Dr Tejal Bhatt
Center Head,
Sterling Accuris Diagnostics Laboratory

It Is Time To Focus On Preanalytic Automation For Laboratories

The pre-analytical phase of the total testing process is complex and very important. It is not surprising that between 32 percent and 75 percent of all testing errors occur in the pre-analytical phase. Considering the amount of automation and process controls that exist in the analytical phase versus those in the pre-analytical phase, we need to focus on pre-analytic automation to make laboratory workflow smooth and error free. Maintaining quality and efficiency during specimen sorting, accessioning, and delivery are the key focus areas for a laboratory. Laboratory automation is now considered the required technology in all clinical laboratories in order to maintain quality and efficiency which can be included in hospital or laboratory budgets. Nowadays laboratories are facing increasing workloads with fewer trained technologists; pre-analytical automation has been developed to assist with specimen transport, specimen sorting, accessioning, and delivery from the accessioning area to the analytical stations in the laboratory.

Before you plan for the implementation of pre-analytical automation, the physical layout of the automated accessioning area (or areas) should be determined since space constraints can have a profound impact on the choice of technologies. Whatever space you have, you can design your accessioning area such that it takes less time to move samples to the laboratory analysis area. The ideal pre-analytical space should be linear with the delivery door at one end and the analytical laboratory instruments at the other. Various sample transportation systems should be considered. Laboratories with limited resources or smaller test volumes should consider a simple conveyor belt placed in the accessioning area to move specimens from the drop-off point and make them easily accessible to a row of seated accessioners. Beyond, the accessioning area automation is available in two general configurations, work cells and systems. Work cells are often designed to be combined into a system that performs a series of steps both sequentially and in parallel, depending on the design. Adopting work cells as needs arise and then combining them into a system is an ideal way to minimize up-front costs and risk. Pre-analytical systems will provide a wide range of pre-analytical tasks and are often provided as part of a total laboratory automation package.

Strong IT systems and barcoding

Automation is always linked with strong IT support in the form of user-friendly software. Specimens should be barcoded before or during the phlebotomy process so that specimen information can direct the automation to perform the appropriate tasks. Some systems will rapidly select one specimen at a time from a bin of randomly oriented specimens, read their bar codes, and then sort them into take-out bins. Other systems will organize them into racks according to their destination. Other systems will not only rack the specimens after the accessioning bar-code reading process, but also use an automated centrifuge to process specimens that require separation and make the appropriate number of labeled aliquots. Various pre-analytical automation systems are considered islands of automation and require manual transportation of the sorted racks to the analytic rack of instruments. Mobile robots can help in this intra or inter-laboratory transfer. But again costing matters a lot for this automation. Currently, available laboratory automation systems provide optimal integration of conveyor belt transportation and analytical instruments for the bulk of routine laboratory tests. Over 80 percent of hematology and routine chemistry test volume can now be analyzed completely by automation. However, there remains the need for automation development in the few tests like few microbiological tests and clinical pathology especially for small-sized laboratories.

Pneumatic tube systems for hospitals

Many reference laboratories and hospitals have adopted a pneumatic tube system for rapid specimen transport but since we are moving toward home collection and online tests booking, we still need to focus on how we can cut short transport time for home collection samples. Making more collection centers and pickup points can help and phlebotomists and delivery boys need to be equipped with temperature controlled bags all the time.

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