Professor Ivan Brandslund works at Vejle Hospital in Denmark. He is in charge of what is probably the most automated laboratory in the world.
"80% of all diagnostics are based on blood samples. Therefore, blood samples are essential to patient flow in any hospital. Predictable, faster test results for blood samples enables efficient planning of care of patients or treatment start. This is essential to patient length of stay in hospitals and the increased demand for ambulatory treatment, meaning that bed wards should only be in play when it is necessary. In order to achieve robust, predictable turn-around time and efficient results, hospital management needs a controlled supply chain and a reliable and fast flow of blood samples," says Ivan Brandslund.
Ivan Brandslund points out that a single bed-day costs EUR 1000 and that bed wards should only be used when essential. This is where the central laboratory's role is so important. Point of Care Testing (POCT) seems like the obvious way to obtain short turnaround times, but compared to central laboratory testing, POCT may experience greater test result variability and high costs.
Variation in personnel competences and training, testing conditions and methods, and perceived simplicity of testing methods all contribute to the potential lack of reliability when using POCT.
Methodologies employed in POCT differ from those employed in the central laboratory. Comparison of results or standardisation across POCT sites or locations may not be possible. This variability may impact patient care.
POCT does not guarantee improved patient outcomes. POCT provides test results with a faster turnaround time in most instances. To effectively expedite clinical management, the entire clinical pathway must be optimised. Faster test results can contribute to improved patient outcome but does not provide the sole factor for this final analysis.
Ivan Brandslund and his team at the laboratory at Vejle Hospital overcame these challenges, initially by streamlining the analysis process. The laboratory then secured predictability and speed of sample transportation by installing a dedicated automated system, which transports blood samples directly from the ward to the laboratory.
Since the laboratory began using Tempus600, a dedicated, one-touch transport system, response time and response failure has decreased significantly.
"The initial efficiency gains were obtained by improving the analysis process. Then we focused on streamlining the transportation process. By dispatching the blood samples via a one-touch system according to the FIFO principle - first in-first out, we can predict transportation time and the Total Turn Around Time for blood samples. The results speak for themselves," says Ivan Brandslund.
Figure 1. The data from Vejle Hospital shows that for 80% of the samples, the total time spent on blood sampling and transport is 5-13 minutes, before the sample is received and registered in the Sysmex/GLP track System in the laboratory. According to Ivan Brandslund, blood sampling takes up to 3-5 minutes of the total 5-13 minutes.
Figure 2. The total number of laboratory analyses at Vejle Hospital in 2015 and 2017 after installing the Tempus600 system. The decrease in response failures from 5.8 - 2.9 permille shows a relative decrease of 50 %. The average daily cost per analysis is EUR 33.52, which means potential annual savings of up to EUR 335.166 because sampling and testing do not need to be repeated.
Today, Vejle Hospital can discharge or treat 80% of the patients more efficiently, because 80% of diagnostics are based on blood samples.
"This is an extremely efficient way to combine hospital savings with better patient treatment. The laboratory has a key role to play in the ‘Healthcare of the future’ and it will become significantly more important in the era of precision used for personalised treatment," says Ivan Brandslund.