Hospital Based Labs (HBL) are evolving – of late, these are switching to automated open track systems. Express Diagnostics profiles the evolution of BLK Hospital’s laboratory services
Nestled in a busy locality of South Delhi, the 700-bedded BL Kapur Hospital deals with thousands of patients in a day. Out of the many specialities one of the busiest department is the department of lab medicine. With pneumatic tube sending blood samples every single minute and a multi-disciplinary team keenly attending to the blood samples to decipher the results, the amount of work done at this lab is truly enormous. The hospital’s aim is to redesign its lab to automated open track system by the next financial year.
Giving details about the laboratory services of BLK, Dr Anil Handoo, Senior Consultant – Haematology and Director, Laboratory Service and AARCE, said, “The laboratory services in BLK started in 2008, lab operations were developed and designed to be futuristic. Most of the private hospitals are reluctant to invest and usually have a small room for a lab. However, they then try to evolve as the footfall of patients increase. BLK Hospital had a full-fledged lab as they considered laboratory services to be pivotal to patient care. From 2008 to 2009, the lab had seen an incremental growth and saw more growth from 2012 onwards . As of now, we get samples of about 1,500 patients in a day. One patient undergoes a minimum of three tests, so we have at least 4,500 to 6,000 tests done every day in the lab.”
HBL vs private labs
Speaking about the challenges of HBL compared to the private held labs, Dr Handoo informed that unlike private-run labs, HBL turn around time is shorter and the laboratory services are quick and precise.
“In HBL, we are not given the leeway of getting the sample and releasing the results the next day. Majority turn around time is less than two hours. If we get the sample during evening hours, then we get less time, even then the results are uploaded on the website. With a stringent time limit in one hand, we have a good number of samples to handle. Being a 700-bedded hospital, we do get samples for specialised investigation from the IPD. However, in HBL, the numbers for specialised investigations are less. This is not just in BLK but across the country tests are given to outside private labs — for instance, sequencing, high-end mutation tests and molecular tests. HBL doesn’t carry out such tests because we don’t have enough batches and it is also not commercially viable. In economic and financial terms, HBL will always be a bit more expensive, as the input costs are higher and the reagent prices are always expensive than what the private labs get. They are able to give you a better rate in terms of pricing,” he informed.
Dr Handoo also highlighted that HBL differs from the private-run labs. He informed that HBL scores out with the kind of expertise they bring in the investigations.
“When you go to a routine lab, you might get only values, but in HBL, you get more information which leads to a detailed diagnosis. Nearly 20 per cent of the cases coming to HBL are being misdiagnosed. For example, recently we had seen about six cases wherein the investigation had detected cancer but when we re-analysed them, they had no cancer. So, the tendency of HBL is that we review the case completely and provide holistic information which is not available in stand-alone labs. Each test takes place in silos and nobody collects all the information and evaluates it. In HBL, we correlate things which you don’t get done in other labs. The other bigger advantage in HBL practice is access to clinical information.”
Automation: New buzz word in HBL
When it comes to medical advances, laboratory technology is usually at the forefront. New advanced testing techniques to diagnose or screen have made testing more efficient and automated. The rapid advancement Lab Information System (LIS) has revolutionised the lab service and automation and open track system is the new buzz word in lab technology.
“Few years ago, majority of instruments used in laboratories were smaller and had less throughput. For example, in haematology, we had five-part instrument and three-part instrument and the workloads were less. Technology was relevant but not advanced. Over a period of time, we upgraded our requirement from smaller instruments to a modular system, right now redesigning the lab is our core concentration. By next financial year, we should put in place an automated open track system. There are various reasons why the lab needs transformation, viz lot of space gets occupied by bench top instruments. Also, the instruments have become modular now – they are plug and play type. So, these have space redundancy. We are trying to remove these small cubicles and we will change it into an open track system where everything is automated and we don’t want anyone to carry the samples. Anyway, the samples come in pneumatic shoot and from there, they are loaded into a loader to be sorted. Further, they get segregated to the respective labs and track takes it to the respective place. By the next financial year, the lab will be fully automated. We need this change primarily because of the increased volumes as BLK Hospital has taken over Max Hospital. Hence, an open track system will help and we will be creating hub labs – one in BLK Hospital and the other at Max Hospital in Saket. With automation in place, we will be able to provide high-quality results at shortest possible time,” he informed.
Commenting about the cost of the transformation, he said, “Fortunately, the cost incurred for HBLs are lesser than the medium-sized labs. In HBL, the price of the instrument gets loaded on the reagents so you don’t pay for the capex upfront based on the agent lease. Therefore, upgrading to a higher platform has become easier but you need to have a minimum volume to play around with. Any HBL will have 30 per cent high prices when compared to stand-alone prices from private labs.”
Adding to it, Dr Handoo said that any HBL’s aim will be imbibing latest technology and constant up-gradation. “BLK Hospital wants to increase the capabilities of the laboratory in terms of infrastructure, hardware and software requirements and make it user-friendly which is easily accessible and available,” he added.
Touching upon the important aspect – the quality of HBL, Dr Handoo informed that usually (National Accreditation Board for Testing and Calibration Laboratories) NABL-accreditation is taken by private hospitals, as they are able to get Central Government Health Scheme (CGHS) and government business. But he pointed out that BLK Hospital did not do it for business purpose, but they are keen on the quality offered by the lab.
“We got our first accreditation in 2010 and we get it every two years once. In the last cycle, NABL and APLAB had taken our labs as model lab. We run three-level quality controls thrice a day, it costs us and we pay the medical equipment company. Even then we do it as we do not compromise in the quality and it showcases in our lab results. For example, our expense on internal quality in haematology alone is Rs 1 lakh per month, which is a recurring cost. It doesn’t happen in many of HBL practices, but we do it,” he added.