As the shortage of qualified clinical laboratory professionals increases, many laboratories are relying on automation and other solutions offered by in vitro diagnostics (IVD) manufacturers as a way of coping with fewer skilled professionals. The Bureau of Labor Statistics expects that 12,000 new clinical laboratory professionals each year would be needed to meet rising demand for services. Yet studies show not even half that many are entering the workforce annually. So how are clinical laboratories supposed to maintain, let alone increase, test volumes?
One answer, according to experts, involves continuing to embrace technology that performs routine tasks in labs, freeing skilled laboratory professionals to spend their time on more complex tasks that require critical thinking. “Automation can allow staff to shift their attention from something that isn’t tremendously challenging to something that is,” said Robin Felder, PhD, associate director of laboratory medicine at the University of Virginia in Charlottesville and a laboratory automation consultant.
By overlaying a lean process on top of automation, a lab can process 30% to 50% more specimens with its existing staff, Felder noted. Given that labor accounts for about 50% of costs in unautomated labs, effective use of automation not only helps with staffing shortages but also reduces operating expenses, he added.
Systems Are Getting Smarter
All the major IVD companies have developed products that allow laboratory personnel to spend more time analyzing results and less time barcoding or loading specimens on racks. Increasingly, miniaturized sensors and better computing power are enabling multiple pieces of clever tech to work together.
For example, Roche’s cobas 6800 and cobas 8800 systems improve work-away times by providing ready-to-use reagents, automated onboard storage and refrigeration systems, and radio-frequency identification (RFID) and barcodes that ensure full traceability from accessioning samples to reporting results.
Both systems essentially combine processes in one room that normally would require three different analyzers in three different rooms, explained Youssef Khayali, life cycle leader and senior vice president of solution integration services, workflow, and information technology (IT) for Roche Diagnostics in Rotkreuz, Switzerland. “Results vary from location to location, but in some parts of the world, we’ve seen efficiency increase by up to 70% as a result of automation,” he said.
For small labs with limited budgets, Roche now offers more customized lab automation solutions, such as stand-alone preanalytical systems and software that can be tailored for different needs. In addition, the cobas connection module provides a fast transportation system that integrates various lab disciplines into one plan.
Two new products, the cobas pro analyzer and the e 801 module, will do even more to aid in the staffing shortage as they require minimal operator intervention, according to Khayali. The cobas pro, available thus far only in Europe, provides continuous loading of reagents and consumables, automated maintenance that requires only 8 minutes of manual intervention, and automated reagents calibration.
The e 801, which offers more than 100 immunoassays across a wide range of disease areas, also allows for continuous loading of reagents and consumables. The goal with these new products is to improve efficiency and reduce errors with less hands-on time, Khayali said.
Sysmex also has focused on developing scalable automation across its customer segments—from physician office laboratories, clinics, and small community hospitals to integrated delivery networks and reference laboratories. The goal is to fully integrate networks, creating efficiencies in training, hardware, software, and reagent management, said Danette Godfrey, director of IVD marketing for Sysmex America.
Software also plays an important role by enabling prescriptive trouble shooting to inform users about any issues. This is especially valuable for systems managed by end users who have not had extensive training in quality management analytics, she added.
“Software programs allow for efficiencies through workflow, rule management, and middleware. This allows test results to be released using autoverification and other user settings to enable test results to reach physicians more efficiently, while at the same time freeing up valuable technologists’ time,” Godfrey explained. “Sysmex’s WAM system, now available for hematology and urinalysis, allows for rules configured on-site with validation assistance, workflow training, and go-live support. Training continues with remote, self-pace courses, and access to ongoing education.”
Sysmex America’s introduction of the UN-2000 urinalysis analyzers reduces the need for manual microscopic analysis and was designed to help laboratory professionals with less morphology experience feel confident in their work output, noted Godfrey. Automation in body fluid counting enabled by the GloCyte CSF cell counter will also help staffing shortages by eliminating both chamber counting of cerebrospinal fluids and the need to maintain competency of manual cell counts, she added.
Virtual training and intelligent quality control (QC) programs also can free up staff time. Sysmex’s BeyondCare Quality Monitor uses advanced algorithms and what the company terms artificial intelligence to detect and correct errors before users are even aware of a problem, relieving laboratorians from having to troubleshoot QC failures, Godfrey said.
“If a lab was out of compliance, for example, for not performing its six-month calibration verification, it would have to spend time resolving the deficiency and responding to the accreditation organizations to address compliance. Allowing the software program to support these functions would be useful to laboratories where staffing is limited, and for other laboratories, allows techs to focus on other critical activities.”
Often, reducing repetitive, time-consuming steps for staff also improves turnaround times (TATs). North Memorial Health Care in Minneapolis, for example, implemented Siemens’ Aptio automation a few years ago and has since seen TATs drop significantly. Aptio provides point-in-space aspiration directly from the primary sample on the track. This speeds processing, streamlines workflows, and reduces the need to remove the samples from the track for aspiration.
A puck-based system with RFID enables individual sample routing and tracking, as well as STAT prioritization. In all, North Memorial Health Care’s automation eliminated about 50 manual steps and reduced basic metabolic panel TAT by 19%, from 35 minutes to 29.
Increasing Volumes Without Adding Staff
TriCore Reference Laboratories in Albuquerque, New Mexico, has learned firsthand how automation and other solutions offered by IVD companies help do more with fewer trained laboratory staff. TriCore employs various types of automation for different testing lines, including chemistry, immunoassay, hematology, infectious diseases, and histology. The lab uses systems from a variety of vendors and also relies on robots to move samples from department to department.
“We are fairly vendor agnostic,” explained Eric Carbonneau, MS, MT(ASCP), director of TriCore’s core laboratory. “We simply select the best analyzer for the job. We have been pushing, as others have, for vendors to develop systems that can work together. They are beginning to do that.”
While only about 20% of TriCore’s instrumentation is automated, those systems perform about 80% of the lab’s volume, he said. Much of the nonautomated testing is esoteric, although Carbonneau expects that this, too, one day will be automated.
TriCore also relies on software that configures automatic workflows, such as reflex testing and confirming negative results. Image analysis in cytology also helps reduce the amount of professional intervention required. Carbonneau said TriCore is now looking to automate receipt and barcoding of specimens, which currently requires between one and three full-time staff members.
“We want to be able to have those staff working on things that require decision-making skills, such as looking at samples that are coming in that are critical or examining when the orders are unclear or where intervention is needed,” he explained. “Not only does this make us more efficient, but we also have seen a decrease in repetitive motion injuries.”
Although there are local training programs for medical laboratory scientists, TriCore still faces a shortage of qualified personnel, Carbonneau noted. Automation has allowed the lab to increase volumes without adding more staff.
“Because of automation, we were able to bring on four additional hospitals in the last two years with minimal staffing increases,” he said. “Without it, we would have struggled to increase our volumes by as much as we have while continuing to meet our turnaround times.”
Kimberly Scott is a freelance writer who lives in Lewes, Delaware. +Email: [email protected]