Today’s benefits and tomorrow’s opportunities are explored
Vol. 24 • Issue 1 • Page 14
Virtually every clinical laboratory is gaining the benefits from some form of robotic automation leading to unprecedented improvements in analytical precision, labor reductions and increased turnaround. However, consolidation of laboratories over the last several decades has put pressure on laboratories to broaden the scope of their automation to include pre- and post-analytical processing and, to some degree, esoteric testing to remain competitive.
TLA or Modular?
For some clinical laboratories, the complexity and cost of the investment in total laboratory automation (TLA) has delayed the implementation of this kind of technology. New generations of automated equipment don’t require the full commitment of purchasing TLA and may include modules designed to automate only a portion of a laboratory’s operations.
Modular automation can be applied to both pre- and post-analytical processes. Modular automation allows one to design the process around the constraints of the laboratory infrastructure, such as the lack of a large open space or if laboratory spaces are not contiguously arranged. Furthermore, modular automation allows recombination of modules as the needs of the laboratory change.
In Japan, for example, a product already in use in thousands of laboratories is a robot that automatically dispenses labeled tubes into a tray or bag dedicated to each patient’s blood testing order. Obviating the need to organize and label patient tubes allows the phlebotomist to focus on patient comfort while facilitating rapid patient throughput in phlebotomy areas.
In the main lab processing area, modular pre-analytical processors can sort, rack, centrifuge and aliquot primary specimen contents into labeled daughter tubes. These devices are reducing analytical errors such as tube mislabeling and reducing the wait time. Mobile robots are available that will pick up racks of tubes and transport them to various areas of the laboratory, and even down the hall to distant labs.
After sample analysis, post-analytical automation stations can automatically store specimens in a robot-equipped refrigerator for rapid and accurate recall of specimens for add-on, reflex, or repeat analysis. Thus, for laboratories that have yet to make the expensive and time-consuming evolution to total laboratory automation, there are task-targeted solutions that allow a gradual step-wise approach to gaining the efficiencies of laboratory automation.
Esoteric Test Benefits
Esoteric testing such as immunoassays and molecular diagnostics are also benefitting from modular automation. For example, fully automated instruments that perform DNA and RNA testing are appearing on the market. The specimen is placed in the instrument and all the steps from DNA/RNA extraction through amplification and analysis are automated. Laboratories can benefit from using existing staff to perform complex DNA and RNA testing.
In addition, esoteric immunoassays may be automated on modular and programmable pipetting robotic systems that may be coupled with an automated microplate reader. Thus, sample preparation through analysis is fully automated. An important change in the market driving modular automation is the willingness for the robot providers to assist the laboratory with assay development and automation.
The selection of automation solutions is not without its challenges. Several labs have reported an over purchase of automation solutions and a relatively slow return on investment. Others have anticipated a more dramatic reduction in labor or turnaround time than what the automation can deliver. Thus, the importance of using automation and process engineering prior to purchasing automation cannot be over emphasized.
The start of a lab automation initiative involves the selection of the appropriate consulting services with lab management and automation experience that can assist with setting the project timeline and budget. Six sigma approaches to lean design will help find the optimal and realistic strategies to employ given today’s technologies. A thorough automation plan will include the organization and placement of phlebotomy sites, transportation corridors and transportation methods.
The layout of the accessioning area is also an important factor that can greatly influence throughput. An increasing number of conveyor manufacturers are making accessioning systems. The placement of accessioning professionals on either side of a multi-lane conveyor can facilitate achieving optimal specimen flow. Inspection stations may soon be available to automatically scan each specimen for quality issues such as tube cap color (which indicates if it was appropriately drawn according to the physician’s wishes), sufficient specimen volume (particularly in the case of pediatric specimens), and the presence of icterus, hemolysis, or lipemia at levels sufficient to cause analytical error.
Areas of the laboratory often overlooked for automation opportunities include inventory management to achieve just-in-time stock and inventory expenditures, and scheduling and management of quality control processes, which are always an underappreciated ongoing process and expense. Optimal management of the “sendout” area can improve not only the turnaround for tests that must be dispatched to other laboratories, but also reduce the cost of this expensive option.
Technologist training can also be automated. Competency assessments can be provided via computer to each laboratory staff member at times the system knows that each individual is available. Automated teaching tools can focus their teaching content on each individual’s personal competency weaknesses.
As well, change management can be automated. Advanced learning about new technologies that have yet to be placed in the laboratory can reduce the anxiety that often accompanies significant changes in laboratory design or operation.
Laboratories can automate their internal assessment systems so they report laboratory efficiency in a manner that is virtually real-time instead of annual or quarterly assessments. Poorly optimized processes can generate significant costs in a relatively short period of time. For example, strategically placed computer monitors can continuously display specimen queues so the laboratory staff can learn to recognize and react to processes that are not optimized. Lost or misplaced specimens can be quickly recognized and minimized so valuable labor is not spent on “seeking steps” that do not contribute to the laboratory mission. Laboratory supervisors will be able to see continuous quality and profitability reports and recognize areas of the laboratory that may be sub-optimal.
Continued growth in clinical laboratories will depend on increasing use of automation in all aspects of laboratory workflow. Hopefully, training courses in advanced laboratory automation for laboratory professionals will become available. Course content should include exercises and simulations designed to show the lean waste in a laboratory environment and how to correct them. Computer programming and communications electronics will also be important skills to acquire. Finally, the design of optimal automation environments that allow laboratory professionals to focus on diagnostic medicine will ultimately improve patient outcomes, safety, and satisfaction.