“We’ve got a ‘Carter-compliant’ laboratory – we centrally process the cold work and we do the hot work where it needs to be done,” says Mick Drake, laboratory manager at Sonic TDL, describing the networked pathology service his company has implemented at The Doctors’ Laboratory’s (TDL) central London laboratory and at Ealing Hospital, a 352-bed hospital with a busy accident and emergency department, situated to the west of the city. Part of Sonic Healthcare, TDL is the largest independent provider of clinical laboratory diagnostic services in the UK, supplying pathology services to a wide range of customers. At Ealing, the company manages the entire laboratory service for the hospital. Around 2000 samples are received in the laboratory at Ealing each day. In-patient samples and short turnaround time (STAT) tests – about a third of the workload – are conducted locally, while samples from GPs, out-patients and those requiring esoteric tests are sent to TDL’s main laboratory. Distributing the workload in this way optimises resource utilisation, giving greater efficiency and cost-effectiveness while ensuring that the needs of healthcare providers are met.
At its central London laboratory, TDL uses 11 Roche MODULAR ANALYTICS analysers in PPPP, PPEE and EEE configurations. These handle over 12 million tests per year. In Ealing, two Roche cobas 6000 instruments, each with a clinical chemistry and immunoassay analyser, are used. For Mick Drake, having a single supplier for both locations is a critical issue as “the benefit of running both laboratories on Roche analysers is that we’ve got disaster recovery across the two sites. The reference ranges are the same and if anything happens at Ealing we could actually do most of their work here,” he comments.
As it is, samples are often tested at both locations. Standard tests can be run on a sample in Ealing, and the primary tube can then be sent to TDL in London if an esoteric test is required. The two sites are connected by an extensive IT system that utilises Roche’s PSM middleware to create a single ‘virtual laboratory’. As Mick explains: “we can book a sample in at either of our sites and then put it on any of our machines and the test will be done. If an additional test is requested later, it doesn’t matter if the sample has been transferred, as it simply gets run at whichever laboratory it’s in.”
Standardisation ensures seamless operation
Despite the distribution of testing, to the clinician the system appears completely seamless – there’s just
one set of results and they may not even be aware that the sample has been processed at multiple locations.
The laboratory at Ealing carries out all authorisations and acts as the single point of contact for GPs and hospital staff. Roche PSM software allows quality control to be reviewed at both laboratories in real time, as Tony Dedman, TDL’s head of biochemistry at Ealing, explains: “If we’re unsure of a result when we’re authorising, we can check it. We can order reruns and, if we’re really still unsure, we can check internal QC, so it gives us complete freedom, regardless of where a test has been run. ” When necessary, Tony can telephone his counterpart in London and both can view the data simultaneously and work through any problems together.
Versatile and flexible system
The versatility of the system isn’t just limited to the software, as Tony explains: “With the cobas 6000’s reagent handling system you just insert a cartridge and the system does all the preparation. In addition, you can add chemistry reagents on the fly without having to stop the system, which gives us a lot more flexibility and lets us keep the analysers running throughout the day.”
Another factor that helps to maintain system uptime is cobas Link, which enables Roche engineers to interrogate the analysers remotely, which facilitates problem-solving and preventative maintenance – a ‘hidden benefit’ for Mick Drake. “We’ve had examples of things being fixed before we even knew we had a problem,” he says.
Partnership commitment
This level of support is a key reason why TDL selected Roche as a supplier, as Mick sums up: “I think what made the difference was the commitment of Roche. The company made me feel that it was more of a partnership, rather than it just selling us things.”
It’s not surprising, therefore, that TDL is already planning to expand the Roche system in its London laboratory with the addition of two automated MODULAR PRE-ANALYTICS systems. This is another
example of how Roche’s networked solutions are helping TDL put into practice the Carter report’s conclusion that joint ventures with the private sector can improve the quality and efficiency of pathology services, and that managed networks allow more efficient use of resources.
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