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From sample receipt to reporting:

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:

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  1. From sample receipt to reporting: Whole process adaptations for an increasing workload Gilly Flavell and Katherine Yates Molecular Genetics laboratory, Cambridge University Hospital

  2. 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.

  3. 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)

  4. Number of samples received

  5. 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.

  6. 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.

  7. Process time (TAT booking in to PCR)

  8. 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.

  9. 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.

  10. 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.

  11. 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)

  12. Overall TATs

  13. 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.

  14. 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.

  15. Thank you for listening!

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