Authors (including presenting author) :
CHIK KK (1) , May Lee (1), Luk Sik (1)
Affiliation :
(1) Clinical Microbiology and Infectious disease, Pathology, Princess Margaret Hospital
Introduction :
Urine culture is the gold standard for diagnosing urinary tract infections (UTIs); however, it is labor-intensive, costly, and time-consuming. In recent years, automated urine flow cytometry analyzers have gained popularity in clinical microbiology laboratories for their efficiency in urine analysis. When combined with specific middleware software, which can bridge clinical data with flow cytometry analysis. Through their automated triage system, it streamlines workflows by identifying urine samples that do not require culture based on predefined cutoff values, while ensuring cultures are performed for high-risk groups, such as immunocompromised and obstetric patients, regardless of microscopy results.
The middleware’s bidirectional linkage between the laboratory worksheet and the Laboratory Information System(LIS) eliminates the need for worksheet printouts and manual data entry. This innovation has resulted in substantial cost savings by reducing labor, culture media usage, and overall resource consumption. Additionally, the shift to a paperless approach minimizes paper waste, promoting environmental sustainability. Faster turnaround times for negative results—achievable within 24 hours—have further enhanced laboratory efficiency and improved patient care outcomes
Objectives :
This study evaluates the financial and operational benefits, including cost reduction, paper savings, and improved turnaround time, following the implementation of the Sysmex UF-5000 and middleware in urine culture analysis
Methodology :
This retrospective study will assess the cost-effectiveness of implementing the Sysmex urine analysis system and middleware in the urine bench workflow of Kowloon West Cluster microbiology laboratory. The evaluation will use 2023 data as the reference for comparison, focusing on potential savings in manpower and operational costs.
Data collection
1. Baseline Data (2023 Reference)
Volume of Samples:
Number of urine samples processed monthly, and annually in 2023.
Manpower Utilization:
Number of full-time equivalent (FTE) staff dedicated to urine analysis, including technicians and support staff.
Cost Analysis:
Personnel costs (salaries and benefits of FTEs).
Consumables and reagents required for manual analysis.
Maintenance and operational costs of existing systems.
2. Simulated Data Post-Implementation
Estimate the changes in sample processing time using Sysmex and middleware automation after applying the following logic: 1) exclude samples from high risk patient groups including paediatrics, obstetrics, urology and immunocompromised patients AND 2) issue negative result directly to LIS if flow cytometry results showed urine white blood cell < 10/μL AND bacterial count < 13/uL AND yeast count < 1/uL. Also to predict reductions in manpower requirements due to automation.
Analysis Plan
1. Cost-Benefit Analysis
Compare pre- and post-implementation costs, including:
Reduction in consumables and reagents.
Savings from optimized manpower allocation.
Potential cost offsets from increased throughput and accuracy.
2. Efficiency Metrics
Calculate average turnaround time (TAT) per sample pre- and post-implementation.
Evaluate the proportion of manual tasks eliminated by automation.
Result & Outcome :
Total urine samples processed in 2023 was 121,926. After middleware triage, only 91,347 samples required full processing, representing a 25.1% reduction in workload due to effective triage capabilities. For the reagent costs, it increased by 81%, primarily due to the introduction of advanced automated processing requirements. However, as 25.1% of urine do not need to be cultured, this reduces the expenditure by HKD 115890. Manpower optimization was evidenced by reduction in full-time equivalents (FTE)of 1.33. This decrease translates to significant labor cost savings while maintaining operational efficiency. The new workflow also has positive environmental Impact with paper usage decreased by 121926 pieces annually, contributing to environmental sustainability and reduced administrative overhead. For the clinical impact, as the urine with normal microscopic results will be issued automatically which can decrease the turnaround time from 48 hours to 24 hours upon acknowledgement in the laboratory. It also reduces the transcription error and improve the patient care.
In conclusion, the implementation of the Sysmex UF-5000 automated urine flow cytometry analyzer, combined with middleware for auto-triage, has significantly improved the efficiency and cost-effectiveness of urine culture workflows in our cluster microbiology laboratory.
