TLA and other laboratory automation solutions help clinical labs cope with shortage medical technologists
It’s been about 15 years since the first total laboratory automation (TLA) solutions were introduced into clinical laboratories in the United States. Starting in the mid-1990s, several commercial laboratory companies and a handful of hospital laboratories took the plunge and installed total laboratory automation systems in their high volume core laboratories.
Today, hundreds of clinical pathology laboratories in the United States have turned to laboratory automation as one approach to improving quality, reducing turnaround times for lab test results, to save money, and to improve staff productivity. Starting around the year 2000, an ever-growing number of in vitro diagnostics (IVD) manufacturers and other companies have introduced laboratory automation solutions and systems. This has widened the choices of medical laboratories, who often prefer a task-targeted automation solution to the “whole enchilada”—total laboratory automation.
Interest among clinical laboratories in laboratory automation is at an all-time high. Yet, too often pathologists and clinical laboratory managers fail to follow a long-accepted guideline. “The oldest and most violated axiom is ‘you don’t want to automate a bad process’,” noted pathologist John Crissman, M.D, who is also an MIT-trained engineer. He is currently CEO of Integrated Laboratory Automation Solutions (iLAS).
Crissman knows his way around laboratories. For several years he was Chair of Pathology at Wayne State University’s (SWU) School of Medicine in Detroit, Michigan. More recently Crissman was Dean of the WSU School of Medicine. During these same years, Crissman was involved in the comprehensive automation of six hospital laboratories that are part of the Detroit Medical Center health system.
“Simply replacing current manual processes in the laboratory with automated instruments is unlikely to achieve the full extent of efficiencies and savings that produce a good return on investment,” observed Crissman. “Today’s savvy pathologist and clinical laboratory manager wants to use process mapping and work flow redesign methods to streamline processes in the laboratory as an integrated approach to introducing total laboratory automation.”
Crissman has several recommendations for any medical laboratory professional who is looking to boost the performance, quality, and productivity of his or her laboratory. “To avoid automating bad work processes, it is essential to examine existing work flow and individual work processes in your laboratory,” advised Crissman. “Good starting points are the techniques of Lean and Six Sigma, which can help your laboratory team identify systemic sources of waste and errors. It is essential to evaluate the entire work flow as part of your program to select and install laboratory automation.
Crissman offered four important steps in the evaluation process of existing work flow and performance in the laboratory:
Step 1: Understand and document current processes from phlebotomy—where the specimen is collected—to lab test report generation—when the referring physician gets the lab test results. It is necessary to evaluate all the pre-analytical, analytical, and post-analytical processes to develop the most productive work flow.
Step 2: Define the end points you want to achieve for your laboratory. These goals can include improved test quality, faster turnaround times for STAT and routine testing, reduced costs, and increased productivity of the laboratory technical staff.
Step 3: Determine the resources available to your lab to reach its goals. This should include finances, internal and external consultants, and availability of staff members to participate in planning and implementation of the proposed laboratory automation project.
Step 4: Assess your clinical laboratory’s physical plant as it exists, against the proposed new work flow options and automation solutions.
Crissman stated that successful adaption of process improvement in support of new laboratory automation is not unlike dieting. “Both require a change in lifestyle. One must be committed to change his or her viewpoint, philosophy, and daily habits to be successful at either. It is a continuous process that must be both encouraged and actively promoted to be successfully implemented. The medical laboratory staff must understand the total workflow and role of LAS in order to contribute to the continuous process of improvement.”
For laboratory managers who are contemplating various laboratory automation options, Dark Daily has published a White Paper “Laboratory Automation: Achieving Best Practices with Total Laboratory Automation in Your Laboratory.” It is a free download and a comprehensive look at this complicated process.
In this White Paper, Crissman addresses automated approaches to both batch processing and continuous flow processing. He presents the benefits and drawbacks of both open and closed automation systems.
The White Paper includes a case study of a conversion to total laboratory automation by the Division of Pathology and Laboratory Medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas. This case study demonstrates many practical applications of laboratory automation to improvements in lab workflow, quality, turnaround time, and staff productivity.
It’s Crissman’s experience that converting to total laboratory automation can mean a 20% to 30% reduction in labor costs for most medium to large sized laboratories. There are comparably significant gains for smaller laboratories that intelligently automate some portion of their operations.
Dark Daily expects the arrival of long-awaited trends will further encourage wider use of laboratory automation by hospital laboratories and clinical laboratories in the United States and abroad. For example, the pace of retirement of the many baby-boomer pathologists, laboratory scientists, and medical technologists is now picking up. This is excacerbating the already significant shortage of skilled clinical laboratory professionals.
A related trend is the increase in chronic diseases, which fuels greater volumes of laboratory tests. A well-planned and well-executed laboratory automation project can give clinical laboratories the needed capacity to meet this demand, along with the capability to scale up to meet future testing needs.
All these factors are likely to motivate more clinical laboratories to consider how various laboratory automation solutions, in combination with a redesign of laboratory work flow, can help them advance their clinical mission in a financially self-sustaining manner.