The Ortho AutoVue system has become an industry standard in blood banking. Here, three senior laboratory managers talk about the operational utility of this system and the specialist team that supports it.
Full automation represents an effective response to the continued necessity to 'do more with less'. Decision-makers under pressure to perform must consider the clinical safety and security of blood, the operational excellence and productivity of instruments, and the true cost-effectiveness of the systems they operate. However, against a background of increasingly sophisticated instrumentation, they must also weigh the benefits of a reliable service and the active support of suppliers.
Speed in acute situations
Dr Peter Baker, laboratory manager in blood transfusion at the 1000-bed Royal Liverpool University Hospital, has used AutoVue for five years. In October 2005 the transfusion laboratory, which employs 30 biomedical staff and tests 35,000 samples per year, upgraded one of its two AutoVue instruments to an AutoVue Ultra and replaced the second with a state-of-the-art AutoVue Innova. Peter said: "One major advantage of the newer instrument is its ability to deliver real speed of service in an acute situation. The facility to test one sample alone û without having to wait for a batch û is extremely useful in an emergency.
"The AutoVue Innova is easier to use than the first-generation AutoVue instrument. The user interface is visually pleasing, there is much more information on the screen and it is easy û almost intuitive û to navigate. Changeover training, which was achieved by a cascade system, starting with two colleagues who had been trained intensively by Ortho-Clinical Diagnostics (OCD), took about 45 minutes per person.
"The introduction of a bi-directional interface with host query on the Innova is a logical development. It means that the work list seen on the screen accurately reflects the samples that have been loaded on the instrument, rather than all the possible samples in the daily worklist. As samples are loaded, the Innova system builds and refreshes the worklist by interrogating the laboratory information system (LIS). The OCD product support specialist installed the instrument and facilitated interfacing with the LIS. The biomedical scientist staff were then encouraged to explore the software and they became comfortable with it very quickly.
"In the Liverpool working environment, other AutoVue Innova features have proved beneficial. The laboratory is large and contains many types of equipment and the audible alert signals û different ones for different processes û make it much easier to work in this environment. A biomedical scientist can now load the instrument and then move on to another task, with no need to return to check it. We know exactly how long the system will take to produce results, with the information displayed clearly on the screen. When the instrument has finished a particular process, the user is alerted by a preprogrammed signal, either audible or a flashing light.
Delivering quality and value
"Working with the AutoVue Innova and AutoVue Ultra in tandem may seem like a luxury, but recently it meant that the department was able to take on work for another trust û an arrangement that added 6000û8000 samples to the workload û without disruption. There is also spare capacity for the inevitable incremental increases."
Peter Baker has also received positive feedback from beyond the confines of the laboratory. First, the trust's quality managers reported that the quality of service provided by transfusion is highly rated by users. Second, more efficient management of blood stocks enabled the hospital to reduce the amount spent on blood by ú500,000 in the year following introduction of AutoVue because the ability to perform electronic issue reduced the need to stockpile blood for operations.
Backlogs eliminated
Total confidence in results and the reassurance of future capacity are of equal importance to Miriam Schramm, transfusion laboratory manager at Southend Healthcare Trust. Early in 2005 the trust installed an AutoVue Innova for groups and screens. Following a period of parallel testing, the department's previous instrumentation was decommissioned and the AutoVue system went fully live with 24-hour working in mid-June. The impact was immediate.
"Staff instantly felt in control of the workload. Staff group and screen 25,000 blood samples each year for a 900-bed district hospital, affiliated to the London Hospital Medical School, which specialises in oncology. Trickle-feeding made it possible to eliminate the backlogs associated with batching and 24-hour working removed backlogs experienced in the mornings and after weekends. Samples are now loaded individually as they arrive, so results are produced more quickly and in an orderly fashion.
"Overall, there is much less retesting, even when staff who do not routinely work in transfusion are involved. Results and process information are shown pictorially on the screen, so staff members gain confidence in the instrument very quickly. If there is a problem, the audit trail makes it easier to trace back. The end result, of course, is an improvement in turnaround times and a better service to clinicians and patients.
"Furthermore, it is now possible to dedicate precious time to strategic planning for the future. The partnership between the laboratory and OCD has resulted in a process of continuous evolution. Working with the customer support specialist, it is possible to apply the latest technical developments to make the laboratory more efficient, as is the ability to discuss changes and developments that staff believe would prove beneficial."
Reassuring customer support
A strong customer support network is a vital part of OCD's service to Ortho AutoVue system users. In the UK alone, a dedicated team of 21 support personnel provides a round-the-clock facility. The existence of this expert team was a particularly decisive factor for Maureen Spence, head biomedical scientist in transfusion at Antrim Hospital's transfusion laboratory, when she opted for the AutoVue system. Maureen said: "Automation was introduced because electronic crossmatching was needed to ensure the safety and security of patients. Prior to January 2004, all testing in Antrim had been performed manually. With 15,000 samples per year, an ever-busier laboratory and only four full-time staff, the potential for human error was increasing. However, with only one analyser in use (with a manual BioVue system as a back-up), confidence in both instrument and supplier was, and is, imperative.
"Ortho-Clinical Diagnostics was chosen because the reassurance of technical support on hand was required. In fact, the tender specified support from a local engineer and OCD was able to satisfy this requirement. In practice, customer support from OCD has been just what was promised. The Ortho Hotline is very effective û all staff members use it and they find it helpful to be able to talk through things with a specialist. Problems can often be solved over the telephone, without recourse to an engineer's visit. However, if this proves necessary then the engineer is already well briefed.
"Good training has also been crucial. After using AutoVue for two years it was upgraded to the AutoVue Ultra in the summer of 2005. When AutoVue was first installed, on-site training lasted for two days; however, following the upgrade to the AutoVue Ultra, staff went on an advanced training course in Strasbourg. This has provided the confidence and knowledge to obtain consistent peak performance from the Ultra, as well as the ability to deal with routine matters in-house.
Facilitating the process at every stage
"The OCD product support specialist has facilitated the process at every stage of installation, upgrade and operation. This involved installing the analyser, helping with the implementation of the validation plan and then training the staff. Currently, a bi-directional interface is being created between the AutoVue Ultra and the LIS, and the OCD specialist is really going the extra mile to make this happen. The electronic interface with host query functionality is very important because it will reduce the potential for human error still further. It will also provide the potential to perform electronic crossmatching. The next improvements planned are an investigation of single sample rather than batch processing and the acquisition of Resolvigen3 software.
"AutoVue Ultra has brought work satisfaction back into the laboratory. Staff are now more relaxed, even on the busiest of days. The preventative maintenance programme built into the Ultra provides added security, and routine maintenance can be scheduled to suit both staff and workload. There has been barely half a day of downtime since upgrading to the AutoVue Ultra system.
"The Ultra has made a further significant difference to the working environment. The OCD system has the capacity to cope with the department's entire workload, now and for the foreseeable future. Most importantly, the staff have total confidence in the instrument."
The technical and customer support network that OCD has developed alongside the evolving AutoVue system is vital in releasing the full potential of automation. Each laboratory has an individual set of requirements to meet the demands of its own particular clinical practice. The active involvement of OCD's expert support team ensures maximum functionality of each system through a comprehensive process of installation, training and ongoing customer support.
Continuing dialogue between supplier and customer provides important feedback and a constant flow of information on improvements and developments. As automation in blood banking evolves, OCD customers are ideally positioned to take advantage of innovations that enhance the laboratory environment and its service to clinicians.