TSF entry sorter module

In the clinical world, the laboratory can never be too safe or too fast. So clinical laboratories are constantly seeking to improve quality and turnaround time, and necessarily, revenue. “Identifying ways to reduce the amount of human contact with the specimen from the collection, through transport, analysis, and archival of the specimen, is key. It automatically results in reduction of human error, reducing the risk of a sample lost or missing, which ultimately improves the result TAT [turnaround time] back to the physician and increases the quality of patient care,” says Troy Galloway, senior director of Automation for Siemens Healthcare Diagnostics, headquartered in Deerfield, Ill.

Galloway cites two primary ways health care institutions have implemented these efforts: pneumatic tube systems in hospitals and lab automation systems in laboratories. Over time, the demands on these systems have grown. Today’s laboratory automation systems are asked to not only perform multiple physical tasks, manage quality and decision-making, and communicate with complementary information systems, but to do so with increasing volumes, greater ease, and complete reliability.

Integration and consolidation are now critical. Hybrid systems and total automation require connectivity and scalability. “In the early days, lab automation was mostly a question for the high-volume aspects of lab testing—clinical chemistry, immunoassays, hematology—where labs deal with large numbers of tubes. Today, we see labs want to also consolidate coagulation on fully automated systems and even go one step beyond that and integrate specialty testing, like allergy testing and serology, on the automation systems,” says Bill Östman, vice president and general manager of the Clinical Diagnostics Division at Thermo Fisher Scientific, Waltham, Mass.

Consolidation of testing means fewer sample tubes are needed, but standardization of tubes and caps remains in a distant future. Bar code technology remains a primary form of specimen identification, and its implementation can bring large benefit. “Bar code specimen collection systems electronically transfer accurate collection information. Manual processes are eliminated, and specimens pass instead of being rejected, increasing an organization’s ROI [return on investment] on its automation line capital purchase,” says Linda Trask, MT(ASCP), manager of laboratory solutions for Iatric Systems Inc, Boxford, Mass.

In general, automation can help a laboratory to maximize its resources, particularly in an unending era of staff shortages. “Full automation can bring real efficiency and peace of mind to the lab,” Galloway says. New and/or improved products attempt to increase both.

Configurability with Components

Abbott Laboratories, a division of Abbott, Abbott Park, Ill, offers the Accelerator Automated Processing System (APS) to help laboratories automate processes involving specimen handling. The component-based system permits laboratories to pick and choose modules to fit their diagnostic and design needs; unsure laboratories can take advantage of the company’s expertise to make smart choices.

The system includes the configurable middleware Instrument Manager, available through partnership with Data Innovations Inc, South Burlington, Vt, that implements tailored rules-based decision-making. Online sample storage (with a capacity of 15,000 tubes) enables automated sample retrieval and retesting. Integration with Abbott’s Architect analyzers limits manual involvement and streamlines workflow.

“The combination of Abbott instruments with an intelligent software solution provides automatic results validation, enhanced QC functionality, offline sample archiving capability, and other advanced features,” says an Abbott spokesperson.

TSF track samples

Portability with Wireless

Iatric Systems’ MobiLab takes automation outside of the laboratory to the point of collection. The software provides multiple hardware options, including handheld devices, mobile carts, and PC workstations, for positive patient identification and bedside label printing. “Multiple hardware options mean a better fit in terms of workflow for various clinicians—phlebotomists, nurses, therapists, etc—and ultimately, higher end user adoption,” Trask says.

The software uses bar code technology to identify patients and samples. Doctors Community Hospital in Lanham, Md, notes the most significant improvement upon implementation of bar codes was patient safety. “Additionally, our STAT draws are being collected and received more quickly. Our phlebotomists make fewer trips to the floors and can prevent multiple sticks because they see new orders appear on their devices immediately. Our receive process is streamlined. We are able to more accurately capture phlebotomy charges, and we now have a much more accurate and detailed audit trail of the collection process,” says Diane Goldstein, manager of IT applications for the hospital.

Phelps County Regional Medical Center in Rolla, Mo, reported drops in turnaround times of 10 to 11 minutes with implementation of bar code technology through MobiLab. Citizens Medical Center in Victoria, Tex, experienced an 80% reduction in telephone dispatching.

The real-time wireless connectivity helps to incorporate the latest medical data (including new orders, thereby reducing draws) and gives laboratories some control outside of its walls in addition to within.

Exhaustive with Expansion

Roche also seeks to expand the laboratory’s previous automated capabilities with new offerings in pre- and postanalytics. With its newer task-targeted automation (TTA) systems, Roche moves robotics into early preanalytical steps, including presorting, decapping, aliquoting, bar coding, and sorting and archiving.

The RSA Pro and RSD Pro differ in functionality; the RSA includes the aliquoter and bar code module. Each offers throughput of up to 1,100 primary samples per hour sorting and decapping; and up to 360 primary samples per hour sorting, decapping, and aliquoting a 340-µL sample.

The systems are designed to integrate with existing analyzers both from Roche and other manufacturers. “Many labs that have high volume today are not consolidated to a singular supplier,” says Pete VanOverwalle, Roche group marketing manager. So the RSA Pro and RDA Pro accommodate a variety of rack types.

The most recent example of innovation, however, according to VanOverwalle, is in postanalytics, particularly the area of storage and retrieval modules (SRMs). “The market has really been asking for more options as it relates to how specimens are managed once the original test requests have been fulfilled, and there haven’t been a lot of options up until recently,” VanOverwalle says.

Seeking to fill this gap, Roche recently launched the cobas p 501 and cobas p 701 postanalytical units to handle specimen storage and archiving. The cobas p 501 features capacity for 13,500 tubes; the cobas p 701 handles 27,000.

The systems offer throughout of up to 400 tubes per hour, automatic disposal of tubes, and automated delivery and selective decapping of specimens for add-on testing. Rapid, automated processing can help to preserve specimen integrity, reduces search time (in some cases, in excess of 20 minutes, according to VanOverwalle), and streamlines workflow.

“In our case, with the storage and retrieval module directly linked to our Modular Pre-Analytic solution, we can have a sample aliquoted for testing on analytics and automatically stored in the SRM within minutes from the time when the tube was initially decapped,” VanOverwalle says.

Speedier with Turnaround

MobiLab lap

Siemens’ lab automation systems also deliver faster turnaround throughout the entire workflow. Once samples arrive in the lab and are connected directly to the automation track, centrifugation and decapping automatically properly prepare samples for testing, including chemistry, immunoassay, and hemostasis. “Our new decapper and high-speed centrifuge for ADVIA automation help ensure these steps are performed quickly and reliably,” Galloway says.

Postanalytically, automated systems can assist with tasks such as specimen traceability for archiving, sealing for sample integrity during storage, online refrigerated storage, and automatic disposal.

Siemens has also introduced a solution for sample collection: Siemens Patient Identification Check, or PPID. Four steps ensure proper collection and labeling. The phlebotomist logs in by scanning his or her ID bar code and entering a personal log-in. Patient identification is confirmed by scanning the patient’s wristband (bar code). Specimen collection details, such as container type and draw order, are displayed for review. And finally, scanning of the specimen container (after the sample has been collected) links to the order and prints labels.

“Patient Identification Check helps the clinician to reduce the potential for human error in the collection of samples and the administration of blood products by confirming that the correct specimen is collected from the right patient,” Galloway says.

Information is integrated with the LIS, and processing is streamlined once the specimen arrives in the laboratory. The elimination of bottlenecks and automated processing speeds turnaround of results consistently.

IS mobile printer

Scalability with Growth

Of course, the use of automation in the laboratory is not new, and customers who have employed first-generation technologies are looking forward to upgrading and customizing solutions to maximize investment and resources. The laboratory automation market, therefore, currently comprises both new and replacement segments.

Scalability is key. Rapidly increasing volumes, growing outreach, and consolidating functionality require flexibility. Thermo Fisher Scientific has made this characteristic a building block for its automation solutions.

“We can cover a broad range of customers ranging from those with small work cells, consolidating the clinical chemistry and immunoassay testing, which is the low end of the spectrum looking at automation today—stretching to the other end, which is the large-scale, fully integrated, high-throughput solutions with a full set of preanalytical functionality, a full set of postanalytical functionality, and all of the major measured testing disciplines integrated into the automation solution,” Östman says.

The question is, generally, how can the product help to make the laboratory perform more efficiently and economically in all of its aspects, Östman suggests, reminding everyone that the clinical laboratory can never be too safe or too fast (or too rich).


Renee Diiulio is a contributing writer for CLP.

Specimen Handling of the Future

Today’s clinical laboratory trends focus on expanding automation into newer tasks, integrating information for greater use, and improving quality of results with a resultant positive impact on quality of care. However, there are some hints as to what may lie in the future regarding specimen handling, most notably those that have remained on the margins for the past decade.

Tube Standardization

The challenge of accommodating a variety of tube and cap types means laboratories can be stumped by a provider’s gap in menu. To facilitate integration, some companies respond by developing instruments that can work with many different types of sample containers and racks. Others foresee a future where these items are standardized, if not on an industry level at least on the institutional.

“I think there is still room for standardization because those are really the things that make the automation process more efficient. I would expect to see standardization happen in this area—not in the form of mandated standards, but standardization meaning customers that want to run an efficient lab automation process will pick the product they actually use in a way that the logistic chain, including lab automation, is as efficient as possible,” says Bill Östman, vice president and general manager of the Clinical Diagnostics Division of Thermo Fisher Scientific, Waltham, Mass.

Vein to Brain

Some laboratories are limited in their ability to effect process improvement because the process is out of their hands. “Laboratorians manage a process that’s very defined from when the sample enters the lab to when the test results get released, but oftentimes, laboratories will receive samples that are underfilled, mislabeled, or sport damaged bar codes. That can be very difficult for a lab because, many times, the reasons why this occurs can be numerous and outside of the laboratory’s control to improve,” says Pete VanOverwalle, group marketing manager with Roche Diagnostics, Indianapolis. More laboratories, therefore, look for innovative ways to reduce these issues and gain control of the process from “vein to brain.”

Radio Frequency

Laboratories might also like to get better control over their specimens by improving their tracking capabilities. RFID, or radio frequency identification technologies, have been touted for some time as a possible solution as it would enable laboratories to easily locate specimens in real time.

However, expense and technical difficulties have thus far prohibited its implementation. The effectiveness of current mainstream bar code applications is also a small obstacle. “Although RFID would have some very obvious technological benefits, I think it is going to have to battle against bar code and more advanced bar code technologies, like 2D bar code. RFID will have to prove that it really saves cost and adds process value compared to barcode,” Östman says.

In addition, the widespread adoption of bar code technologies means that health care institutions would need to tackle multiple systems to implement a solution based on a different foundation. “It doesn’t help the lab a lot to start using RFID at one end, if at the other end of the lab the tube would need a bar code to be processed within an analyzer,” Östman says.

—RD