BENEFITS OF LABORATORY AUTOMATION: SAFETY AND ACCURACY

With improvements in analytical technology and laboratory information systems over the past decade, novel approaches to manage the workflow of highly complex laboratory operations more efficiently are being evaluated. (Figure 1) The challenge is to accommodate the increased workload while lowering the unit cost of performing the testing, especially in light of lower reimbursement rates. Inevitably, laboratory automation emerges as a potential solution.

The typical scenario occurs when the laboratory begins to search for a more current methodology and instrumentation to replace outdated analyzers with the goal of having larger menudriven systems, with faster throughput, which can aid in the consolidation of workstations. For example, an instrument could be chosen which could perform multiple therapeutic drug levels simultaneously, rather than performing the assays on several pieces of equipment. This leads to the possibility of considering the components of the latest generation of equipment which can automate many pre- and post- analytical functions. Pre-analytical functions include confirmation of sample receipt and positive-sample identification, centrifugation and preparation and labeling of aliquots. Each of these steps is subject to human error if performed manually. Similarly, post- analytical functions including sorting, storage, labeling and retrieval, and electronic archiving, are also fraught with the same possibility of error.

At the same time, the laboratory is trying to maintain itself in a competitive posture, searching for the best technologies and analytical methods while dealing with the shortage of skilled laboratory professionals. Additionally, the laboratory may be looking to increase revenues by launching or expanding an existing outreach program. In any event, these are the times to consider all possible solutions.Having seen presentations demonstrating that automation of laboratory systems is taking place in the US and throughout the world at an increasing pace, what are the reasons and justifications for choosing laboratory automation over traditional laboratory operations? What benefits can be accrued by automation? Will it reduce pre- and post- analytical errors in handling of specimens and reduce test turnaround times (TATs)? What automation components should be considered to achieve these goals? Will automation help to handle the increasing volumes and shortages of personnel? Will laboratory automation make the laboratory safer?

RATIONALES FOR INTRODUCING A LABORATORY AUTOMATION SYSTEM

The first images that probably flash across one's mind are computer downtimes, power outages, equipment failures, service issues, and crises when the system is down, all too horrific to contemplate. Then there is the cost. In times of fiscal and capital restraint, it is difficult to believe that any laboratory would be in a position to acquire such "cutting edge" technology. However, since there are currently over 120 automated laboratory systems operating in the US, this approach must be feasible.1

The automation system for our Biochemistry Laboratory has been in operation for nearly 4 years. The principle gains have been:

* Accuracy of steps previously performed manually - One of the major areas where the laboratory focused great attention in past years was the elimination of potential failure points in processes subject to errors. Bidirectional instrument interfaces have had a significant impact on these types of errors. However, failure points still exist. These include all pre-analytical steps including the manual creation of aliquot tubes which can result not only in sample mis-identification but also cross contamination of specimens. For the traditional laboratory, up to 12 sets of hands could handle a specimen from the time it is drawn to the time the testing is completed and reported; automation could reduce this handling by more than 50%. Automation of all pre-analytical steps including an automated aliquotter provides 100% accuracy, as well as positive sample identification with no cross-contamination of samples.

* Safety concerns for staff- Automation eliminates much of the direct handling of specimens including removal of caps, centrifugation, the creation of aliquot tubes and the recapping of samples. Clearly, laboratory automation circumvents exposure of laboratory staff to potentially hazardous samples.2-4

* Faster throughput of specimens - Automation never gets distracted or forgets about the sample in the centrifuge. In the traditional laboratory, there are many steps where a technologist must simply move a sample from one station to another. Each step, be it placing or removing a sample from a centrifuge to loading the sample onto an analyzer, can introduce delays in TAT for result reporting. Automation is constant, effortless and 100% reliable.5