through everything,” she says.

These days, with hospitals and health care facilities everywhere concerned with understaffing and a lack of new recruits to fill open lab tech spots, maximizing efficiency is they key to keeping up with an ever-expanding workload. Understaffing is an ongoing challenge for the lab, but the BIOMIC has managed to improve the team’s time management. “The instrument has shortened our quality control bench from something that used to take a tech all day, to something they can complete in half a day,” she says. “Now that tech is able to able to help out around the lab a lot more.”

Stephen Noonoo is associate editor of CLP.