preview:• This lecture is about autoanalysers in relationship to biochemistry.
• The clinical biochemistry laboratory is one of the most automated disciplines within pathology within BMS and because it performs the huge bulk of the entire workload received by the pathology department, it is im...
This lecture is about autoanalysers in relationship to biochemistry.
The clinical biochemistry laboratory is one of the most automated disciplines within
pathology within BMS and because it performs the huge bulk of the entire workload
received by the pathology department, it is important understand turnaround times and
reflex testing.
Quality assurance – how do we know that the results we have obtained are accurate and
reliable, what procedures do we have in place to ensure that.
Ancient Greeks performed very simplistic diagnostic tests like the tasting of urine and
noticing that had a sweet smell.
English physician in Oxford and his name is Thomas Willis was alive in the 17th century and
he noticed that the urine of particular patients was wonderfully sweet like sugar or honey.
Manually performed test before the increase in population and the understanding of
different diseases and how we could detect those.
That was labour intensive quite cumbersome takes a long time in which to do, differences in
interpretation.
Leonard Skegs introduced the first auto analyser in chemistry that could measure around 20
samples at a given time.
Increased due to demand and ability to detect a wide variety of analytes, now thousands of
samples are processed and on average 10 tests are performed on each one.
Also due to this technological age that we find ourselves in.
Demand has increased on pathology services and turnaround times have become
increasingly short there is the need to get results out quicker particularly in emergency
situations you want to get there as fast as you can so turn times may have originally been
two hours for a particular analytes now you've got 15 minutes and if you have an hour
turnaround time that clock starts ticking down from the minute it is collected not the time
that it arrives in the lab.
This bottom picture shows the levels of automation and the levels of sophistication that we
know find in clinical biochemistry laboratories where we have number of analysers linked to
a track system.
We can now link different analyses together and then samples will go on this track system in
in a rack of one so one sample in its own rack, it will then go to the different analysers, bar
codes will be read and it will be determined whether that sample needs to be tested on that
particular analyser or continue on the track and in some cases it goes on the track and
straight to the fridge after all the testing has been completed so it's really sophisticated and
it's very impressive.
This came out of Lord Carter of Coles review within 2000s regarding pathology how
pathology was currently operating and what changes needed to be made not only as cost
saving mechanisms but also to improve and continue with modernization.
One of the findings of this was the development of the hub and spoke model.
Central hospital – routine tests, non-urgent tests, the satellite sites send their routine work
to the central hospital.
Satellite hospitals – kept urgent work.
This stops the duplication of tests, it is cost effective as the routine work all require the same
reagents and analysers, it also means that you have to process less samples, you don't have
, 9. Autoanalysers Automation
to send duplicate samples for example, it is time saving, and helps with storage in terms of
duplicate samples.
You can use the extra money that you’ve saved to invest in modernising analysers.
Patients have improved access to specialist tests and the results can be shared across the
site because you will standardise the laboratory information management systems across
the sites.
Staff can move across the sites as part of career progression.
Savings in terms of buying costs (analysers) but also running costs (reagents).
Difference between what we mean by laboratory organisation and what we mean by
mechanisation.
Most hospitals now will have a completely or total automated laboratory and we refer to it
as the track laboratory in those particular laboratories we would have machines that will cap
and de-cap samples, automatically centrifuge samples, load them into the centrifuge
automatically you'll have to manually load a centrifuge.
Part of the mechanisation will be that the samples will go straight into the fridge as part of
the track system you don't have to unload the samples manually.
Automation is mechanisation with process controls and the use of computers and that helps
with sample analysis so computers can generate the results from particular testing but you
still require BMSs to interpret those results, if the machine says that there is an elevated
level of an analyte, it is up to the BMS to determine if that is because of an interference with
the sample or is that because there's true and therefore what we need to do, the machine
can flag potential error might be e.g. a blockage within the probe, otherwise it is up to the
BMS to look at the clinical history to determine whether that result is true or whether it is
not.
If the biochemistry department is small, they may still be performed manually.
The analyser will scan the barcode and determine what tests need to be performed so you
don’t have to request it, however we still request tests manually for a number of reasons.
Can use the computer system to know if it’s on the centrifuge or an analyser somewhere.
In one sample you can take the aliquots and all the tests can be performed.
Anyone in the trust can access those results.
Automation minimises the risk of human errors with pipetting volumes and things relating to
that.
Automated analysers have been developed with this in mind to take into account that we
require often a very small sample volume.
Continuous flow analysers are an old school technique releases and are phased out largely.
In the centrifugal analyse the sample is mixed with the reagent.
The discrete analyser has largely replaced all of these other approaches now and this is
where you have a robotic sampling arm and it performs tests with disposable cuvettes, you
have one cuvette for one particular patient sample for one particular diagnostic test that
you're going to perform.
The rate of flow and the diameter of that tubing determines how quickly these samples will
be analysed, the samples and air bubbles are pushed or drawn through the tubing system,
the sample then meets that particular reagent that then goes to the detector which uses
absorbance and when the absorbance is measured the reaction chamber will be washed out.
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