CHALLENGES FOR LABORATORY MEDICINE

Caroline Joyce,

Principal Clinical Biochemist,

CUH

CUH & CUMH

Laboratory Medicine

Histopathology (Molecular Pathology)

Microbiology

Virology

Haematology

Coagulation

Blood Transfusion

Biochemistry (Immunology, Genetics)

Medical Specialties (40+)

Emergency Medicine

Oncology

Endocrinology

Neurology

Paediatrics

Neonatal

Rheumatology, Orthopaedics, etc…

CLINICAL BIOCHEMISTRY

CUH

BUSY LABORATORY!

• Core biochemistry - 8M tests/year

• Huge increase in annual workload

• Staffing levels have not kept pace

• Diversity and complexity of tests

growing

• Metabolic and neonatal medicine

putting extra demands on service

• Referral services expanding year on

year (17% increase in 2017)

WORKLOAD INCREASES

• CUMH – Cork University Maternity Hospital -3 maternity hospitals merged and relocated to CUH in 2007

• CRC – Cardiac Renal Centre established on CUH campus in 2010

• GPs contribute to 60% of workload but don’t have access to electronic requesting.

CUH Clinical Biochemistry Laboratory Workload

2004 to 2016.

↓ CUMH

CRC

↓

PAPER BASED REFERRALS • Referrals 2017

Biochemistry (24398)

Immunology (1224)

Genetics (1615)

• Over 40 different labs

• Very labour intensive!!

• Most lab NCs relate to

referrals – huge RISK!

SIMPLE REPORTS

Example: Pharmacogenetics

TPMT enzyme activity

What to Report?

• Numerical result

• Reference Ranges

• Caveats/Interpretations

• Name of Referral Lab

• Methodology Used

COMPLEX REPORTS

Example: Metabolic Report

What to Report?

• Result for each Amino Acid

• Clinical Interpretation only

MORE COMPLEX REPORTS

Example: Urinary Steroid Profile

What to Report?

• Numerical results

• Clinical Interpretation

• Are reference ranges age and

gender appropriate?

• How do we flag a change in

RRs

CHALLENGES FOR MANUAL ENTRY DATA ENTRY

Referral Laboratory linked to test

Assay changes

Analyser changes

Changes in Reference Ranges

Gender based

Age related

Interpretative comments

Caveats

LOGISTICS

Clerical input

Scientific entry check

Authorisation

Scanning Reports

RISKS

Transcription Error!!!

Report missed - Incomplete Lists

Delayed Reporting (↑TAT) – Patient Management

EQA MANAGEMENT

• 6 Different EQA Providers

IEQAS, NEQAS

WEQAS, DEQAS

IMMQAS, EMQN

• Number of Schemes (40+)

• Distributions annually (12)

• Returning Results

• Downloading Reports

THE SOLUTION

• Two way communication with

• EQA providers

• Specialist National Laboratories

• Referral Laboratories in UK

• Real Time Electronic Reporting

• Less risk, faster TAT

• Long term savings

• Improved diagnostic service

• MEDLIS compatible?