Problems and solutions Stuart Matthews Laboratory Manager Department of Medical Microbiology Salisbury District Hospital

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

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

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

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

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

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

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

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

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)

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

So what does it look like? The system is configured to suit the individual requirements of each laboratory Some examples of this are:

General view showing tracking and stackers

Tracking system and workstations

Plate sorters

Bench height can be adjusted to individual needs

Workbench showing display screen

Laboratory view showing work stations

Printing barcodes onto plates

Plates entering the incubator

Plates are moved within the incubator on the tracks

Scanning images of plates

Discard door, track, and discard bin

The plan for the Salisbury laboratory