Streamlining Urinalysis Workflows

Urinalysis forms an integral part of the detection and management of several disorders, ranging from urinary tract infections to diabetes. However, the frequent need for manual intervention can significantly impact the speed and accuracy of results.

To learn more about the impact of manual inspection on urinalysis labs and how automated solutions such as the DxU Iris are helping to streamline workflows, Technology Networks spoke to Jose Crespo, senior director sales and marketing Europe, Beckman Coulter.

Anna MacDonald (AM): What enhancements have been made in urinalysis to address the new needs faced by laboratories? How has the pandemic impacted the area?

Jose Crespo (JC): Today’s laboratories face many challenges, causing a disruption in workflow and ultimately a delay in the delivery of patient care – this is especially true considering the challenges posed by the pandemic to laboratory workflow. A surge in coronavirus testing during the pandemic meant more routine tests were put on hold. When it comes to urinalysis, the challenges are augmented as a routine urinalysis test is one of the tests most commonly ordered by physicians, representing up to 30% of all samples received.

Along with the operational challenge of adequate staffing, another hurdle that urinalysis labs face is the frequent need to manually review sediment. In urinalysis, there are generally two types of manual inspection procedures: microscopic review, which is performed under a microscope, and onboard instrument review, which is done within the analyzer.

In manual microscopy – the traditional method – urine is spun, and the sediment is observed manually through a microscope. Manual microscopic sediment examination is a labor-intensive, time-consuming process that lacks standardization in laboratories and can take up to six times as long per sample when compared to automated systems. Given that many of the results of such tests are negative, alternatives are sought to avoid the interruption to workflow, the resources required and high overall system cost.

On-board instrument review can be conducted within the instrument and performed with the following particles: red blood cells, white blood cells, white blood cell clumps, bacteria, crystals, sperm, mucus, yeast, squamous epithelial cells, non-squamous epithelial cells, hyaline cast and unclassified cast.

Conducting manual reviews creates bottlenecks of work, causes worker fatigue and impacts on lab team morale. The key to successfully processing a large daily volume of samples are high throughput analyzers with reproducible capabilities, allowing for uninterrupted delivery of vital patient services in the event of instrument maintenance or unexpected downtime. Utilizing analyzers with automation, walkway and remote IT technology should be a must in today’s labs so as to allow staff to focus their expertise across the entire laboratory, therefore creating a seamless workflow experience.

AM: Why are interruptions so prejudicial to urinalysis workflows? Could technology reduce these interruptions?

JC: Any interruption for a manual sample review increases the time required for this analysis workflow, as well as requiring intensive, time-consuming labor. Moreover, the process lacks standardization. With these interruptions, patient results are also delayed, therefore affecting diagnostic and therapeutic stewardship.

DxU technology helps minimize operator intervention and interruptions using Edit-Free Release technology (EFR). EFR technology streamlines lab workflow, provides true walk-away automation and improves turnaround time by minimizing operator interaction with testing results, thereby maximizing analyzer automation. Improving urinalysis testing efficiency and reducing manpower with iWARE autoverification software also ensures the reliability of test results – a standard feature across DxU Iris instruments.

AM: How much has image analysis technology improved urinalysis?

JC: Image analysis technology has been a revolution in urinalysis. Robust APR Software evaluates particles by size, shape, contrast and texture. It auto-classifies 12 urine sediment particles and sub-classifies 27 particles, resulting in high confidence levels being achieved thanks to the accurate identification of particles and shortened turnaround times.

Using proprietary Digital Flow Morphology technology with Auto-Particle Recognition (APR) Software, the DxU Iris Workcell helps isolate, identify and characterize particles on the screen to virtually eliminate the need for manual microscopy.

AM: Beckman Coulter has a strong history in urinalysis innovation. How does the DxU Iris build upon this legacy?

JC: The DxU Iris uses Beckman Coulter’s industry-leading technology to streamline urinalysis workflow by reducing manual reviews to less than 3%. It features load-and-go walkaway capability and Edit-Free Release technology that minimizes interruptions and operator intervention. We have added new enhanced features to elevate operator experience and access to advanced software solutions that can improve laboratory system uptime. The solution has a new high-resolution monitor that enhances the view of images. Our sleek, intuitive software user interface allows operators to comfortably navigate, access key reference information and simplify training across multiple Beckman Coulter instruments.

AM: Can samples other than urine be analyzed in the new DxU Iris?

JC: Yes. What’s special is that the DxU Microscopy Series, which includes the recently-launched DxU Iris, is the only urinalysis system regulatory-cleared for body fluids with linearity down to zero. A great feature with running fluids on the DxU Microscopy Series is that there is virtually no interruption to the workflow. Body fluids can be run concurrently with urine, resulting in a more efficient process.

Jose Crespo was speaking to Anna MacDonald, Science Writer for Technology Networks.