Lab Technology Boosts Speed, Accuracy and Patient Safety

UCLA Medical Center's Clinical Laboratory performs thousands of tests each day — more than 5 million each year — collecting specimens from throughout the medical center and processing each one according to physicians' orders. Compound this huge volume with the pressure to return results quickly so physicians can make patient care decisions, results in tens of thousands of opportunities each day for something to go wrong.

"I can't tell you the number of errors that could potentially be made with a manual system," says David Bruckner, Sc.D., chief operating officer of Clinical Laboratories. To prevent such errors, the Clinical Laboratory has put in place procedures and technology to improve speed and accuracy and to enhance patient safety.

UCLA Medical Center phlebotomists dispatched to draw blood carry handheld devices called PDTs (patient data terminals) that communicate with the laboratory information system to streamline specimen collection and ensure that both patient and specimen identification are correct. When the phlebotomist arrives at a patient's bedside, the PDT scans the barcode on the patient's ID bracelet, identifying the patient and listing the tests that should be drawn. The phlebotomist then scans a barcode on the specimen tube to cross-check that the correct type of specimen is being taken. The phlebotomist uses a portable printer to create a label for the specimen before sending it to the lab, in most cases through the hospital's pneumatic tube system.

"Phlebotomists used to arrive at the patient room with a pre-printed label for the test they had been set for," explains hospital lab technician Nadine Neri, "but that didn't tell them what other orders might be pending for that patient. The PDTs show all tests within a six-hour window and allows phlebotomists to consolidate their work."

Once specimen tubes arrive in the laboratory, automated equipment processes them quickly and accurately. The front-end processor receives specimens into the lab and tracks them. The processor consists of multiple stations that can perform a number of operations. Each station has a scanner that reads the specimen label and, with an interface to the laboratory information system, provides information about what tests are needed.

The front-end system can centrifuge a specimen, measure the serum level to determine if there is enough in the tube, divide the specimen into separate tubes when multiple tests are needed and label all the secondary tubes. Each module has an error alarm light to notify an operator when intervention is needed. Hospital lab technician Mario Torrico praises the system's more precise processing of samples. "Our error rate for alloquots has gone down dramatically," he says.

"The whole process has smoothed out our operation. On a test that might have taken us about six hours before, we're now down to two to three hours from the time the order is placed until results are reported for most of our high-throughput instruments," explains Dr. Bruckner. The new procedures will be implemented at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in the future.