Hours of work-away time with automated workflow

The Vall d'Hebron clinical laboratories are a merger of the three laboratories in Barcelona city, making us one of the largest and complex labs in Europe.

At the moment, we are attending to around 6,000 patients a day and we make 20 million determinations a year. 83% are within core, but 70% of our catalogue is outside of core. So, at the beginning we had a traditional core. And slowly we developed something we considered very important, which was the transversalization of the laboratory.

On an average day I would process about 200 samples, which would take between four and five hours. The process that would take me the longest would be aliquoting the samples, as they have to be opened and transferred to the secondary tube.

The current process is a bit slow because there's a lot of manual work.

The pre-analytical part is very time-consuming, so our response time is slower and the time in which we can give the pathologists the sample is delayed, so we see a lot of manual work.

All these processes are very manual.

That can lead to errors, and so this element is perhaps the one which we'd be most interested in changing and automating in order to reduce errors and to have greater traceability of the samples we process.

My ideal process would be to eliminate the whole manual part, which could generate errors, and to dedicate myself to a more accurate interpretation of results.

Obviously, I would change the complex and risky process in the pre-analytical phase, incorporating it as much as possible.

Besides, we're in an environment where all the analytical systems are together. There is a clear

risk of contamination. We have to avoid as much as possible manipulating the samples outside the automated systems.

And if I had a magic wand, I would immediately implement a system that would allow me to eliminate all of these steps.

We had been thinking for a long time that we needed a molecular core, similar to how we have a biochemistry or haematology core. And since we had been searching for this for years, and Roche was the first to provide it, we decided for Roche's solution, which isn't just prime. It's the robotisation or complete automation of PCRs with the 8000 series and with the prime series.

The pre-analytical process is the most complex stage, and the most relevant, perhaps, for in-vitro diagnoses, particularly when you're working with molecular samples like we do here.

Since the installation of cobas® prime, the way in which I work has changed noticeably. It has eliminated many of the sub-processes and it's a much simpler process now.

I receive the samples, place them in their assigned racks, introduce them in prime, and it takes care of the aliquoting, from removing the tops to placing them in the cobas® 6800 so that the samples can then be processed.

The integration of cobas® prime into our molecular platform has, firstly, allowed us to keep all of the equipment in one space, which reduces times, not only with processing but for our technicians, who don't have to go from one place to another.

Another great advantage of the cobas® prime system is that many of the processes that were previously manual, like aliquoting in secondary tubes or saving samples in order to check for errors at a later date, all of these steps are done automatically.

This reduces greatly the risk of a manual error because, since the equipment is closed, we can control the risk of contamination between samples as well as contamination from the environment.

In addition, in this set-up, the prime is connected automatically via robotic lines to the analytics systems. This has an additional advantage, which is that it has allowed us to fulfil the original vision for the space.

This space was designed to be as it currently is, in a completely open environment, where people and resources can pass through freely and you avoid the risks associated with handling the results.

In terms of the savings or the financial considerations of the cores, which are sometimes viewed apprehensively, because, certainly, the cores are expensive to build, but if one does a proper study of flows and techniques and has a sufficient volume of samples, the return on investment is very quick.

We're beyond happy. It's fantastic.

The Corona pandemic has affected not only our lab, but the entire world in every way. It was practically from one day to the next that we required to measure far more than 1,000 samples a day.

In the meantime, it has suddenly become a few thousand samples a day. Until then, this was not the norm in molecular biology laboratories, at least not in Austria. At the moment, Covid samples dominate our daily laboratory routine, and we are also able to process the usual samples. The most time-consuming sample preparation is that of the HPV samples.

At the moment, unfortunately, most of it is still manual. Every manual step in this whole sample processing can be a source of error, where of course also human errors can happen. And in the worst case such errors are not detected until the end. Which is, of course, the worst-case scenario. Of course we work to the best of our knowledge, but what we would like, of course, is to be able to place, as in other automatic solutions, the tubes directly in the devices, so that sample identification is ensured.

In the end, of course, it's about providing the best possible service for the patient. Patients don't want to deal with laboratory analytics and laboratory findings as much as doctors don't, but this is a service that's easy to provide with minimal effort for the person using it. 

By increasing the speed to fully automated solutions and by consulting Roche Healthcare Consulting, we succeeded in providing our patients, who are at the center of our thinking, the best possible care, and thus also with our colleagues to find the best cooperation.

The installation of cobas® prime and the automated sample preparation has dramatically reduced the hands-on-time. This has meant that results have been available more quickly.

Working with infectious samples has also been made easier, because we no longer have to open and close the samples, but that has been taken over by cobas® prime.

Yes, we use the cobas® prime mainly for HPV analyses, because the time savings are greatest here compared to the manual workflow.

The workflow now looks like this:

We load the samples into the instrument, then load the instrument with the necessary consumables, and the rest takes care of itself.

And as soon as the sample preparation is done, the samples run directly over our road to the cobas® 6800, and as soon as a complete patch comes together, the run is started automatically.

And what you also have to remember is that because of the prime, we now have automated sample documentation. That means we can view an information system in our lab at any time: When did a sample come into the device and thus estimate when the findings will be ready.

The strategic outlook for the future of our laboratory has undoubtedly improved thanks to cobas® prime.

I see this as an opportunity to make better use of our highly specialised staff in the field of molecular diagnostics.

The analytics are a major issue in every laboratory, in particular at present in molecular diagnostics, as we have very long runs with COVID-19 diagnostics, with up to 1,000 samples per day. To some extent, these need to be prepared and unscrewed manually, which puts a lot of physical strain on members of staff. As a result, we are striving for an automated solution in order to avoid the confusion of samples or other pre-analytical errors. The sample preparation is dependent on the sample material which is sent to us.

There are basic samples, for instance chlamydia, influenza or corona viruses, which are placed on the automated device for immediate analysis.

Papillomaviruses are particularly time-consuming, as they require centrifugation and boiling up, followed by a second centrifugation, before they can be placed in the device.

In the light of the current situation in which we are pipetting many things manually, we need to be very careful not to cross-contaminate, as to not transfer anything from one sample to another, to not make any pipetting errors in general, and to not have any mix-ups when transferring a sample from one tube to a secondary tube.

This is very error-prone nowadays, which could be avoided almost completely by automation. As you've heard from the testimonials, there is a lot of issuesto be addressed in the lab, and that's where consultancy can help you.

Based on our experience, we have Developed new tools and methodologies that help in working together with the customers to design customised solutions that deliver the immediate needs and be ready for future goals.

Since we have the cobas® prime here with us, we only need to unpack the samples, label them, and then they are placed on the multi-trays of the cobas® prime, and fill the machine once with reagents and consumables, and from there the samples are pipetted into secondary tubes and pre-texted, heated, cooled, centrifuged...

We don't need to do all that any more, the cobas® prime does it all for us. Our work process has changed so that we have far fewer sources of error. People make mistakes, we can get confused by pipetting or barcodes or whatever.

That's impossible with the cobas® prime. There is much less risk of contamination, because we don't even open the samples.

Everything is done in the instrument, therefore there is no human contamination. The cobas® prime is a benefit for the lab, because we can analyse a lot of samples at once.

It saves a lot of time, and we have a fully automated system that can also work together with other Roche equipment, which has ultimately led to a fully automated work process in the laboratory.

Cobas® prime can of course also change our strategy in the future. We can now focus to a large extent on offering molecular tests. This is certainly also the growth market of the future.

Of course, any laboratory can do the classic clinical chemical tests. We will strategically focus on the molecular track, and this will be one of the main components for our future business development.