06 July 2008
8:54:00 PM
Subject Title: LMQA
Topic: Laboratory Automation SystemHello people! Hope everyone is enjoying your sip as much as I do. =)
I have been attached to the clinical biochemistry department of this hospital. Although it is a clinical biochemistry lab, what I have learnt there is not about CCHEM but more about LMQA.
This lab that I’m currently in is a 24 hour routine lab, which means they are doing the same thing everyday, 24/7. This lab is using LAS (Lab Automation System), which covers about 70-80% of the lab work and few other offline analyzers. Offline analyzers means they are not connected to the LAS but the results from the analyzers will still be downloaded into the LIS (Lab Information System). Does it sound confusing? Well, I’ll give you the overview from the specimens reaching the lab to the release of the results.
Once the specimens, usually patients urine, blood, cerebral spinal fluid and serum, arrive in the lab, we will stamp time on the request form. This stamped time is very important to calculate the turnaround time of the specimen. Turnaround time is counted from the time the specimens arrive in the lab till the results of the test are released. The turnaround time for A&E or urgent specimen is about 45 mins to an hour. The turnaround time for non-urgent specimen is about 1-2hours and for polyclinic specimens about 3 hours. After the time is stamped, the specimen will be sort according to urgent (aka STAT, which means short turnaround time) and non urgent specimens. The reason for sorting them out is to give priority to the urgent specimens because urgent specimens usually linked to life and death of the patients.
After the specimens are sorted out, there will be staffs to type in the patient’s demographics and the tests order by the doctors into the LIS. After that, 2 pieces barcode (in sticker form) will be printed, for example, 05073001 (date/month/barcode number). 1 will be pasted on the request form and 1 on the specimen (blood tube). It is very important for the staff to check that the name or IC number labeled on the specimen is identical to the name or IC number written on the request form. If there is a mistake at this stage, the wrong result will be released and the patient will receive the wrong treatment which may lead to life and death. After the test requisition, the specimens (in test tubes) will be loaded onto the LAS.
The specimens will enter the LAS through the inlet, it can be manually loaded or just leave it on the rack and the gripper will automatically load them for you. The specimens will then be sent for centrifuge. Our LAS consist of 2 centrifuges which can spin 40 specimens at one time. After centrifuging, specimens will enter the serum level detector to allow that serum level to be identified and recorded. After which, the specimens will be decapped by the decapper. There are sensors found through the track to identify the specimen and know what are the tests to be done. If there are some test which need to be tested on other offline analyzer, a barcode will automatically be generated by the labeler and be pasted on the daughter tube. Then the aliquoter will aliquot out some of the serum into the daughter tube. We only have 3 analyzers which is physically connected to the LAS so they are called online analyzers. They are DxI, DxC1 and DxC2. After the tests which are required to be carried out are tested, those specimens which have other tests which need to be conducted on other offline analyzers will exit at the outlet. As for those specimens which have completed the entire test, they are move to the stockyard for storage. In case you wonder what is stockyard, they function the same as refrigerator. Anyway, for your info, the LAS my lab is using is by Beckman Coulter.
As I have mentioned earlier on the online analyzer, here are some of the tests that they conduct. DxI conduct tests such as vitamin B12, folic, ferritin, hormones like PTH, cortisol and testosterone and insulin. DxC1 is usually used for liver function test, iron, TIBC, aldolase, lipase and renal function test. DxC2 is mainly used for testing therapeutic drug. We also have other offline analyzer like DxC3 modular PE, modular DP, TDX and Cobas E601. Dxc3 works exactly like DxC1 and 2 but it is used to perform tests on urine sample and cerebral spinal fluid. PE usually tests for cardiac enzymes, specific protein and fertility hormone. DP specifically runs specimens from polyclinic. TDX is used to test for Cyclosporine A, Methotrexate and etc. Cobas E601 is a new analyzer that we have got. It will replace some of the older analyzer and it will be used to test for cardiac enzyme and tumor markers.
After the analyzer have analyzed the test ordered, the results will be downloaded into the LIS and there will be a matcher (one of our staff) to verify the results, making sure that the results “make sense” before releasing the results. If a very high or low result is spotted, the matcher will “call” for the specimen (using LIS), and the specimen will exit at the outlet. The matcher will then check if the name and IC number on the specimen tally with the LIS. Then they will call for re-run (repeat) of the test. If the value is still falls out of the reference range, the matcher will make a panic value call to inform the staff nurse in-charge about the value. It is important that they only inform the staff nurse or the doctor in-charge so that they’ll know what action is to be taken and we have enter a comment on LIS who is informed. Eg. S/N TAN IS INFORMED OF THE HIGH GLUCOSE VALUE ON 06/07/08 AT 1243HR. if the specimen is haemolysed, we have to report that too. It is because haemolysis of the blood will/may affect the result. Eg. Potassium.
Here is the list for panic value call:
Potassium: <2.5> or = 5.8 mmol/L
Sodium: <120>160 mmol/L
Calcium: <1.75>3.25 mmol/L
Glucose: <2.00>25.5 mmol/L
pH: <7.1>7.6
Digoxin: >2.5
Theophylline: >25.0
Blood Ketone: >1.4
Paracetamol: Inform all the results
Salicylate: Inform all the results
Yupx! This is the rough idea of how my lab works. And every week, I’ll change station and each station means 1 analyzer. The first week I’m at DxC and second week at modular DP. I wonder what’s next for me. =) Hope it's not too wordly for you guys to digest.
Chew Yu Mei0605926ETG01
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