LABORATORY MANAGEMENT


As well as to be able to implement any appropriate changes and additions if required.


Some of the most common metrics that can be used, and therefore should be considered during the planning phase, are: n variation in turn-around-time (TAT), considered from the arrival of the sample in the laboratory until the release of the result to the LIS, measured either as median or 95th percentile;


n type and number of laboratory errors; n level of laboratory staff satisfaction and collection of feedback.


It is important the measures should be implemented well in advance of automation implementation, to establish an adequate basis for ‘pre’ and ‘post’ comparison.


Economical evaluation The cost justification of an automation project is necessary to obtain the financial support from the management of the health care facility. Although some aspects of laboratory activities are easily measurable, other potential benefits of automation, (improved analytical reproducibility, improved TAT, reduced errors, etc.), may be more difficult to translate into economic value because hospitals’ internal accounting systems are not designed for this type of measurements.


The demonstration of economic benefit must necessarily consider not only the platforms purchasing cost but also the impact that the automation will have on the various cost items of the laboratory, both ‘direct’ and ‘indirect’. Regarding the initial acquisition cost of the system, it should be considered that the depreciation value decreases as the time horizon of the supply contract increases, and therefore the expected duration of the supply will range from a minimum of 3-5 years, up to 7-10 years, to allow the cost of the equipment to be fully absorbed by a progressive reduction in operating costs and an increase in revenue due to increased work volumes.


When justifying this type of investment, the goal is also to increase the decision maker’s awareness of the benefits from increased levels of safety and satisfaction, both of patients and physicians, achieved through faster and more accurate diagnoses.


By taking the variation in TAT into consideration, as an example, a number of direct consequences can be achieved and measured, such as: n optimisation of diagnosis and patient


IMPACT OF AUTOMATION ON LABORATORY PROCESSES


Redefinition of laboratory operational capacity and resources allocation criteria Reduction in fixed and variable costs


Standardised, consistent and predictable performances Significant increase in productivity and efficiency Reduction in response time (TAT) Reduction in WIP (‘Work In Process’) levels Improvement in RFT (‘Right FirstTime’) Increased autonomy of laboratory staff


Proactive culture of performance management and continuous improvement Improved patient care


Fig 3. Examples of laboratory value drivers impacted by automation.


management in the emergency department;


n reduction in hospital admissions and reduction in hospitalisation time;


n increase in physician satisfaction; n reduction in complaints about laboratory service;


n increase in patient satisfaction (timely receipt of laboratory test results is among the metrics by which patients evaluate hospitals and medical care);


n reduction in the need for outpatients to return to the facility for a second visit, and reduction in problems related to post-visit follow-up by physicians.


The benefits from an automation project can also be analysed through the technique of ‘value-drivers analysis’ a commonly adopted methodology to support strategic planning and focus attention on activities that have the greatest impact on the value of a service. Although peculiar according to the context of use, there are three main categories of value drivers: 1. Growth: service improvement and innovation, staff skills.


2. Efficiency: productivity, error reduction, process flexibility.


3. Financial: cost reduction, increased turnover, increased operating income.


Laboratory automation can generate a significant positive impact on each of the three value drivers, as shown in Figure 3.


Conclusions To cope with the increasing pressure to reduce healthcare costs over the past decade, laboratories are more and more relying on automation with the goal of increasing service standards and ensuring required levels of efficiency and profitability.


Laboratory automation is a viable solution to maximise overall efficiency, minimise errors and support the


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continued expansion of modern laboratories.


Adopting an automation system


requires a proper management of all project phases, from defining objectives, to selecting commercially available technologies, to post-implementation monitoring, through the adoption of techniques specific to project management and the involvement of all stakeholders and laboratory personnel in tight co-operation with technology suppliers.


A well-defined and implemented


project makes it possible to achieve the expected objectives, reducing risks while increasing the satisfaction of laboratory medicine professionals and patients.


Further reading n Dolci A, Giavarina D, Pasqualetti S, Szőke D,


Panteghini M. Total laboratory automation: Do stat tests still matter?. Clin Biochem. 2017;50(10-11):605-611. doi:10.1016/j. clinbiochem.2017.04.002.


n Hawker CD. Laboratory automation: total and subtotal. Clin Lab Med. 2007;27(4): 749-vi. doi:10.1016/j.cll.2007.07.010.


n Hawker CD, Genzen JR, Wittwer CT. Automation in the Clinical Laboratory, in Rifai N, Horvath AR, Wittwer CT eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th Edn. Philadelphia, PA: Elsevier, 2018.


n Lippi G, Salvagno GL, Guidi GC. Automation of the preanalytical phase. Biochimica Clinica. 2007;31(2):131-137.


n Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview. Clin Chem Lab Med. 2019;57(6):802-811. doi:10.1515/cclm- 2018-1323.


Renato Gargiani is Country Manager, Italy for Stago. He has had a long career in the medical devices / IVD / laboratory area with various managerial roles with Stago, Roche and Diasorin.


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