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User experiences

University Hospital, Germany

The University Hospital in the west of Germany has a patient load of approximately 50,000 a year. In addition to the many different clinics and centres, there is also an approved paediatric hospital.

Urinalysis is a common investigation here, with special cases of paediatric urine samples. These patients have a previous medical history of various renal disorders, as a result of which there are many positive samples in the daily routine.

The requirements for comprehensive urinalysis include manual microscopy of native urine in a counting chamber following dry chemistry analysis with a test strip reader. Since we have patients with a previous medical history almost exclusively, we have to perform microscopy on almost every sample. Performing urinalysis according to this traditional workflow demands a lot of staff and time. In the counting chamber we examine native urine without previous centrifugation. This makes it difficult to detect small numbers of particles. There is also a lack of standardisation because of the technicians’ individual skills and personal experience. A standardised quality level of lab results, however, is very important for the work of the treating physicians, especially in our casualty department during the night shift.

The UF-1000i is a high-end instrument that helps us to perform urinalysis more effectively. We decreased the number of staff involved in urinalysis while increasing the quantity and quality of the results. Since the results are clearly displayed, lab staff can decide quickly and easily how to proceed further with the individual samples.

Because of the small urine volumes of the paediatric samples we use the UF-1000i in manual mode as the instrument requires only 1mL of urine in this mode. Because quality control is performed by the technicians in the same mode, operation is really standardised, which makes work even easier. For quality control, two clinically practical levels of control material are used, offering us an adequate degree of safety. Using urine flow cytometry enables us to provide urinalysis results at any time on a high quality level, and increase the throughput compared to the manual procedure.

The cross-check function of the sis-u software means there is additional standardisation. This software automatically compares the results from the test strip reader and the UF-1000i. It also creates work lists.

University hospital, 500 specimens/day

Ours is a university hospital with around 1,000 beds and some 3,000 outpatients per day. We provide healthcare based on the philosophy “We use and improve advanced healthcare and provide the proper healthcare to each patient”. In other words, we try to improve the quality of our work for the benefit of every patient day by day.

Urinalysis is very valuable, in most cases, it is not painful for patients and provides a great deal of information on the status of the kidneys and the urinary tract. Especially in case of non-specific symptoms, it can deliver hints of possible health issues in the urogenital tract and trigger further differential testing. Urinary sediment counting by microscopy is a technique that demands a lot of knowledge from laboratory technicians. Experience is crucial for proper classification of particles, particularly in pathological samples as this can be crucial for clinicians who have to decide on next steps. For this reason, laboratory technicians need to maintain and continuously expand their skill and knowledge.

One of the problems in the lab was that checking the urine samples by microscope took more time than was available, so that the technicians were overloaded with work. As a consequence, there was little time and particularly the pathological samples, which require more time for accurate classification of sediment particles, could not be dealt with at a high quality as there was not enough time available. The quality of testing was not standardised in this work area either.

Since we get approx. 500 urinary specimens a day, we’ve been trying to improve our workflow efficiently to deal with these many specimens and to keep the quality of data high all the same. We test a specimen initially with a urinary test strip reader, and then report the results of negative specimens first to shorten their turn-around time. However, in the past we still had to spend more time and dedicate more staff to urinary sediment counting when many specimens were judged positive by urine test strip analysis. And we needed to look for a new technician to be trained whenever a technician in our laboratory retired or quit the job.

The opportunity to evaluate the UF-1000i improved our urinalysis procedure dramatically. Urinary sediment took three technicians to count and report before we used UF-1000i. Now just one technician conducts all urinary sediments, even though there are many specimens. And - new flagging rules have reduced the microscopy review rate to less than 20% in daily routine. The UF-1000i not only shortens turn-around times but also lets us finish our work faster than before. We gain a significant amount of time in performing the complete urine testing, and the pathological samples get the concentrated attention of our experienced technicians. Our urinalysis procedure is now standardised with the new workflow and manuals. I’m convinced our urinalysis will improve further thanks to our efforts and the UFC technology.

Lab with 20,000 samples/day

As the core lab within an association, this private lab in the west of Germany receives about 20,000 samples per day from medical service centres, national health services and hospitals. Some 13,000 of these need basic diagnostics are requested, which is completed after five to six hours.

Thanks to modern equipment, our lab copes with our daily high sample workload, and we analyse around 400 to 600 urine samples every day. We opted for the Sysmex UF-1000i and the work area management system sis-u so that we could process each sample with comparable quality. This was an important decision factor for us since over 30 medical technicians are appointed to the urinalysis workplace on a rotation basis. We wanted to standardise the urine samples’ analysis, as well as the technical validation process.

We managed to simplify the process for everybody thanks to the rules implemented in sis-u, which are also responsible for steering samples, i.e. those samples that can be validated after test strip analysis or which need additional particle counting by the UF-1000i. Our association definitely needs a standard operating procedure – we need each technician to follow the same analysis and technical validation procedure so that we can assure the same diagnostic quality for each sample. With the analysis standardisation enabled by the UF-1000i and the post analytics by the sis-u, we decided to also standardise the pre-analytics as much as possible. We rearranged the transport times for urine samples so that fresher urine samples arrive at our lab. As a result, we decreased the microscopy review rate for all urine samples to about 5%.

Academic teaching hospital

As a laboratory within an academic teaching hospital with 600 beds, our diagnostic testing strategy must address the range of test orders obtained from 16 specialties as well as external samples. The laboratory service is guaranteed day and night to enable prompt laboratory diagnostics for about 13,000 surgeries per year, of which 3,000 are outpatients. With the DRG-based reimbursement system the duration of hospital stays has become shorter and the number of ambulatory treatments has increased. Both trends heighten the existing demand for fast and comprehensive laboratory testing procedures that enable timely use of results to support clinically relevant decisions. To ensure results are available quickly, the laboratory service
provides in-house testing for a very wide range of tests.

Our lab receives a manageable number of about 40 urine samples per day. But some 50% of them come with the order to clarify whether the patient has a urinary tract infection. Not long ago these samples went directly to the microbiology workplace to be cultured on culture media and to get an antibiogram. This meant that, for the majority of samples, complete microbiology data were available after 24 hours at the earliest. The other urine samples were examined with a test strip reader, and then the sediment was viewed under the microscope.

We were interested in the Sysmex UF-500i because it offered fast screening as part of the microbiology urine testing approach. Two aspects were particularly interesting: being able to deselect the samples without an indication of a urinary tract infection within minutes, particularly with regard to those patients not needing to take any broad spectrum antibiotics, and being able to reassure clinicians in excluding urinary tract infections in certain cases. With the recent implementation of the UF-500i in our routine, we simply place the samples with suspected urinary tract infection onto the UF-500i and only culture those urines marked by the special “UTI flag”, which indicates positive findings for UTI. Around 40–50% of the samples received are UTI flag positive. The ones without a flag are immediately reported as negative to the wards or clinicians.

The specimens obtained for test strip testing and sediment microscopy are also analysed on the UF-500i after undergoing test strip readings. This has helped cut down the review rate and limit microscopy to specimens that show serious abnormalities. The decreased review rate was critical as it was important for us to speed up the diagnostic exclusion of urinary tract infections and benefit from the related cost savings. Ewe also wanted to introduce a higher level of quality and standardisation to our lab. The consolidation of the urinalysis work areas in microbiology and sediment microscopy has led to a new standardised workplace for all urine samples where analytics are performed with a higher quality and reporting of results for negative findings has been considerably accelerated.

Fig.1: Streamlined workflow with UF-series

Microbiology lab

Our microbiology laboratory has to process about 36,000 urine samples per year. Due to the merging of our hospital with other ones the number of urine specimens in our laboratory is increasing. Financial restrictions and limited staff numbers, but also the need of a faster turn-around time has led us to consider the uf-1000i as a possibility to cut down on manual procedures at the urinalysis workplace.

On the face of it, manual microscopy as a first step in the analysis procedure to separate negative samples from positive ones seems to be a cheap test. But if we allow for the cost of staff time needed either to perform microscopy for the detection of bacteria and leucocytes or to check Gram-stained urines, then the cost situation is completely different. After having evaluated the uf-1000i we could see that we can replace the traditional time-consuming microscopy check and report negative samples faster than ever before. This enables us to alert the treating clinicians as early as possible so that they may be able to avoid some of the unnecessary prescribing of broad-spectrum antibiotics, one of the reasons for the alarming increase in resistances of pathogenic agents to these drugs. The uf-1000i has proven to be a suitable initial screening system which can process samples within much shorter time than the manual methods were able to at this
workplace before.

Noteworthy is the fast acceptance of the uf-1000i from the technicians’ side. The instrument was received by them very well since it is very easy to use due to its generally intelligible and very user-friendly interactive interface.

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