Abstracts of the Scientific Posters, 2013 AACC Annual Meeting ...

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Automation/Computer Applications Tuesday, July 30, 9:30 am – 5:00 pm Integra 400 for serum proteins, and Thermo Scientific Konelab with DiagAm reagent for microalbuminuria. Valtec protocol designed by the French Society of Clinical Biology was used for comparison analysis. Results: For within-run precision using QC materials (n=30) all 93 coefficients of variation were below 2 %, 68 % being lower than 1 %. For total precision (n=30), CVs for serum chemistry parameters were below 2.5 % except for CO2 and creatinine. Urine chemistry parameters showed CVs below 2.5 %, and urine microalbuminuria CV was below 3.7 %. There was no significant cross-contamination between samples, and the method linearities were consistent with the manufacturer’s claims. Interferences were mainly associated with icterus: above a bilirubin concentration of 400 μmol/L a decrease of recovery was observed for creatinine (Jaffe), total protein and cholesterol. Grossly haemolysed samples showed decreased bilirubin recovery. Correlation studies were very satisfactory; some differences were observed with urine protein results, but this is due to the well-known interference of some polypeptidebased plasma expanders. Time for obtaining the results of 900 tests (9 parameters on 100 samples) was 36 min. 06 sec., starting from stand-by. Turnaround time (TAT) for an emergency sample with 7 tests was 11 min. when the analyser was in routine operation. Conclusion: The analytical features and the throughput of the AU5811analyser make it suitable for a laboratory dealing with a large number of samples and looking for fast TAT for emergency analysis. A-90 Throughput Evaluation of ACCELERATOR p540 Perianalytical Sample Processor using Primary and Secondary Aliquot Samples A. DeFrance 1 , J. Lucio 1 , K. Reed 1 , Y. Smith 1 , D. Overcash 2 . 1 Abbott Laboratories, Irving, TX, 2 Abbott Laboratories, Abbott Park, IL Introduction: The ACCELERATOR p540 is a fully automated perianalytical sample processor that performs sample loading and identification, decapping, aliquoting, and sorting operations. The p540 consists of two managed integrated modules. The aliquoter module has aliquoting and sorting capabilities and the sorter module has the capability of sorting into preconfigured instrument specific racks. Primary tubes are pre-loaded into five position racks and introduced to the aliquoter. The primary sample tubes and aliquot samples are sorted to the Aliquoter and /or connected Sorter module. The objective of this study was to measure the p540’s throughput per hour of primary collection tubes and of various aliquot sampling profiles. Methodology: The p540 was programmed using an LIS to process an assortment of capped primary collection tubes and aliquots. The throughput in terms of number of tubes processed per hour was measured. Variations were ordered calling for one, two, or three aliquots from the primary tube. In one experiment, sample tubes were sorted to the Sorter Module connected to the Aliquoter Module via a bridge connection. In a second experiment, all tubes were sorted to the Aliquoter Module secondary sorting garage. The p540 can be configured for either path or a combination of both for maximum tube throughput. Results: The table summarizes the throughput results for the various combinations of primary tubes, aliquots, and processor paths. Tube Throughput Under Various Workload Conditions 1 Primary tube + 1 1 Primary tube +2 Aliquot Aliquots All All Tubes All Tubes All Tubes Tubes Sent to Sent to Sent to Sent to Secondary Sorter: Secondary % Aliquots Sorter: Garage: Total Garage: Total Total No. of No.of Total No. of No.of tubes/hr tubes/hr tubes/hr tubes/hr 1 Primary tube + 3 Aliquots All Tubes Sent to Sorter: Total No.of tubes/hr All Tubes Sent to Secondary Garage: Total No. of tubes/hr 0 483 490 483 490 483 490 10 529 534 517 558 538 589 20 572 562 543 603 565 691 30 575 565 551 658 536 713 50 592 637 566 756 580 708 70 614 722 578 775 592 694 100 642 862 597 779 611 697 Conclusion: The p540 significantly increases workflow efficiency as a standalone sample processor as demonstrated by this throughput study. Utilizing a LIS, approximately 500 primary tubes can be processed with increasing efficiency as the number of aliquots increase. This study demonstrates the benefit of sorting tubes directly to analyzer specific racks while maintaining satisfactory throughput. The p540 Aliquoter and Sorter Modules provide sorting capabilities as desired for optimum efficiency. A-91 Optimization of sample workflow with focus in the pre-analytical phase in a reference laboratory in Brazil L. G. S. Carvalho 1 , C. Pereira 2 , A. Bertini 2 , F. E. Pereira 1 , G. Ludovico 1 , J. A. D. Maciel 3 , T. P. Souza 3 . 1 DASA, Cascavel, Brazil, 2 DASA, São Paulo, Brazil, 3 DASA, Rio de Janeiro, Brazil Background: The workflow of samples within the pre-analytical laboratory stage is already well defined. However, laboratory workloads are constantly growing at the same time that laboratories are under pressure to contain or lower costs. In addition to that, it is not always available sorting automation instruments to meet adequately and timely the distribution process and all the variety of sample recipients demanded for sorting. The causes can vary from tubes standardization (difficult to obtain in reference labs) to demand fluctuation (due to commercial or seasonal reasons), common in reference labs routine. When these variables are present, sample flow is less efficient, increasing materials and employees cost, as well as arising potential human errors. Alvaro laboratory receives around 50.000 tubes a day only for the serum work area tests and provides a very important attribute to its customer: single tube submission of the tests, what makes the sorting process a challenge for the lab. The aim of this study is to present the tools and processes developed to achieve excellence and efficiency in the pre analytical phase of a large and differentiated reference lab. Methods: New setting rules for sample distribution (sorting) and RSD samples flow (RSD work cycle tray creation) were proposed within the pre analytical system and was implemented via IT solution, allowing the integration between three lab sectors of higher sample volume (Biochemistry, Immunology and Immunochemistry). This integration was established based in the criteria of speed, capacity and throughput, together with the institution of a tube “transfer” flow between these areas. This new procedure simplified the analytical flow and enabled the generation of fewer aliquots, giving preference to route the single tube. The labor-intensive sorting and aliquoting practice was dedicated only to manual tests or specific routines, which lead to standardization of manual distribution, compared to those used in automated distribution (RSD). These rules were customized according to the lay out and instrument design of Alvaro Laboratory. Results: With the implementation of the optimized manual and RSDs sorting process, we obtained in the period of June 2011 to June 2012, a saving of 112,000 aliquoting tubes, decreasing the overall aliquoting percentage rate from 16.7% to 5.5% and improving the patient / Aliquot rate from 5.96 to 18.34. Conclusion: This project allowed quantitative and qualitative gains that conducted the lab to improvements in productivity, cost and turnaround time for the sorting process, with positive impact on key performance indicators. A-92 Overutilization of Hemoglobin A1c and Serum protein Electrophoresis Tests in a Large Tertiary Hospital M. Fenelus, T. C. Brandler, L. Bilello, L. K. Bjornson. North Shore University Hospital Laboratory, Manhasset, NY Introduction: Under the new Healthcare Reform Act, laboratory professionals are expected to review ordering patterns for clinical laboratory tests to ensure appropriate and efficient use of laboratory resources. Inappropriate ordering practices contribute to the high cost of healthcare. It is incumbent upon members of the laboratory to work with their clinical colleagues to achieve appropriate utilization of laboratory tests. Objective: To review utilization of two laboratory tests, Hemoglobin A1c (HbA1c) and Serum Protein Electrophoresis (SPEP) over a 6 month period. Methods: A retrospective computerized query of our clinical data repository was performed to document all HbA1c and SPEP tests performed from January to June 2012 for a large tertiary care hospital in central Long Island, NY (North Shore University Hospital). HbA1c test results totaling 4,736 from 3,940 patients and SPEP test results totaling 272 from 256 patients were examined. This study examines utilization of HbA1c and SPEP tests, which are usually ordered once per admission. A second order for the SPEP test within 7 days and HbA1c within 30 days is considered overuse in our study. Results: Review of the HbA1c data showed 415 out of a total of 3,940 patients had two or more HbA1c ordered within one month which confers a 10.5% overutilization for this test. Review of SPEP data showed more than one SPEP ordered within the same week for 9 out of 256 patients, which confers a 3.5% overutilization for this test. CLINICAL CHEMISTRY, Vol. 59, No. 10, Supplement, 2013 A25
Tuesday, July 30, 9:30 am – 5:00 pm Automation/Computer Applications Conclusion: Review of the utilization of HbA1c and SPEP in our institution demonstrated overutilization of 10.5% and 3.5% occurred for HbA1c and SPEP, respectively. For HbA1c most of the duplicate orders occurred on the same day or within two consecutive days. The probable explanation for this is that two different physicians independently ordered the test unaware that it had already been ordered. An alternate explanation, that the physician was suspicious of the result and reordered the test for confirmation, is much less likely considering the time span of one to two days. These percentages represent overutilization of these tests that could be prevented most directly by adding software or intelligent rules to the laboratory or hospital information systems alerting physicians to previous orders in order to avoid duplication. A26 CLINICAL CHEMISTRY, Vol. 59, No. 10, Supplement, 2013
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