Kirsch’s lab was the first transfusion service in the United States to implement TANGO in 2006.

Allentown, Pa, a quiet little city of a little more than 100,000 people about 2 hours west of New York City, may not sound like it would be on the forefront of emerging blood banking technology. But it is here that Health Networks Laboratories (HNL), which provides blood banking and transfusion services to the city’s Lehigh Valley Hospital, became the first transfusion service in the United States to implement a new automated blood banking system. Manager Ann Kirsch runs the HNL blood bank, where 20 dedicated blood bankers share the workload of three sites. Kirsch maintains that the then-manual lab was stretched thin before it introduced the TANGO|optimo® in September 2006.

Kirsch has been with HNL since 2005, and took over as manager in February 2006. Before that, she spent 15 years as immuno-hematology reference lab supervisor at the Miller-Keystone Blood Center in Bethlehem, Pa. The lab was entirely manual before it switched to the TANGO, but the experienced blood bankers believed they could still keep up with the demand. In 2006, the lab decided to make the switch to automated blood banking in order to improve and, they hoped, free up techs to focus on other projects.

The lab was close to selecting another automation system when the techs were invited to check out Biotest’s TANGO|optimo. Boasting features such as automated quality control testing, batch validation, on-demand volume verification, automated streamlined maintenance, and new reporting capabilities, the TANGO|optimo is the only blood bank analyzer that offers 7-day on-board storage of liquid and microplate reagents.

After checking it out, they immediately liked what they saw. “When it came down to it, the numbers and the reagant contact, everything was amenable. We couldn’t find anything that deterred us from purchasing it, other than it was another technology—that was the only resistance,” Kirsch says.

The TANGO was quickly put to the test, as not 4 months later Lehigh Valley Hospital opened a brand-new seven-story complex, adding beds in critical areas, such as the emergency department and the operating rooms, and increasing the workload for the HNL team. No new blood bankers were added to the staff, which could have led to a crisis considering the lab was working on a relatively unfamiliar system. Fortunately, the team took to the system and was able to perform better and more efficiently than before, even under such challenging circumstances.

Initially, however, the techs were unsure of what to make of the TANGO. Some of the blood banking vets didn’t see the need to learn yet another new technology when their current methods were working just fine. But Kirsch saw things differently. She saw the chance to not only switch her lab from manual blood banking to automation, but also to give those depending on her lab’s results the most reliable and up-to-date blood banking options available.

Another concern was maintenance and solving problems on a system the techs knew nothing about. “At first,” Kirsch says, “a lot of the errors were really tech induced. They didn’t put the plate in right, or the test rack was cocked or something. Also in the beginning, it was like, ‘Alright, I’m not touching it; it says it’s not working. Get someone out here to fix it.’ That ended pretty quickly once they were more comfortable with automation.”

Communication with the support team at Biotest began to improve once the techs spent more time with the TANGO and got all the jargon down pat. Although the TANGO’s positive effects on the lab’s efficiency were seen almost immediately, it took the lab a bit longer to really hit their stride. Once the system was in place, the biggest issue for the lab was adjusting to the learning curve.

“I would say it took 8 months to get comfortable with the technology, and before the techs began to really trust in automation,” Kirsh says. “Once they realized that the TANGO was reliable and dependable, and it worked the way they wanted it to work, now they clamor for it.”

Working with the system for two years now, the lab has finally achieved a high level of familiarity and comfort with the system, and Kirsch and her team are very pleased with Biotest’s support and maintenance services. “We’d give them a huge thumbsup. In general, their service has been wonderful. They’re very cooperative,” she says.

These days, the techs will even follow the over-the-phone tech help and take the system apart themselves to find a problem. Kirsch praises how relatively low-maintenance the system is. “The TANGO has very little downtime,” she says. “If it goes down, it’s because of maintenance on a routine basis. They hate when there’s downtime or they come in to do their PMs or something. The techs say, ‘We want it! Get it up.'”

Hands Off

Since the TANGO|optimo is a walkaway instrument, meaning a tech can load a sample and go off and do other things while the sample processes, Kirsch’s lab has been able to refocus its attentions. For example, prior to 2006, HNL outsourced about 30 complex antibody tests to a different reference lab. “We had the expertise,” she says, “but not the time.” However, last year they sent only one.

“It’s given us the ability to train new blood bankers in our department in true blood bank techniques,” Kirsch says of her lab’s improved efficiency. “I’m not just putting out robots that just know how to issue or type and screen. Now you can spend more time on developing a real blood banker.”

Recently, Kirsch’s superiors asked her to gauge the effectiveness of automation. After doing some research, she found another lab that had benchmarked its efficiency at 1.5 hours worked per units transfused. Kirsch thought that was pretty good and decided to put her own lab to the test. After conducting the same experiment, she learned that her automated facility was averaging 1.1 to 1.3 hours per units transfused—well under the benchmark, she found.

Results from her lab preautomation show an average of 1.7 to 1.9 hours per units transfused—proof positive of the TANGO’s impact on lab efficiency. “I think we’ve come a long way” she says of the improvement. “We’ve really improved our process.”


Currently, HNL is interfacing the TANGO with its Sunquest Lab System, which was not interfaced when it started. But less than a year after working with the TANGO, the techs began asking for it in the hopes that it will automatically double- check results, eliminating the need for time-consuming manual checks and reducing clerical work.

“We were slow to embrace it,” Kirsch says of automation. “But now I’m sure that any person that comes into my lab now and asks about the automation would get wholehearted praise from anyone in my department.” But the real reason she’s so glowing about the TANGO? “The techs are happy, and I think that’s the most important thing.”

Stephen Noonoo is associate editor of CLP.