AUTOMATION IN SEROLOGY

AUTOMATION IN SEROLOGY

Serology is the scientific study of serum. In medicine, it refers to the diagnostic identification of antibodies in the serum obtained from a patient’s blood sample. In practice, it has many applications. Microbiology, specifically serology, has stubbornly resisted efforts at automation. The reasons are multiple, from lack of space to remote proximity to the main lab, from complexity of procedure to dedicated versus shared FTEs. Serology will always have some level of manual testing involved. The question is how to minimize manual procedures without compromising the quality of results. The upside is potentially huge; as one of the most labor-intensive areas in the lab, automation offers a way to reduce FTEs that are increasingly in short supply. Concomitantly, it holds the promise of significantly

reducing turnaround time and preventing life-threatening errors through sample consolidation; eliminating sample splitting, automating sample handling, and speeding results notification. There is also the advantage of increasing the serology lab’s capacity; as the volume of infectious disease (ID) testing grows, the need to process more samples with reduced resources is becoming acute. The solution may actually lie within the emerging field of microautomation, where serology platforms are combined with sophisticated automation systems. It goes beyond front-end sample handling; it requires an elevated level of automation intelligence to merge autonomous characteristics of different platforms into a unified whole.Serology has traditionally been served by Elisa-based micro-titer plate (MTP) manual or semi-automated benchtop systems. With the expansion of ID testing portfolios on mainframe and dedicated immunoassay analyzers, the opportunity to consolidate has improved. The problem is that no one platform has all the requisite tests.

Benefits of Automation:

Turnaround Time (TAT)

Automation reduces the turnaround time required to report results through several areas. In the instance of this study, the TAT decreased to less than 1 day for 96% of the workload. Every request arriving prior to 4:00 PM is now completed same day. Previously, accessions coming in after 1:00 PM would not be done until the following day. Turnaround time savings also translates into increased quality metrics and physician satisfaction. At MCA, TAT dropped by over 24 hours for over 30% of the tests. The reduced TAT can accelerate patient care pathways, improving patient care.

Labor

Automation dramatically reduces labor elements such as sample handling, sample splitting, interventions, and results reporting.

Workflow Mapping

The most obvious impact from automation and workstation consolidation is improved workflow in the serology laboratory. Since serology is often not physically located near the main laboratory, hooking platforms onto the automation line is not Practical. Workflow mapping can show significant reductions in the number of human steps required to process the workload. This translates to reduced labor and turnaround time (TAT).

Productivity

Improved productivity is defined as increasing output relative to a fixed input, such as labor or resources. Productivity is measured from the individual technologist’s perspective, the overall lab’s perspective, and the Relative Productivity Index (RPI).

Technologist Productivity

Increasing productivity for the technologist means increasing the number of tests that each technologist produces; therefore, reducing the number of FTEs while holding test volume constant reflects increased technologist productivity. Conversely, increasing the number of tests while holding the number of FTEs constant also results in increased FTE productivity

Laboratory Productivity

Productivity gains are found in increased capacity utilization for testing in the lab. By adding automation, the inherent capacity of each system is able to be maximized both in terms of FTEs and instruments having more capacity. As more tests are able to be processed, a.k.a. produced, overall lab productivity goes up. It is possible for a lab to be more productive without the FTE productivity increasing (i.e. more tests are produced due to increased demand, but the number of techs also increases, so the productivity per tech stays the same). It is also possible for the FTEs to be more productive without the lab productivity increasing (i.e. there are less FTEs but the total volume of testing that the lab produces does not change.)

Quality

There are many elements that define quality, but several key areas include reproducibility, lack of repeats, and minimized human error rates. The benefits of automation include elimination of repetitive tasks, such as reduced sample splitting and pipetting, and a highly reproducible process, with minimal direct interaction.

Sample Handling

In the central area for sample processing, human operators only have to open the sample drawer, load the sample tubes, and close the door. From a LEAN perspective, this has a major impact on non–value added tasks, while significantly reducing the potential for human error. Anyone in the lab can operate the system with no need to dedicate the highest skill level technician for daily routine use. A laboratory supervisor with knowledge of software, adjustment, and troubleshooting is enough to ensure smooth operation of the system.

Sample Splitting

Because the automated system uses a primary tube, there are fewer errors than with a manual approach. No sample splitting is required eliminating the potential of technicians pipetting a sample into the wrong tube. As a result, there are fewer manual errors with a reduced need to repeat tests; blood draws are kept to a minimum. This minimizes the amount of tubes, labels, and pipettes that need to be purchased.

Cost

The impact of the efficiency, productivity and quality improvements translates to significant savings for the serology lab. Savings are realized not only in supplies and labor, but in reduced repeats and sendouts. In addition, the improved capacity utilization increases revenue to offset costs.

Summary

The implementation of micro-automation in the serology lab can bring significant improvements in efficiency, productivity, quality and cost to operations. While traditional automation schemes are not practical in most serology lab settings, the combined effect of high volume immunoassay platforms with large ID portfolios in addition to the unique front-end and sample management capabilities System, enable labs to achieve dramatic improvements in their operations. Automation delivers predictable and consistent service coupled with a reduction in staff