The 2015 NZIMLS North Island Seminar was held in sunny Rotorua on Saturday 9th May. With fourteen, highly informative topics presented, my head was buzzing on the journey back to Auckland that evening. The flow of tweets #NZIMLS from @SysmexNZ provide the evidence! Being a multi-disciplinary lab science seminar, the presentations were across all aspects of the laboratory – I took away four key themes from the content:
Murray Robinson opened the seminar presenting Pathology Associates “Path to Microbiology Automation”. The audience was wowed with a fascinating video of the Kiestra automation system that will be installed at Pathology Associates new lab in Tauranga. His presentation described the drivers for change in the laboratory – aging population, increased life expectancy, aging workforce, fiscal limitations, increased service demand (more for less). He also discussed the innovations that will enable this change –transport and logistics, IT systems, digital imaging, and robotics. Over the past decade, the evolution of liquid specimen systems and the emergence of new diagnostic techniques such as automated urinalysis, MALDI-TOF, chromogenic culture, molecular diagnostics and blood culture instruments have changed the way scientists work in the micro lab. Traditionally the micro lab was very paper-based. Murray described that through systems like Delphic LIS and Delphic Micro (middleware for the micro lab) and interfaces to the micro instrumentation, there has been a positive change in the lab workflow. A paperless environment is now possible, as it has been in other departments like Biochemistry and Haematology for many years. Automation is a big change and fear for some Microbiology staff, but Murray assured the delegates that automation will take away the boring bits, creating more time for the science and clinical interpretation. Automation will improve quality, safety and precision. Ajesh Joseph, from Waikato DHB specimen services shared their lab service’s vision to complete the electronic loop. The ability for clinicians to place and view orders, and signoff results on a mobile device were presented as part of the future plans for Waikato DHB lab services. The presentation emphasized the known benefits of CPOE:
It was interesting to hear that Waikato DHB is looking to align with the National Health IT Board eLabs and eRads plan; a model that is already being rolled out across labs and healthcare organisations in NZ. A presentation from Mel Olds an embryologist at Wellington’s Fertility Associates laboratory recapped the importance of endocrinology lab tests for monitoring of fertility patients and described newer lab testing options such as pre-implant genetic diagnosis. Amazing videos showed the intricacy of the IVF techniques and time lapse photography of embryo development. Mel’s presentation also took out the “Best Presentation Award” for the seminar.
The seminar included topics describing process improvements that ensure safer, quality systems, such as Lakes DHB’s recent implementation of a new Massive Transfusion Protocol (MTP). Raewyn Cameron, from Lab Services Rotorua shared their experience implementing the new system, the introduction of Tranexamic acid which reduces the risk of fibrinolysis, minimising haemorrhage, and the benefits of reduced coagulopathy in patients – “Request, Deliver, Transfuse”. Middlemore Hospital’s Dr David Holland, an expert in infectious diseases, presented the Ebola response procedures that have been established at the hospital including the laboratory testing requirements. It is certainly reassuring to know that New Zealand MOH has ensured the right teams and facilities are prepared in the rare event that the Ebola virus presents in NZ.
The patient is central to all we do in healthcare. Four excellent speakers educated the audience on the importance of always considering the patient in all aspects of lab work. Fale Tomu from LabPlus, Auckland DHB works in Tissue Management Services. She described the detailed system and considerable care the service takes in managing the return of tissue and body parts to patients and ensuring patient’s rights are respected at all times. On a similar topic, Waereti Paraki, who works as a Mortuary Technician at Lakes DHB Mortuary department, shared the many cultural aspects of why this is so important to those that work in medical practice and related disciplines, especially the laboratory. Ailsa Bunker manages Middlemore Hospital’s Specimen Collection Service. She stated that from the patient’s perspective the phlebotomist is ‘the face of the laboratory.’ So true! When working as a medical lab scientist and describing what you do for a job to someone, their immediate reaction is that you are the people that take their blood. While we know the picture is much bigger than that, the patient’s view of the lab is the phlebotomist. Therefore as well as possessing great phlebotomy skills, the staff must possess exceptional communication skills and a genuine care and understanding of the patient. Ailsa talked about using patient experiences to co-design better health and patient care services and, more importantly, that customer service is not a department – but everyone’s job. Mary Southee, Technical Head of Phlebotomy at Capital and Coast DHB presented a review of the new phlebotomy systems they have introduced at Wellington Hospital. She described the advances in specimen collection devices, and how they prevent needle-stick injuries from occurring. No one likes to have blood drawn and it can be a particularly daunting experience for children. Mary was able to share feedback received from patients that with the introduction of these devices they have been able to provide a greatly improved patient experience.
This is what it is all about! As a medical scientist, the complexity of what goes on behind the doors of the laboratory is always fascinating. It was great to be reminded how significant the laboratory is in the contribution to medicine and ultimately patient care. The range of patient cases that were presented highlighted the importance and value of the lab in patient diagnosis. The information should not be siloed within a particular lab or clinical discipline. All aspects of laboratory diagnostics, pathology, radiology and medications should be considered to ensure a whole of patient approach.
Karin Norman, the Clinical Nurse Manager for the Rotorua Satellite Renal Unit Renal has diverse experience in managing complex patient cases with Chronic Kidney Disease (CKD) and other co-morbidities. Karin highlighted the importance of renal pathology results in guiding the adequacy of treatment regimes and response to treatment in CKD patients. Healthcare providers need immediate access to all the information regardless of which laboratory performed the test. Laboratory tests are always ordered for a reason, and it is the responsibility of the clinical team to ensure these tests are always reviewed and followed up.
Therese Chikunda, a multi-disciplinary scientist from Te Kuiti Hospital described a patient case study and the lab’s role in determining the diagnosis of- autoimmune hepatitis. Barbara Hoy, Waikato DHB, demonstrated the use of multi pathology to aid in the diagnosis of rEPO (recombinant erythropoietin) resistance, causing pure red cell aplasia – a rare adverse effect in treatment of CKD patients.
A case of Noonan Syndrome in newborn twins was presented by Rotorua based medical scientist Ceryn Hutin. The laboratory work was pivotal to the differential diagnosis of a case that originally indicated juvenile myelo-monocytic leukemia. However molecular studies and diagnostic genetics as well as the clinical presentation (including heart murmur and physical characteristics) of the patients, lead to confirming the diagnosis as the benign disorder Noonan Syndrome and a better prognosis for the twins.
I was equally fascinated with the Janet Ross’ (Cytogenetics, Waikato DHB) talk on the application of karyotype and FISH analysis contributing to the specific diagnosis and prognostic group in multiple myeloma. With escalating rates of cancer, diagnostic genetics (molecular and cyto genetics) is a rapidly growing discipline in the laboratory. Each of the case studies presented during the seminar demonstrate how important these disciplines are in making a differential diagnosis, providing prognostic indicators and therapeutic monitoring. With the rise of personalised medicine, the lab is also becoming involved in diagnosing the genetic effects of targeted therapies.
The continuing breakthroughs in genetics and molecular diagnostics are resulting in an increase in the volume of data, generating demand for workflow automation and the complexity of the testing, composite reporting and intelligent interpretation – all of which require specialised management by the LIS. Sysmex, as a provider of LIS software, work with our customers to understand the changing needs and future requirements to support this expanding area of diagnostics.
The day certainly delivered a series of educational topics from a range of presenters across NZ’s North Island Laboratories. I look forward to the next #NZIMLS event. Many thanks to the organising committee.