Lab Automation Prepares Hospital for a Changing Future

Like many areas of health care, hospital clinical laboratories must maintain high volumes of work while managing staffing shortages, changing technology and rising costs. Shore Health System is the first clinical laboratory on Maryland’s Eastern Shore to address these issues by implementing a fully automated testing system at The Memorial Hospital at Easton.

Gary Shortall, manager of Shore Health Laboratories, says, “Fewer students are choosing the field of medical technology. At the same time, nearly half of medical technologists nationwide will be ready for retirement by 2010. With this automated system in place, Memorial Hospital can respond to the increased demand for lab tests even as our workforce decreases.”

Since June, medical technologists at Memorial Hospital have been learning new ways to perform their highest volume of lab tests. The transition to lab automation took place over a three-month period. The first step was installation of a conveyor “track” and connecting it to testing instrumentation in the existing lab workspace.

“It was like living in a house under construction,” says Karen Bitter, supervisor and automation specialist for Memorial Hospital. “Each day was a new adventure. Throughout construction, all of the equipment we use to perform testing was kept up and running to meet our 24/7 testing schedule.”

While the track was being installed in the lab, Bitter and other members of the Memorial Hospital laboratory staff traveled to California for training on the Beckman Coulter automation system. Bitter also worked closely with Shore Health System’s information technology experts to program software that tells the track how to move specimens along the line for each of the tests that the system handles.

The automated system is now programmed to perform over 100 of the tests most commonly ordered by physicians. The new system processes over one million tests a year. The menu of tests includes blood glucose levels, cholesterol, triglycerides, kidney function, cancer markers, prostate specific antigen and pregnancy tests.

Efficiency and safety top the list of benefits that automation has brought to the Memorial Hospital lab. Before automation, a medical technologist handled one specimen multiple times if it was needed for more than one test. “Now, once a tube is on the track, that is the last time a tech touches it,” Bitter says. “The specimen goes where it needs to go without constant monitoring by a technologist.”

When the medical technologist places a tube onto the automated track, the system removes the stopper from the specimen tube. The track delivers the specimen to separate instruments if the same sample is needed for more than one test. The tube travels around the track from one station to the next in a shallow metal cup called a “puck.” When the cycle of testing is completed, the tube is lifted from the puck by an automated “finger” and placed in a storage rack, where it can easily be retrieved if another test is requested for the same patient.

With less human handling, specimens are less likely to be dropped, spilled or lost. Additionally, medical technologists are not exposed to potentially infectious specimens since they no longer come in contact with the contents of each tube.

Once a specimen is put onto the track, medical technologists consult computer terminals at a “central command” work area to oversee the testing process. The tracking system displays the status of each test and the location of each specimen. Bitter adds, “The system also flags a test that has not been completed within a timely fashion so that a technologist can troubleshoot the delay.”

The benefits of lab automation extend beyond the lab itself. The automated system produces test results more quickly, which gives physicians the information they need to make prompt diagnoses and treatment decisions for their patients.

The system uses a bar code reader that matches the specimen with the test ordered for a specific patient. “A bar code reading is taken at every significant point in the testing process,” Bitter explains. “This ensures that we are performing the right test for the right patient every time.”

Tapping the power of automation will continue with phase two of the project. In 2009, the system will be programmed for auto verification of test results to ordering physicians. This new functional will allows test results that are considered normal to be automatically reported without manual intervention, which expedites access to this information.

“Automation is a potential answer to help alleviate the growing labor shortage in the field of medical technology,” says John Nevins, director of laboratory services for Shore Health System. “The system we have installed brings with it improved functionality to the laboratory, while robotics and expert decision-making software assists the technologists in maintaining increased workloads.”

Nevins adds, “Automation gives the medical technologists more time to focus on abnormal samples, problem solving and complex procedures, activities that utilize their specialized knowledge, experience and judgment.”

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