In these times of budget constraints, smart management, tracking, and ordering of supplies and equipment are of paramount importance to labs of all sizes. It’s all about overseeing the waste and cost equations of supply usage in the laboratory. Controlling the costs of ownership and running of tests can be the difference between success and failure.
One lab manager shared with MLO a great example that she had discovered at the AACC conference this past August. She related how she was reminded that test cartridges used to run tests cost the same to use whether there are three test vials loaded in them or the maximum of 32 to 64. Those cartridges can cost hundreds of dollars, and the reimbursement rates are for single tests…so the potential problem is obvious. Labs will probably do well to gravitate toward vendors or testing options that offer flexibility on those cartridges, or otherwise offer useful solutions.
In fact, comparison shopping is a key to smart management. With that in mind, MLO decided to go right to the source(s) for this article; we asked representatives of several leading suppliers to laboratories to address the issue of utilization of supplies and equipment. Solutions that resonated with many companies included recommendations for lab professionals to take the time to analyze their labs workflow, look at waste management, and get involved in cost analysis and product choices.
MLO asked several questions to guide them, including:
- How does your company’s product help eliminate wasteful processes in its usage in the lab?
- What tips or procedures would educate users on using your product optimally and cost-effectively?
- Do you offer tools that help end users oversee the waste and cost equations of supply usage in the lab for the tests they run with your product?
- Do you offer information that would help optimize tests that reduce costs vs. reimbursement levels?
Here’s how they responded, in alphabetical order by supplier.
Eliminating wasteful practices:
The Anoxomat system offers a substantial cost-of-ownership savings when compared to gas chambers where a laboratory could be using 10 or 12 cylinders per year and requiring an expensive service contract. The ongoing costs for a single year could pay the entire purchase price of an Anoxomat system.
A comparison with the gas bag method is equally dramatic. Consider a typically busy laboratory in a large hospital utilizing gas bags for anaerobe isolation. This lab might use 15 bags per day, with associated indicator strips, deployed in standard glass jars. At $2.25 to $3.50 per bag and indicator, disposables cost anywhere from $33.75 to $52.50 per day, or $12,320 to $19,163 per year.
But when this laboratory switches to the Anoxomat system, a volume of 15 jars a day—with a low fill cost of only 14 cents per jar—that translates to using only six or seven gas cylinders per year. The approximate annual gas cost is less than $700. While with gas bag technology, there is a cost savings of at least $11,620 per year.
Tips/procedures for product use:
The Anoxomat offers a technology to replace consumable products, but we do recommend that all accessories pertaining to the system be maintained properly to extend life. For our jars it is recommended that the technicians clean them with the Halamid solutions, while the catalysts should be regenerated using a dry over for 90 minutes at 160 degrees C.
Tools that help users oversee waste and cost equations:
As we approach potential customers, we offer a ROI spreadsheet calculation, to show how the laboratory can cut cost and eliminate waste. The calculations are based on the laboratory’s daily and monthly number of samples processed for anaerobic and microaerophilic cultivation. We then compare the results to the current method used, consumable costs, and gas costs—monthly and yearly.
Other information offered to optimize tests:
Bacterial cultivation in a clinical setting is part of the required culture test needed by doctors. The reimbursement cost is very minimal, and it has never been an issue for clinicians. However, our customers are more interested in reducing operation costs in the laboratory and streamlining the work flow, by minimizing the steps needed to culture a sample. With Anoxomat’s technology, the system eliminates the risk of false negative results, and therefore minimizes the reprocessing of the sample and eliminates potential costs associated.
Eliminating wasteful practices:
Lean principles focus on the reduction of waste as a means to reduce costs and improve quality. With these principles in mind, the BioPlex 2200 System provides labs with full automation and random access processing to reduce waste in all its different forms—overproduction, waiting time, transportation, over-processing, overstock, excess motion, and scrap. The BioPlex assay methodology permits simultaneous detection and identification of multiple antibodies and/or antigens in a single reaction vessel from one small patient sample (5 µL). Its multiplex chemistry, disease focus test menu, integrated QC module, internal QC beads, track line connectivity capabilities, and ready-to-use reagents help laboratories streamline their workflow, consolidate platforms, and reduce sample errors and reagent waste, leading to Lean processes and decreased operational costs.
Tips/procedures for product use:
Labs seeking to consolidate multiple platforms that manually run or use several semi-automated systems to process traditional single analyte tests in batch mode are advised to transition this testing to their BioPlex System. This allows them to maximize their BioPlex System’s eight-hour walkaway testing capacity and dramatically improve their turnaround time (TAT) by more than 50 percent. To illustrate, a typical morning enzyme-linked immunoassay (EIA) batch test run (~90 minutes/run) could include instrument #1 testing 60 samples in two assays, instrument #2 testing 60 samples in five assays, and instrument #3 testing 10 samples in three assays, totaling ~1700 pre-analytical steps and TAT of 350 minutes. In comparison, testing all 130 samples in 10 different assays using the BioPlex System would require ~370 pre-analytical steps and TAT of 200 minutes.
Tools that help users oversee waste and cost equations:
Bio-Rad will assist the lab in completing a workflow analysis, providing a clear, objective, data-driven picture of the strengths and weaknesses of the lab’s current workflow. As previously discussed, huge wins in accuracy, efficiency, and quality can be identified while closely examining the pre-/post-sample processing steps, whereby the biggest drag on time and attention of the lab’s staff can be during the mundane tasks of tube preparation, including barcode verification, sorting, capping, de-capping, and sample logging. The previous example showed a decreased total number of pre-analytical steps or lab staff time, translating into an operational cost savings of ~80 percent (i.e., 370 touch points versus 1700) and improved TAT of ~60 percent (200 minutes versus 350 minutes).
Other information offered to optimize tests:
The BioPlex System software allows users to retrieve results for tests that were not previously ordered without having to redraw a patient/re-running a test. For example, by virtue of its multiplex chemistry, the BioPlex ANA Screen assay provides up to 12 results/samples. (All 12 results are available in the BioPlex System software for up to 30 days.) The user may receive a test order for one patient sample consisting of three of the 12 ANA Screen assays. One week later, the physician may want to see the remaining nine of 12 ANA Screen results for this same patient sample. In this case, the user is able to retrieve these nine results from the software with minimal labor and no additional operational cost.
Eliminating wasteful practices:
Helping labs stay efficient and productive is a primary focus at Ortho, and we take numerous steps to help our customers eliminate wasteful processes. Ortho’s VITROS Systems offer simplified calibration frequencies of six months or lot change for chemistry assays, which reflects the systems’ stability. Stable systems can help reduce error potential, improve labor utilization, and reduce costs.
Another way that Ortho helps eliminate waste is through a Lean analytical workflow. Ideally, 100 percent of sample tubes should generate reportable results without manual intervention. Getting the right result the first time is called First Pass Yield. Ortho’s VITROS chemistry systems feature a best-in-class First Pass Yield of 96.5 percent, which means greater productivity and fewer errors, which in turn minimizes reagent waste and optimizes labor.
System downtime and onsite troubleshooting represent a key opportunity for labs seeking to reduce waste. Ortho offers top-rated predictive diagnostic technologies through eConnectivity. Using a secure connection available globally, 24×7, between our Predictive Technologies Center and the analyzer, we offer proactive service and remote resolution, including remote control diagnostics. Predictive alerts and remote analyzer monitoring alert Ortho Care Support of potential problems before they happen.
Tips/procedures for product use:
Ortho’s reagents come ready to use and can be loaded while the system continues to produce patient results. Many of the MicroSlide chemistry assay cartridges come in two sizes to accommodate low and high testing volumes. They have on-board stability of up to 12 weeks for reagent packs, which allows maximum test efficiency even for low-volume assays. Loading reagents is easy, and most labs can replenish their systems with reagents just once per day. The disposable tips eliminate sample and reagent carryover, while reducing the number of liquid consumables, maintenance, and associated labor required with traditional probe-based systems.
Most systems available today offer sample indices checks that consume additional reagent and can slow throughput. Conversely, the VITROS x600 systems measure sample indices using technology which generates assay-specific flags for hemolysis, icterus, and turbidity. The MicroSensor technology does not require additional sample, reagent, or consumables, and results do not impact turnaround time.
Ortho’s VITROS reagents and consumables are standardized across the entire series of instruments and have the flexibility to be moved from one analyzer to another without wasted reagent. The systems utilize direct tube sampling and require minimal sample volumes as low as 2-10uL, with very low dead volumes of just 35uL. Low sample requirements mean less potential for redraws and delays in result reporting.
Tools that help users oversee waste and cost equations:
Ortho Plus Inventory Management powered by e-Connectivity is an easy-to-use order management tool. The tool assists the laboratory in optimizing its ordering patterns to reduce planned calibrations, while minimizing reagent waste and potential product shortages. The tool may help improve staff productivity by automatically monitoring and planning inventory based directly from the analyzer’s real-time reagent consumption. This gives labs the ability to monitor inventory levels quickly and efficiently across all sites, allowing for a more consistent monthly budget and spend.
Ortho incorporates reduction of waste every step of the way in the customer partnership journey. During the VITROS system customized implementation process, our teams of technical experts use a variety of tools to ensure the most efficient lab operation. Ortho Valumetrix Services Consultants optimize the lab design and system layout to help ensure Lean processes that minimize the eight wastes (transportation, storage, waiting, overproduction, inventory, motion, over-processing, and skill) that impact laboratories.
Other information offered to optimize tests:
Ortho’s global collaboration with Data Innovations connects laboratories with the data generated from their VITROS analyzers. Instrument Manager Solutions for VITROS (IMSV) contains the optional Laboratory Intelligence (Lab Intel) module that enables performance management through customizable dashboards with key performance metrics. Lab Intel provides a snapshot of laboratory operations that helps lab management focus on performance issues. By providing critical analytics and drill-down capability, it helps identify revenue and cost trends early and helps users isolate root causes simply.
Eliminating wasteful practices:
In the core chemistry lab, our preanalytic, analytic, and automation systems like the cobas 8100 automated workflow series are inherently designed to optimize efficiency and reduce hands-on time and the potential for errors. They also enable labs to consolidate multiple platforms into integrated, automated systems with broad test menus to streamline workflow and increase efficiency throughout the entire analytic process. We also offer the new cobas connection modules which, for the first time, allow health networks to connect chemistry and molecular testing platforms on an integrated system, further improving their overall process efficiency.
On the molecular side, our automated high-throughput cobas 6800 and 8800 systems are actually approved for CLIA moderately complex testing and have been designed to help reduce the tedium of manual process steps. For histology labs, our new automated VENTANA HE 600 system utilizes individual slide staining to eliminate reagent waste associated with traditional “bath” technology.
Tips/procedures for product use:
True lab efficiency and waste reduction involves more than the use of automation systems, and it can yield much more than productivity gains. For example, an analysis conducted with one of our customers showed that if they replaced an existing molecular testing platform with our new integrated and automated cobas 6800 system, they would not only eliminate 47 of 61 process steps—a 77 percent reduction—they would also eliminate 7 of 8 quality risk points—an 87 percent reduction.
That said, our goal in working with labs on waste reduction and quality improvement processes is to take a more holistic approach and assess their overall laboratory workflow. We have a lab process consulting team with LEAN-certified Six Sigma Black Belt consultants who troubleshoot and streamline processes and track down waste in several critical areas, including such things as waiting and transportation time. They then make recommendations based on the lab’s specific goals to reduce waste and optimize efficiency. About six months after a lab implements the recommendations, we conduct an audit and make any necessary adjustments to ensure peak operating efficiency.
Tools that help users oversee waste and cost equations:
As part of our lab workflow process analysis, Roche utilizes simulations and various analytic tools to envision the proposed process changes and the automation, reagent, and instrument utilization. During and after the implementation phase, the Roche Support Network works closely with lab staff and others to ensure best practices and eliminate both waste and wasteful processes. In addition, lab staff can access Roche Diagnostics University online 24/7 for continuing education on topics related to lab process optimization.
Other information offered to optimize tests:
With the shift in healthcare reimbursement structure from fee-for-service to pay-for-performance, labs are viewed through a lens that focuses on improved quality at a reduced cost. Using integrated and automated platforms and optimizing workflow can help labs reduce waste, minimize mundane, repetitive manual tasks, and enable highly trained personnel to focus their attention on more critical, value-added areas of need in the lab.
Eliminating wasteful practices:
Wasteful practices start with inefficient processes. Starting from lab design, we utilize Lean concepts (e.g., process mapping, value stream mapping, spaghetti mapping, Lean laboratory design, etc.) to simplify and eliminate wasteful practices. We offer total laboratory solutions that are designed to reduce redundancies, efficiently utilize resources, and cut waste. We take this approach from a holistic lab-management level down to specific system features.
Once a solution is implemented, we have powerful IT offerings, including Atellica PM 1.0 Software and syngo Lab Inventory Manager (sLIM), that give customers transparency on all system activities and consumable usage throughout multiple labs. These IT solutions give actionable analytics (alerts, remote instrument access, and test monitoring) that can be used to adjust workflow and monitor inventory in real time so customers can continually improve their resource utilization.
Tips/procedures for product use:
All the consumable usage can be monitored and controlled in real-time by sLIM, helping laboratories to carry optimal stock level without wasting reagent and consumables due to expiration. On board inventory of each instrument can also be monitored by Atellica PM 1.0 Software, helping users to utilize reagents and consumables in a cost-effective manner.
We offer different size reagent kits to provide labs the most suitable volumes for their testing needs. This optimizes spending on reagents and reduces the potential for expired stock as well. Concentrated reagents on our chemistry systems allow more tests from a single container, greatly reducing packaging waste.
Tools that help users oversee waste and cost equations:
Our analyzers are designed with advanced assay utilization analytics that go beyond traditional assay usage metrics. Our assay utilization analytics track the number of reagent aspirations used for patient samples, repeats, dilutions, controls, etc. They also provide statistics to monitor a laboratory’s usage and efficiency.
This information is cascaded to Atellica PM 1.0 Software for centralized, real-time data analytics reports across multiple instruments and labs, giving the customer the ability to spot trends and identify root causes of waste and inefficiency.
Inefficient management of inventory can result in inaccurate stock levels, leading to wastage of expired materials. sLIM tracks usage and proactively monitors and replenishes stock levels. sLIM can also save money by reducing the need for emergency shipments and send-out testing caused by reagent shortages.
Other information offered to optimize tests:
With our results-based workflow, we test only when needed, without wasteful unnecessary testing. CentraLink Data Management System registers the sample collection time, and the time the sample was loaded into the centrifuge. It can use these two data points to calculate whether the sample is still viable for a glucose determination, and, if not, it can automatically provide sample comment alerts or stop further testing. Patient result history can also be used in estradiol testing by running a current sample with a 1:5 dilution from the start if the previous result was higher than the analytical method range. SMART algorithms have hot zone capabilities that reduce the need for additional tests. SMART algorithms can be enhanced with automation and IT solutions so reactive samples can be re-tested after centrifugation without unnecessary manual steps.
Eliminating wasteful practices:
By design, the Sysmex XN-Series analyzers only perform tests that are requested per the barcode label and bidirectional interface. This reduces utilization of unnecessary reagents. In addition, the system requires lower sample volumes along with the corresponding decrease in reagent usage. Overall, this results in a low-volume waste stream from the analyzer. The unique analyzer spout kit systems ensure complete depletion of all volume contained and to avoid reagent waste.
Sysmex’s RU-20 reagent unit, in conjunction with lab grade water, allows the usage of concentrated diluent, CellPack DST. At a 1:25 concentration ratio compared to the non-concentrated CellPack DCL, the laboratory sees benefits in less reagent shipping, storage, and waste as well as overall reduction in interactions with the system.
The XN-Series reagent system is focused on enhanced convenience factors such as the size and ease of replacement, while maintaining maximum test utilization from each reagent. The reagent system mirrors both the practical nature and elegance in design of the XN analyzers. This reduces the frequency of replacement (25 times) by using the RU-20 and CELLPACK DST compared with CELLPACK DCL.
Alifax ESR analyzers are reagent-free. With an extremely small sample size, that is the only waste generated on the system outside of Quality Control material and a bleach and water solution used in daily maintenance.
Tips/procedures for product use:
The set-up of a system with a bidirectional interface ensures optimal use of reagents. There are flexible sizes of reagent containers which provide better inventory space usage and are equipped to provide ergonomic benefits for the user. In addition, Sysmex support teams provide technical consultations with each customer to review suggested on-board rules and settings and achieve optimization and greater efficiencies. This consultative approach ensures that each customer understands the manufacturer-recommended rules and settings so that the system performs optimally.
Tools that help users oversee waste and cost equations:
Sysmex offers a reagent calculator to help customers see the benefit of the RU-20. The tool can help customers realize how many cubitainers and how many pounds they are lifting for each box of diluent they are placing on a system. That number is then compared to the number of cubitainers and pounds they would lift if they implemented the RU-20 with the concentrated CellPack DST. At a 1:25 ratio, the savings are remarkable.
Other information offered to optimize tests:
Sysmex’s advanced clinical parameters such as RET-He guide laboratories to optimize their test offering that impact overall cost. The RET-He is included in key guidelines that drive the national and global anemia management of kidney disease. These guiding principles include Kidney Disease Outcome Quality Initiative Guidelines (KDOQI) published in 2006; Kidney Disease: Improving Global Outcomes Guidelines (KDIGO) published in 2012; and most recently NICE (National Institute for Health and Care Excellence) 2015 recommendations.
The use of RET-He in challenging patients is extremely helpful because it can alert practitioners to the presence of iron deficiency anemia when traditional tests are inconclusive. It can also help assess the effectiveness of treatment earlier than traditional parameters. RET-He has been applied to meet quality initiatives such as reduction in hospital readmissions.
Eliminating wasteful practices:
Thermo Fisher Scientific’s laboratory equipment business has been focused on developing not only innovative but also sustainable solutions. The Thermo Scientific TSX Series refrigerators, freezers, and ultra-low temperature freezers have achieved the U.S. Environmental Protection Agency’s Significant New Alternatives Policy (SNAP) compliance for sustainability objectives in energy consumption using adaptive V-drive technology, which greatly reduces energy consumption for cold storage and offers tight temperature uniformity and whisper-quiet operation.
Our energy efficient 1300 Series, Type A2 Class II Biological Safety Cabinets reduce energy consumption by up to two-thirds compared to competitive technologies. Proprietary airflow design and efficient DC motors provide both energy savings and extended filter life, reducing carbon footprint by up to 1.7 tons of CO2 per year.
Large capacity and floor model centrifuges are used continuously in many laboratories. Our blood banking and bioprocessing large capacity centrifuges have many features that reduce energy consumption including our Eco-Spin windshielded rotors that can achieve up to 64 percent energy savings versus non-windshielded rotors. The efficient cooling system uses an environmentally friendly non-CFC refrigerant and has an automatic cooling program that is shut down when not in use. Smart Vacuum technology available on the Thermo Scientific Sorvall LYNX 6000 removes up to 80 percent of the air in the chamber, reducing friction on the rotor and thus the energy required to spin by up to 74 percent versus previous
generation centrifuges.
Our Thermo Scientific Heratherm refrigerated incubators also provide energy savings and reduce CO2 footprint. Putting a combination of these solutions in place in a given laboratory can greatly decrease energy consumption and carbon footprint.
Tips/procedures for product use:
Laboratory equipment is often running 24 hours a day, but taking advantage of certain features can optimize processes and reduce cost. For example, the Sorvall LYNX superspeed floor model centrifuges have a Green Mode that enables the instrument to go into sleep mode when not in use for more than two hours.
Using the flexible timer functions and programs to run a Heratherm refrigerated incubator just when needed can provide significant energy savings.
Most biological material does not have to be stored at -80°C. Raising your freezer cabinet temperature by just 10°C can lead to significant energy savings that can have a huge impact on both energy consumption and environmental footprint.
The increased capacity of our floor model centrifuges enables three units to separate the same amount of samples as four legacy units, reducing not only the number of instruments needed, but also improving the ergonomics and throughput as well as overall power consumption.
Tools that help users oversee waste and cost equations:
We help our customers understand the energy and waste savings of various options for laboratory products. The breadth of our offering enables us to take a holistic approach to working with customers to understand their goals and how best to achieve them, taking into account the scientific objective, the product with the right features and most efficient solution. We seek to expand the discussion to the application or the scientific discipline level, beyond just product-by-product, to work in partnership with our customers to understand how the ever-advancing cutting-edge of technology enables discovery to become faster, easier, and more efficient.
Other information offered to optimize tests:
For cost reduction and reimbursement levels—a particular concern for clinical laboratories—Thermo Fisher Scientific helps health system leaders and clinical laboratory professionals achieve their goals with a consultative, comprehensive approach that includes a dedicated point of contact; streamlined, effective workflows; maximized capacity and throughput; cost optimization; quality and regulatory support; and waste disposal reduction.
