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From sample receipt to reporting:. Whole process adaptations for an increasing workload. Gilly Flavell and Katherine Yates Molecular Genetics laboratory, Cambridge University Hospital. Background.
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From sample receipt to reporting: Whole process adaptations for an increasing workload Gilly Flavell and Katherine Yates Molecular Genetics laboratory, Cambridge University Hospital
Background • In February this year the laboratory workload increased by over 30% when the Molecular Haemostasis dept merged with Molecular Genetics. • Several members of staff including scientists and band 5 technologists moved on from the department and were not replaced. • It became apparent that the staff organisation of working as two separate teams (fragment tests, and high and low throughput sequencing) for testing and analysis/reporting would become unsustainable once annual leave and sickness was factored in. • A closer working relationship between Cytogenetics and Molecular Genetics was also needed. • Thus a radical overhaul of the entire testing, analysing and reporting process was required. This began in May.
Staff organisation prior to May 2010 Sample reception – all samples (band 3-5) Sample extraction – all samples (band 3-5) SEQUENCING TEAM FRAGMENT TEAM High/low throughput sequencing (band 5/6) Fragment testing (band 5) Fragment analysis and reporting (band 6/7) Sequencing analysis and reporting (band 6/7) Checking – data (band 7 state registered) - report (band 7 MRCPath/band 8)
Booking in and Extraction • Four new band 3 technologists were employed and trained to manage sample reception and extraction, allowing band 5 technologists to focus on testing. • An average of 45 whole bloods, 5-10 DNAs and a small number of Guthrie spots and/or Buffy coats arrive every day to be booked in, extracted and stored. • An extended working day with an even spread of staff working 8.30am-4.30pm and 9.30am-5.30pm on a rotation system enabled more samples to be received and efficiently processed to testing stage each day.
Booking in and Extraction cont… • Gentra (our automated DNA extractor) is now used for more runs per day (4 x 16 bloods) due to the introduction of the extended working day. • To reduce and maintain processing time from arrival to being ‘PCR ready,’ combined heater-shakers were purchased to re-hydrate extracted DNA quickly and efficiently improving the accuracy of nano-dropping. • Accurate concentrations are vital in reducing test failure which in turn reduces costs.
Referrals and Testing • All scientists now rotate between referrals, analysis and reporting for all tests carried out by the laboratory. • The referral scientist produces worksheets for patients that are due to be tested, and places them in order of urgency in a ‘days of the week’ tray system. • Technologists from the previously separate teams are now in the process of being trained so that all can carry out high throughput and low throughput tests, with band 3 technologists trained to carry out simpler PCR setup.
Testing cont… • Technologists rotate between Pre and Post PCR robotics (for the high throughput sequencing), and complex and simple PCR setup (in accordance with their band/training) collecting work from the trays. • The lab has also begun increasing its testing repertoire by developing new tests and bringing tests back in house that traditionally were send outs to other laboratories.
Analysis and Reporting • All scientists now analyse and report both low and high throughput data. • Training has begun so that band 5 technologists can analyse and report simple tests. • The SAMS (Semi-automated mutation surveyor) programme has increased productivity speeding up mutation detection for BRCA, PGRN, TAU etc. • Reporting times have improved because of these changes despite the increased workload.
Staff organisation post May 2010 (a work in progress!) Sample reception and extraction – all samples (band 3 team) (Joint reception with Cytogenetics by December 2010) Fragment tests and low throughput sequencing. Simple tests (Band 3-5), Complex tests (Band 4/5) High throughput sequencing (robotics) Pre and Post PCR setup (Band 4-6) Lab team rotates daily between duties Analysis (Band 5-7) and Reporting (Band 5-7) of all data Checking – data (band 7reg) - report (band 7mrcpath/band 8)
Summary • Creation of a strong band 3 technologist team to handle an increased workload and improve the efficiency of sample processing. • Separation of tests by complexity instead of style/disease to enable training to be focused on banding/ability and promotion of team flexibility. • Increasing staff familiarity with a greater breadth of tests and disorders. • Creation of a referrals role to enable the smooth flow of samples between arrival, processing and testing. • A merge of the office based scientists to ensure all work is analysed and reported on the basis of urgency. • These changes have improved efficiency and increased productivity. Turnaround times are now better than before the merge of departments.
The Future • Continued focus on training and registration so that eventually band 5 technologists become multi-disciplinary and can test, analyse and report, promoting flexibility between laboratory and office based staff. • Improvements in the ranges of our service as we increase our testing repertoire and efficiency. • The future merge of other departments including tissue typing will create new challenges that the team are now better equipped to handle.
