It has been five years since the (then) Greater Glasgow Health Board entered into a managed service contract with Abbott Diagnostics UK. This first-of-a-kind contract – believed to be one of the largest contracts for pathology provision ever awarded in Europe – saw Abbott Diagnostics UK (in conjunction with third-party suppliers) selected to provide laboratory testing services incorporating biochemistry, virology, immunology and haematology. Here, we talk to staff in the laboratories to learn how the contract has enabled the departments to evolve in response to pathology’s changing landscape.
Time for change
The move towards a managed service contract using a single supplier came from within the health board and it took considerable effort to organise three divisions (incorporating seven acute hospitals) for a coordinated tender process. “There was a lot of coming together during the process,” explains Colin Smith, laboratory manager for biochemistry, south Glasgow. “The joint tender came out of an extensive acute services review that examined changes in clinical services to ensure we continue to provide good laboratory services at the right locations.”
“From the start we knew we wanted a single laboratory supplier – although we were aware that there was no one company that could actually meet all our needs without collaboration,” remarks David Cameron, head of technical services for north Glasgow. Other key drivers for seeking a managed service included financial savings – both through potential VAT reclamation and economies of scale – that could be used to fund future laboratory building works across the health board.
Decision-making
“The decision to award the contract to Abbott was based on our requirement for the best operational solution for the city,” says Dr Richard Spooner, lead clinician for north Glasgow biochemistry. “In particular, the data management solution scored highly and Abbott offered far and away the most flexible systems. We knew it was important to consider future as well as current needs.”
The chosen solution was to install Abbott’s ACCELERATOR APS laboratory automation system – incorporating not only ARCHITECT analytical platforms but also pre- and post-analytical functionality – at the three largest hospitals. ARCHITECT ci8200 combined clinical chemistry and immunoassay analysers were installed at the smaller sites.
Responding to change
“Over the past five years, the city’s workload has increased some 20%, with a growing proportion coming from GPs,” remarks Richard. “Processing the annual two million samples and 18 million tests within the ‘9 to 5’ window has been challenging. The managed service contract has withstood this and has permitted technology updates and instrument upgrades where necessary.”
David adds: “The forthcoming closure of Stobhill Hospital means that Glasgow Royal Infirmary will experience a further significant rise in the number of requests. Three of our ARCHITECT c8000 clinical chemistry analysers have now been replaced with higher-throughput ARCHITECT c16000 systems, with a fourth due for upgrade next year. Another i2000SR immunoassay analyser has also been added. Our configuration of ACCELERATOR APS and analysers has stood the test of time and been easy to upgrade.”
Uniformity of analysers and methods across the city has allowed decentralisation of testing where this is appropriate.
Quality results
For most of the laboratory teams, full laboratory automation was a new experience and it required a different way of thinking in terms of working practice. “With new analysers, new middleware and a new approach to working, the learning curve was steep,” says Colin. Laboratory personnel are, however, very positive about the new systems. We no longer rely on separate, dedicated equipment or people to provide an emergency service, as we believe our routine turnaround times are good enough in nearly every situation. Even with a daily workload of 20,000 tests, we analyse and report 98% of acute work within 90 minutes.”
With respect to analyser performance and accuracy, David comments: “The ARCHITECT analysers at Glasgow Royal Infirmary have proved robust and reliable. We’ve had very few issues with the assays and this has been confirmed by quality control (QC) analysis – in fact, the past five years have been the easiest we’ve had where quality is concerned. This success has been helped by the Analyser Management System (AMS – provided by Abbott in partnership with Omnilab), which is excellent middleware – possibly the most flexible analyser management system I have seen. Abbott’s other IT systems have also proved their worth. The Reagent Management System (RMS – provided by Abbott in partnership with CoMed), for example, makes it easier for laboratory managers to oversee spend, and reagent stock control and ordering are much more under control.”
“We are pleased to have improved efficiency across the board, which was a key requirement of the new laboratory solution,” explains Richard. “And we are well on our way to eliminating the need to aliquot samples.” David adds: “We have become even more efficient than we expected. One example is the ease with which we can re-run tests. Previously, staff would have needed to locate the sample in the refrigerator and reload it on the analyser. Now, with samples retained in the storage module of the ACCELERATOR APS, it takes just a key stroke to retrieve the sample and return it to the analyser.”
On your team
“Having our own facilities manager comes highly recommended,” remarks Richard. “Glasgow’s dedicated facilities manager has been the window between ourselves and Abbott and this has smoothed much of the contract detail so that, for most of us, there are absolutely no hassles. Being the first and the largest UK contract of this type has given us unparalleled access to Abbott’s global scientists, for example, in obtaining method details.”
Introducing Clyde
In 2009, Clyde was incorporated into the trust, creating the UK’s largest health board, NHS Greater Glasgow and Clyde. Following an additional tender, the Abbott managed service contract was rolled west to incorporate three more hospitals.
“Abbott undertook extensive site surveys and workload analysis in Clyde,” explains laboratory manager John McKellar. Integrated ARCHITECT clinical chemistry and immunoassay analysers were installed at the Royal Alexandra Hospital (three ci16200), Inverclyde Royal Hospital (two ci8200) and Vale of Leven District General Hospital (ci8200 and c8000).
“At the Royal Alexandra Hospital, which processes 3.5 million tests per annum, the installation took just two and a half weeks from arrival of the instruments to going live! Financial restrictions meant we were unable to adapt the laboratory building as originally planned, so one of our two existing modules had to be decommissioned before we could install the Abbott systems. But, with good planning, all went smoothly.
“Laboratory personnel were impressed with Abbott’s offsite training, which was very intensive. Our team has quickly got to grips with the new ARCHITECT systems and, at the Vale of Leven, our on-call haematology staff are happy using them, too. Standardising equipment across the trust has been advantageous for movement of both tests and staff.
“Abbott’s on-site system application specialist provided fantastic support during installation, performing extensive test comparisons on the new analysers to ensure everything was running as we would expect. The ongoing support is a real benefit of the managed service contract.
“As our Glasgow colleagues led us to believe, the precision of Abbott’s chemistry is very impressive – it’s as good as I’ve seen. The new analysers cope with our workload very well. Previously, we had to stop processing GP work when we reached our capacity. We now clear it all every day, and I believe our average turnaround times have improved.”
Richard says: “During the Clyde tender process and the subsequent installation phase, our colleagues in Clyde challenged some of our established working practices. Through this interesting and valuable learning experience we reassessed our procedures and made some changes. We should always ask ourselves: are we providing the best service we can?”
Final words
“In financial, technical and quality terms, the Abbott managed service contract was the right choice for us,” concludes Colin. “The demands on our laboratory service – and the structure of the service itself – has changed considerably over the past five years. The Abbott solution equipped us well for this and has enabled us to improve both quality and turnaround time. Users are pleased with the service we offer.”
“Our partnership with Abbott has matured over time,” adds David. “The trust has been important as we have all shared more than we ever anticipated, but this has given us excellent access to Abbott’s decision-makers.”
“My only regret is as a consequence of Abbott’s global success in rolling out ACCELERATOR APS,” sighs Richard. “After three years of being the place everybody from the USA to New Zealand wanted to visit, we no longer get to host site visits, and I miss the chance to exchange views on practice with international colleagues.”
This managed service contract was a groundbreaking deal, both in size and complexity. Abbott solutions are designed to provide flexibility and in Glasgow this enabled different configurations across the city, while still offering all the benefits of commonality. Instrumentation can be reconfigured or upgraded as required, providing a truly future-proof solution.
www.abbottdiagnostics.co.uk