A core laboratory in Halifax, Nova Scotia, that implemented a series of lean approaches to improve turnaround time (TAT) of blood test results found that total lab automation (TLA) and auto-verification rules were effective in managing large quantities of routine and urgent samples. 

A third approach, an electric track vehicle system (ETV) yielded less promising results, delaying phlebotomy to reporting TAT (PR-TAT) in the core lab setting. 

Investigators in 2013 had established a core lab system in the hopes of improving methods for processing samples and conducting tests. The core laboratory business model “has a number of benefits, such as less fragmentation and redundancy of resources, and enhanced [TAT] for more rapid diagnosis, that results in improvement of both the cost and quality of services,” they wrote, describing their findings in Clinical Biochemistry. 

TLA, ETV, and auto-verification rules were included as elements of this system. TLA “was a critical component of this project, which complemented the goal of efficiency created by the harmonious interaction between state-of-the-art robotics, highly sophisticated middleware, and laboratory information systems,” the investigators observed.

Clinical labs use auto-verification predefined rules to deliver sample results without any manual interventions. ETV systems are used to deliver registered samples to the core lab.

To determine the impact of these lean measures on PR-TAT under the core lab model, the investigators enlisted five representative tests to compare mean, median, and percentage of outlier (OP) for PR-TAT during two time periods: before the core lab was implemented, and afterward. 

They also did a comparative analysis of two other parameters, in-lab to reporting TAT (IR-TAT) and the phlebotomy to in-lab TAT or delivery TAT (PI-TAT), to determine the respective efficiencies of the TLA and ETV systems. 

For urgent samples, median PR-TATs across all scenarios went down by an average of 16%, the investigators reported. Median PR-TAT for routine samples experienced the following reductions: 51% for urea; 50% for potassium; 49% for thyroid stimulating hormone; 34% for complete blood count (CBC), and 22% for prothrombin time (PT). 

The authors attributed the shorter PR-TAT to a significant reduction of IR-TAT brought about by the TLA. At the same time, however, they found that using the ETV delayed median PI-TAT. 

Auto-verification rules managed to reduce median IR-TATs for urea and potassium. And yet, investigators noticed that the post-core lab PR-TAT OP for STAT requests exceeding one hour was higher than before the core lab was implemented. 

The ETV system experienced the worst results. Compared with the pre-ETV period, ETV delayed median PI-TATs for CBC and PT STAT and urgent samples by an average of 12 and 14 minutes, respectively. The transition to ETV didn’t appear to affect results for routine samples. 

While it didn’t improve OP times for STAT and routine requests, ETV did shorten OP for urgent requests that exceeded 120 minutes.  

The investigators cited design problems for the issues with ETV and poor TAT results. “The ETV system installed in our laboratory contains three cars, and its efficiency relies on the timely loading and unloading of the cars by laboratory staff. This poses a challenge if there is an insufficient number of dedicated staff or during peak times when the number of samples arriving could exceed the capacity of the system,” they explained. 

Lab personnel have since learned how to run the ETV system more efficiently, in conjunction with manual delivery procedures. The authors recommended a follow-up study on the ETV system’s efficiency in light of these improvements.