For almost two years medical laboratories throughout NZ have been reportingSARS-CoV-2 PCR test results within two to three days of collection – usually within 24 hours. This turn-around-time (TAT) includes sample collection, transport, registration, analysis and reporting. For the first few months of the outbreak in 2020 there could be significant delays at the registration stage while donor demographics were manually checked and entered into the LIS for each specimen. This is a critical stage where patient demographic information written on the swab container is checked against the details recorded on the request form. These details must then be accurately transcribed from the form into the LIS, and a bar-code generated and applied to the specimen before analysis can even begin.
With the steady increase in testing numbers, and especially during surges, there was no way useful TATs could be achieved using the usual registration system. The introduction of the National Covid eOrders system, designed by Dr Lara Hopley, has removed the need for a request form and donor identifiers no longer need to be recorded on the specimen containers. Instead each specimen container is pre-labelled with a unique identifier that the collector linked to the donor’s NHI details.
ISO15189 requires the labelling of a primary sample in a manner that provides an unequivocal link with the patient from whom it was collected, and also the identity of the person collecting the primary sample and date and time of collection - something IANZ assessors diligently check during an assessment.
The eCollection system saves time at collection. A process that took five minutes now takes one minute, and there is a lot less walking backwards and forwards. Registration can be done with a tablet of any kind, however it does require cellular or Wi-Fi connection to the internet, but outside of that it’s a lot more mobile than using a Patient Management System to print a patient label and the risk of transcription error is removed.
The following questions are asked at the collection stage allowing the determination of pre-test probability and the identification of high value/high priority specimens.
The system is currently being upgraded to populate the ‘Urgency’ field with the calculated priority/pre-test probability.
When the specimens arrive at the laboratory reception the specimen barcode is scanned to ensure it is linked to a donor. On average the time required for Specimen Reception to receipt a Covid-19 specimen into the laboratory has been reduced from 2 minutes per specimen to approximately 30 seconds and the risk of transcription error has been removed. At the Specimen Reception stage a second, analyser-readable, barcode is applied to the specimen container. This goes over the original barcode. At Waitematā DHB laboratory the IT co-ordinator, Jon Atkinson, is working with Sysmex to develop a system that allows the analysers to read the original pre-applied barcode, negating the need for the second barcode.
Occasionally when a specimen is scanned upon arrival in the laboratory no donor information appears. This may be because the collector did not complete the eOrder. These samples, referred to as ‘orphans’ are never processed.
Another issue being worked on is the ability to flag urgent specimens or to identify specimens that should not be pooled due to a higher probability of being positive. Normally this information would be stated on an accompanying request form.
This eCollection system has proven so successful at both reducing the time at the specimen collection and specimen reception stages, plus reducing the risk of transcription error, that there is now talk of utilizing it for other laboratory test requests.
Dr Lara Hopley is quick to point out she is just one person in a large team that has made this system work. What follows are her words crediting the other teams involved:
ESR have embraced the challenge and invested heavily in the skills and hardware required. They have up-skilled, up-teamed (brought on more staff) and embraced the challenge with a can-do attitude.
Dr Hopley points out that if she supplied the 1% inspiration, then Sysmex put in a large proportion of the remaining 99%.
LabPlus and Faith Taylor must take credit to sticking with me and bringing the entire national laboratory teams together. Issues were ironed out, and iterative improvement plans have been brought to fruition through the two-weekly paperless laboratory meetings. This has not just been the public labs, the private labs have been incredible and again, the camaraderie and nobody-left-behind attitude of the lab's digital and quality teams has been a joy to be involved in. They keep coming to the table with a “how do we make it work” attitude.
