The role of total laboratory automation in a consolidated laboratory network.

BACKGROUND: In an effort to reduce overall laboratory costs and improve overall laboratory efficiencies at all of its network hospitals, the North Shore-Long Island Health System recently established a Consolidated Laboratory Network with a Core Laboratory at its center. METHODS: We established and implemented a centralized Core Laboratory designed around the Roche/Hitachi CLAS Total Laboratory Automation system to perform the general and esoteric laboratory testing throughout the system in a timely and cost-effective fashion. All remaining STAT testing will be performed within the Rapid Response Laboratories (RRLs) at each of the system's hospitals. RESULTS: Results for this laboratory consolidation and implementation effort demonstrated a decrease in labor costs and improved turnaround time (TAT) at the core laboratory. Anticipated system savings are approximately $2.7 million. TATs averaged 1.3 h within the Core Laboratory and less than 30 min in the RRLs. CONCLUSIONS: When properly implemented, automation systems can reduce overall laboratory expenses, enhance patient services, and address the overall concerns facing the laboratory today: job satisfaction, decreased length of stay, and safety. The financial savings realized are primarily a result of labor reductions.

Planning and implementing total laboratory automation at the North Shore-Long Island Jewish Health System Laboratories.

Lab automation and consolidation can be a daunting, risky, major reengineering project. Done right, it can mean decreased labor costs and space requirements, increased test volume, and more efficient use of personnel. See how this health system got the job done using a carefully defined, seven-step plan.

Caught in the Web. Combating work stress in the information age.

The computer, the fax, the cell phone, the pager--all the trappings of the information age--cause much stress in the workplace. Mastering these gadgets--knowing how and when to use them and dealing with the barrage of messages generated by them--is essential to maintaining workplace sanity.

Nutrition and cancer.

Diet can play a key role in the pathogenesis of cancer. Diets high in fat and low in fiber predispose individuals to colon cancer. A high-fat diet is also implicated in breast cancer and prostate cancer. The dietary fat-cancer linkage is supported by epidemiological evidence, animal studies, and prospective trials. The antioxidants vitamin E, ascorbic acid, and beta-carotene have a protective effect and act as antipromoters of carcinogenesis. A diet of less than or equal to 10% of calories from fat and less than or equal to 40 g of fiber daily that includes fruits and vegetables will prevent up to 35% of cancers.

A multicenter evaluation of lipid profiling with a compact analyzer (Miles Clinistat).

We evaluated the Clinistat Analyzer (Miles Inc., Diagnostics Division, Elkhart, IN) for measuring cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol at three medical centers. The system, based on multilayer film technology, uses precalibrated, dry film reagent disks. Ten microliters of serum is applied to the dry film reagent disk in the test procedure. For HDL-cholesterol measurement, serum is pretreated by precipitation with phosphotungstic acid and magnesium chloride. Total precision (CVs) of each of the three assays was less than or equal to 5%. The assay ranges were linear and satisfactory for clinical use. Patients' results compared well with established methods. No significant interferences were found with hemolysis, icterus, and lipemia.

Colorimetric determination of potassium in plasma and serum by reflectance photometry with a dry-chemistry reagent.

We evaluated a colorimetric assay of potassium in plasma and serum with the Boehringer Mannheim Reflotron reflectance photometric analyzer, which is designed for near-patient testing in hospitals and physicians' offices. This potassium method does not require calibration or instrument maintenance by the operator. Analysis of 30 microL of plasma or serum takes approximately 140 s. Within-day imprecision (CV) was 1.0-1.2%. Total CVs over a 1-month period were 1.0-1.4%. Patients' results from the Reflotron correlated well with those from the IL 643 flame photometer and the Beckman Synchron CX3 ion-selective electrode methods. The accuracy of Reflotron values was also verified with Standard Reference Material 956 from the National Institute of Standards and Technology.

Direct measurement of high-density lipoprotein cholesterol by the reflotron assay with no manual precipitation step.

We evaluated the quantification of high-density lipoprotein (HDL) cholesterol in plasma with the Boehringer Mannheim Reflotron reflectance photometric analyzer. The Reflotron is designed for testing in small to medium-size laboratories and physicians' offices. This HDL method does not require a manual precipitation step because the reagent tab contains dextran sulfate (Mr 50,000) and magnesium acetate. It takes 90 s to complete an analysis of 30 microL of plasma. Within-day standard deviations (SDs) were 0.02-0.04 mmol/L (6-16 mg/L). Total SDs over a three-month period were 0.03-0.06 mmol/L (11-23 mg/L). The Reflotron values averaged 0.02 mmol/L (6 mg/L) or 1.3% lower than the Hitachi 737 values; the standard error of the estimate (Sy.x) was 0.07 mmol/L (29 mg/L).

A review of the analytic performance of the Reflotron System for cholesterol testing.

The analytic performance of the Reflotron System for cholesterol testing has been assessed in 17 studies since 1987. The precision of the test (total coefficient of variation) ranged from 0.8% to 9.9% and was between 1% and 5% in 23 of the 27 specimen types tested. The correlation coefficient of the Reflotron with that of a reference methods was over .9 in 15 specimen types tested and over .95 in ten of 15. The type of specimen tested and the training of the test personnel affected both precision and accuracy. It is concluded that the Reflotron analyzer provides reliable and accurate cholesterol measurements.