MRI virology

Xchange newsletter - Summer 2007

Transformed!

The Central Manchester and Manchester Children's University Hospitals NHS Trust has one of the largest clinical virology departments in the UK. Located at the Manchester Royal Infirmary (MRI), it processes around 300,000 patient samples per year and has more than 80 staff. Dave Ellis, lead biomedical scientist, explains, "Our work comes from the MRI, neighbouring St Mary's Hospital, Manchester Children's Hospital, other local Trust hospitals and community practitioners."

Like most virology departments, the MRI lab has a long history of working with batch processes and batch analysers for its routine work. So, when it was time to re-procure, it's not surprising that the original tender issued was for replacing batch with batch.

But, some way into the process, the tender was withdrawn and a new, more radical solution sought.

Random benefits

The team in Manchester intuitively knew that the benefits of random access analysers and automated sample handling systems enjoyed by colleagues in other pathology disciplines would offer them something better; higher throughput, faster turnaround times, end-to-end positive sample ID and seamless integration into the hospital laboratory management system, for example. They realised though, that this approach had not been considered in virology before and that no potential supplier had a proven, off-the-shelf solution to cope with the diverse range of assays, sample types and tubes that arrive in the lab each day.

Through extensive research, a series of visits to other pathology sites and discussions with Abbott and other potential suppliers, a system specification emerged. An audit was carried out by the Abbott process/workflow team and once the results were reviewed, Abbott became MRI's chosen partner for the modernisation project. The contract is a managed service agreement, with Abbott managing two other third party suppliers in providing a total solution to the laboratory.

Teamwork, teamwork, teamwork

A project implementation team, including both Abbott and laboratory personnel, met frequently and kept everyone informed by publishing comprehensive minutes and project timelines.

An enormous amount of groundwork was completed in a very short time: sample handling protocols were streamlined; agreement was reached on limiting the number of sample tube types that would be accepted; SOPs for the ARCHITECT and AxSYM Plus platforms and assays were established; and data handling and other IT issues were resolved. Dave Ellis again, "This was a period of very intensive work and, don't forget, we were making physical changes too. Benches were being taken out, opening up the whole lab so that the physical arrangement of the new analysers could be optimised for our new process."

Then, only a few months ahead of the department's CPA accreditation audit, it was out with the old and in with the new!

"Of course we had teething troubles," said Dave Ellis. "Everything was new so we expected that. But Abbott and the whole MRI team kept the faith and problems were solved. We passed our audit and now just eight months in, the department has been transformed."

A new routine

The rationalisation of platforms means that more than 80% of routine serology assays are now run on Abbott instruments (table 1). Sample reception and basic preparation work have been streamlined. A Tecan FE500 liquid handling system, which aliquots from primary into secondary tubes in dedicated instrument racks, feeds the analysers and a second, smaller, Tecan system prepares an archive sample for storage.

The result? Increased productivity and faster delivery. The vast majority of results are validated and out of the lab next day. Quality is improved too, from both analytical and clinical standpoints.

We'll leave the last word to Dave Ellis to sum up. "Looking back now, I don't know how we did it in such a short time! The whole team can be very proud of what they have achieved. Our clinical 'customers' have certainly noticed the improvement in service. But just as important for me is the air of calmness and the feeling that everything is under complete control in the lab. The result is fantastic."