By Nicholas Borgert 

 A conveyor track (above) delivers samples to various instruments at the Detroit Medical Center University Laboratories.

Many have asked why clinical labs are not investing in more automation and robotic systems to offset personnel shortages, more requests for tests, and cost and regulatory pressures. The short answer is that labs are becoming more automated, but they’re doing it slowly and with a variety of approaches.

The market is immense, but according to a spokesman at Beckman Coulter, a major provider of lab automation systems in the United States, only 1% to 2% of hospitals worldwide have automated their labs.

 Direct track sampling  from a primary blood collection tube.

William Neeley, MD, is medical director of the Detroit Medical Center University Laboratories (DMCUL). DMCUL’s consolidated system performs testing from eight hospitals and physician office labs across southeastern Michigan. DMCUL offers a menu of more than 1,000 tests, including specialty testing in molecular microbiology, diagnostic cytogenetics, immunogenetics (HLA), and molecular genetics.

When studying automation systems from the largest vendors, DMCUL officials found a number of limitations, Dr Neeley says. Besides their extremely high price, the systems lacked flexibility to handle tubes of different sizes. Moreover, they often lacked compatibility with instruments not tied into the vendor’s own brand. Also, commercial systems had difficulty handling stat testing, Neeley says.

“Frankly, some of the instruments offered by these big suppliers are simply not up to the task in terms of reliability and performance,” Dr Neeley says. “And if you buy their automation platform, you’re locked into their instruments.”

Dr Neeley says tube handling is important because about 50% of his lab’s testing volume is generated through outreach with regional clients who use tubes in a range of sizes.

Going It Alone
Dr Neeley and two of his colleagues decided to introduce their own custom-built automation system. Dr Neeley is board certified in clinical pathology and clinical chemistry, but it was his postmedicine engineering background that proved essential to the project’s success.

The Neeley team began planning in 2002. They acquired a basic conveyor track, commonly used in microchip clean rooms, as well as a variety of PLCs and other controls. To keep costs down and enhance reliability, team members designed, machined, and assembled most of the required components. They also designed and wrote their own software with special emphasis placed on handling Stat samples and a wide variety of tube sizes.

In October 2003, the DMCUL system went live with a 100-foot track connecting 11 instruments. The track is set to add two more instruments this spring. Cost of the custom system totaled less than $200,000, less than one quarter of the $900,000 cost of a vendor system with an average of three connected instruments.

Neeley’s automated process now handles about 2,100 tubes a day. Seven of the 11 linked instruments perform direct sampling from the primary blood tubes. The new system is helping the laboratory process more samples with less labor. Because the system is handling both stat and routine tests, lab techs can focus on more esoteric testing.

“We handle about 81/2 million billable tests a year and we send out only 0.8% of our tests,” Dr Neeley says. “We do HIV typing and sequencing right here. It is a big cost savings to do our testing in-house and it provides faster turnaround times.”

As successful as his system is, Dr Neeley does not advise other laboratories to go it alone on automation. “It is a very difficult thing to do; it takes too many specialized skills to do the job,” he says.

Dr Neeley thinks the future of automation in the clinical laboratory is a bright one. “We are all going to be forced to use automation over the next 10 years because of the shrinking number of medical technologists,” Dr Neeley says. “We have to get the price down to make automation more reasonable to use and to have a better return on investment. We also have to address the instrumentation compatibility issues.”

Beckman officials say automation systems are more flexible and more easily integrated than previously thought. They point to “open” platforms that meet National Committee for Clinical Laboratory Standards.

The Ohio State University Medical Center lab uses a Beckman Coulter system linked to a Bayer Centaur and a Stago coagulation analyzer. The lab had identified more than 41,000 opportunities for human error in a typical week. That includes 16,000 potential tube-sorting errors, 15,000 possible specimen labeling errors, 5,000 or more possible pour-off errors, and 5,000 potential exposures to biohazards. The lab uses automation to reduce human error possibilities by 71% and biohazard exposures by 88%. In addition, they cut receipt-to-result turnaround time by 50%.

Hybrid System in Japan
Japan’s Toyota Memorial Hospital, the medical support facility for Toyota Motor Corp, took a semi-custom approach. The 513-bed hospital’s lab automation system combines a Beckman Power Processor for sample handling with custom components. The lab processes about 2,800 tubes in its 9 hours of daily operation, up from 1,300 previously. Full-time equivalents in the lab have dropped from 33 8 years ago to 17 now.

Small Hospital Model
Automation can help smaller hospital labs, like that at St Joseph, a 370-bed regional medical center in Towson, Md, says Lab Director Anthony D. La Porta, MS, MT (ASCP). A recent expansion of the hospital’s ER is expected to double the current 30,000 annual visits in the next 4 years. “Our hematology volumes have increased from 225 samples per day to approximately 400 samples per day,” La Porta says.

He says St Joseph was first to install a Beckman LH1501 system and has served as a beta site, working through some issues, mostly mechanical, from the beginning.

“Since that time, we have been developing software components with our LIS (Meditech Magic) vendor to achieve additional benefits from a completely automated hands-off system,” La Porta says.

St Joseph’s system will not immediately reduce staff levels. “Our system was designed to retain our current staffing requirements in the face of projected ER volume increases,” La Porta says.

Nicholas Borgert is a contributing writer for Clinical Lab Products.