PROBABLY NO AREA OF CLINICAL LABORATORY MEDICINE is experiencing the dramatic transformation happening in microbiology. From rapid molecular testing to the full automation of traditional manual processes, significant changes are happening in microbiology labs.
Moreover, the smart use of Lean techniques and quality management techniques magnify the positive effects of these new diagnostic technologies and automation in microbiology.
One early-adopter laboratory leveraging all of these trends to deliver more value with microbiology testing services is DynaLIFEDx Diagnostic Laboratory Services in Edmonton, Alberta, Canada. DynaLIFEDx was one of the first two labs in North America to implement total lab automation (TLA) in its microbiology lab and the first to go live in September 2013 with patient specimens being processed on the BD Kiestra TLA system from Becton Dickinson (BD). The DynaLIFEDx microbiology team concurrently used Lean techniques to optimize processes in its microbiology department and obtain added productivity from automation.
Another notable aspect about this microbiology lab makeover is that it involves one of the largest microbiology laboratories providing hospital acute care and community patient services in Canada and the United States. DynaLIFEDx processes 900,000 microbiology specimens annually for more than 120 hospitals and health centers across Alberta, Saskatchewan, and the Northwest Territories. Among the benefits DynaLIFEDx realized were improved turnaround time, reduced errors, standardization of specimen handling and processing, streamlined operating procedures, improved patient and staff safety, and enhanced antibiotic stewardship.
The metrics from the combined use of Lean techniques and total lab automation are impressive. Productivity gains supported a specimen volume increase of 15%, in addition to MLT staffing reductions of six full-time equivalent positions over 18 months. Also, workflow in microbiology has become much more efficient. DynaLIFEDx expects to realize further staff reductions as the lab continues to optimize the TLA system, further improve workflows, and implement new features and components.
“We are a private laboratory within an integrated laboratory service and work closely with Alberta Health Services, the public health system,” stated Norma Page, the laboratory’s Vice President of Clinical Operations. “We provide anatomic pathology, microbiology, and a wide array of other lab testing, including referrals, consultation, and support services.
“From our large referral laboratory in Edmonton, and from labs we operate in regional and rural hospitals within Alberta, we service an area about the size of California,” she continued. “We employ 1,200 professional laboratory staff, including 40 pathologists, medical microbiologists, biochemists and other medical laboratory specialists.”
Improving Quality and TaT
“We provide microbiology testing for dozens of hospitals including large acute-care facilities, and regional, community, and rural hospitals and health centers,” she added. “Those hospitals don’t have microbiology departments, but they do have rapid response or stat labs.”
“Over the years, DynaLIFEDx has consistently had a forward-looking approach toward innovation,” commented Page. “Consequently, we look first for opportunities to use new tools rather than increase the number of hands needed to handle the steady expansion in specimen volume along with increases in our scope of service. Because of our focus on innovation, we often realize big leaps forward when there are new opportunities in technology, automation, systems, or internal innovation.
“These management philosophies supported the major changes implemented in the microbiology lab. Late in 2012 we recognized a need to automate our microbiology department,” stated Page. “Over 40% of the 900,000 microbiology specimens we test each year are for acute care patients. We saw the opportunity to combine automation and new technologies with Lean to improve turnaround time, quality, and productivity.
“Our team started with a thorough analysis of the available automation options,” explained Page. “We chose the BD Kiestra system because it had a multi-year track record in various labs in Europe and it offered more flexibility in terms of handling different specimen types. By comparison, other automated systems we considered were early in their development at that time.
“This microbiology automation system has changed—or facilitated changes—to almost every component of our microbiology laboratory,” said Page. “It does automatic plate barcoding, automated processing of liquid specimens, semi-auto- mated processing of non-liquid specimens, and automated incubation and imaging.
Benefit of Standardization
“One major benefit that came with this total laboratory automation solution is standardization,” added Page. “For us, it allowed us to standardize many aspects of microbiology. This was important to us because our previous traditional microbiology processes were manual with significant differences from person to person and specimen to specimen. We had variations in operating procedures affecting everything from the size of the inoculum to how the plates were streaked and how long culture plates were actually in incubators.
“Perhaps the most interesting technology in the BD Kiestra system is how it uses magnetic beads to streak the plates,” she stated.