Bacteriology ~ The New Paradigm

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Bacteriology - The Future
Problems and solutions Stuart Matthews Laboratory
Manager Department of Medical
Microbiology Salisbury District Hospital
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Bacteriology - The Future

• Service Requirements
• To provide a 24 hour 7 day service
• To remain within budget
• To conform to CPA standards
• To reduce overtime costs
• To recruit and retain quality staff
• To maximise the efficient and effective use of
  staff and resources
• To increase the quality of life of existing staff

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Bacteriology - The Future

• The Problems
• Insufficient qualified staff
• Rising workload
• Increased overtime costs
• Recruitment problems
• Late arrival of specimens
• Vacancies increase pressure on existing staff
• Requirement to cover for absences of medical
  staff
• Danger of increase in stress related sickness

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Bacteriology - The Future

• The Problems
• Quality of work going down
• Internal quality control being performed
  intermittently
• Non-essential work not being done
• Danger of losing CPA accreditation
• Increased use of locum staff (42644, 03 to
  date)
• Only four qualified staff to cover out of hours
  service
• Requirement to do overtime every night

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Bacteriology - The Future
Solutions 1. Increase the staff establishment
to cope with the work 2. Move all
bacteriological processing to a
nearby hospital laboratory 3. Invest in total
laboratory automation
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Bacteriology - The Future

• Solution 1 Increase establishment
• Would need to increase our staffing levels by
  4.6 wte (2 BMS 1 and 2.6 MLA) just to cope with
  current workload
• These figures are based on average staff
  establishment in European laboratories
• This assumes we could recruit qualified staff
  given the national shortage
• This would greatly increase our budgetary
  requirements
• We do not favour this approach

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Bacteriology - The Future

• Solution 2 Sub-contract
• Can another laboratory cope with our workload?
• Cost of couriers?
• Requirement for a hot-lab?
• Transport delays
• Delivery of results back to requestors
• Effects on service delivery
• Where would the medical staff be based?
• Loss of staff here and recruitment problems at
  contracting laboratory

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Bacteriology - The Future

• Solution 3
• Automation - The Paradigm Shift !!!
• Senior staff believe this to be the future of
  bacteriological processing
• Allows more efficient use of scarce resources
  (staff)
• Allows current staff to cope with workload
• Raises the quality of life of staff
• Lessens the need to increase establishment
• Eliminates the requirement for overtime to deal
  with the current workload

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Bacteriology - The Future

• Solution 3
• Automation - The Paradigm Shift !!!
• The Kiestra approach
• A truly new approach to bacteriological
  processing
• Kiestra works in partnership with the laboratory
• System being constantly developed
• System flexible to reflect workload
• No extra space required

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Bacteriology - The Future

• Solution 3
• Automation - The Paradigm Shift !!!
• Will complement other automation such as the
  blood culture urine analyser
• Full audit trail to comply with CPA
• Can be interfaced with our LIMS (Telepath)

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Bacteriology - The Future

• What can Kiestra offer us?
• A way to cope with increased demand during a time
  of skills and financial shortage
• A more efficient use of scarce staff resource
• Selection, labelling and presentation of plates
  to staff ready for inoculation
• Selection of plates post incubation for further
  work or discard
• Photographic record of each plate presented to
  the BMS for interpretation or you can work from
  the plates
• A full audit trail

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Bacteriology - The Future
So what does it look like? The system is
configured to suit the individual requirements of
each laboratory Some examples of this are
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Bacteriology - The Future
General view showing tracking and stackers
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Bacteriology - The Future
Tracking system and workstations
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Bacteriology - The Future
Plate sorters
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Bacteriology - The Future
Bench height can be adjusted to individual needs
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Bacteriology - The Future
Workbench showing display screen
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Bacteriology - The Future
Laboratory view showing work stations
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Bacteriology - The Future
Printing barcodes onto plates
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Bacteriology - The Future
Plates entering the incubator
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Bacteriology - The Future
Plates are moved within the incubator on the
tracks
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Bacteriology - The Future
Scanning images of plates
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Bacteriology - The Future
Discard door, track, and discard bin
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Bacteriology - The Future
The plan for the Salisbury laboratory
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Bacteriology - The Future