1. Improving Efficiency in Clinical Laboratory
Dr Farooq Ghani
Aga Khan University

2. Over 70% of Healthcare Decisions are based on Medical Tests

3. Clinical Lab Process Improvement
Online connectivity of the main lab to11 regional labs and 187 phlebotomy centers throughout the country
Barcoding samples at collection site
Lab Automation

4. Online Connectivity & Barcoding

5. Routine Lab Practice Blood Samples Whole blood Hematology
~25 %
Serum based / plain blood
~75 %
Chemistry / Immuno chem
Other assays
Automation
~ 90 %
~ 10 %

6. “The first rule of any technology used in an organization is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency”
Bill Gates

8. Personnel Optimisation
Increase
Capacity
Reduce
Errors
Faster
TAT
Laboratory
Automation
Space
Utilization
Personnel Optimisation

9. High Gain Opportunities
Turnaround Time
High Gain Opportunities

10. Goal: Reduce Costs and Turnaround Time
17 Steps
Samples manually logged into laboratory
Verification of Collection at LIS
Load individual tubes into centrifuge
Centrifuge Samples
Unload each tube from centrifuge
Split samples for separate workstation
Distribute samples to each workstation
Visualize Serum Indices
Check QC
Load sample tube on wheel
Results validated and verified at LIS
Samples Stored
Delta Checking
Program tests not validated
Rerun tests not validated
Identify samples for reflex testing
Reflex Testing
Fewer steps equal
faster, more consistent
turnaround
Costs
&
TAT
9 Steps
Samples manually logged into laboratory
Verification of Collection at LIS
Load racks into centrifuge
Centrifuge samples
Unload racks from centrifuge
Place racks on analyzer
Rerun tests not validated
Identify samples for reflex testing
Reflex Testing
5 Steps
3 Steps
Samples placed into inlet station
Place racks on analyzer
Rerun test not validated
Reflex Testing automatically
Samples stored
Samples placed into inlet station
Review by exception
Samples stored
Current Lab
Process
System-Based
Automation
Discrete
Automation
Connected
Automation
Productivity Increases

11. Steps Automated in the Diagnostic Laboratory
Post-Analytical
Pre-Analytical
prepare order
collect sample
transport to lab
Sample retrieval
accession sample
store samples
centrifuge
dispose of waste
post-sort
decap tubes
transmit test results
pre-sort/aliquot
technical validation
transport to analyzer
Analytical

12. Solutions to Streamline the ProcessX
Pre-Analytics
EDTA
tubes X
Track X
Tube Storage & Retrieval X
Informatics
Receive
into lab
Sort
Sample
tubes
Load
centrifuge
Unload
centrifuge
Decap
Label
aliquot
tubes
Aliquot
Sort
Load in
Input Queue
Walk to
analyzers
Pre-Analytics (100% of tubes / >50% of labor)
Load
analyzers
Post-Analytics (100% of tubes / 8% of labor)
Store
racks
Archive
tubes
Recap
tubes
Walk
to storage
area
Unload
analyzers
Verify/ Manage
exceptions
Rerun
exceptions
Locate
exceptions
Verify
at LIS
To summarize, with Abbott you will have the flexibility to implement some or all of our solutions which will help streamline your process. This diagram depicts a typical laboratory process. By implementing a pre-analytic automation such as ACCELERATOR APS you will be able to automate the most labor intensive processes in the lab. Informatics can address many of the post-analytic steps such as archiving and results validation. Implementation of a track will eliminate the sneaker net and tube storage and retrieval will automate add-on and repeat testing. Furthermore, APS gives you the flexibility to any or all of these components at any time ensuring that your system will grow and change as you do.
Find
tube
Load on
analyzer
Verify at
LIS
Unload
analyzer
Recap
tube
Archive
tubes
Store
racks
Exceptions (10% of tubes)

13. Understanding your Processes
Process Mapping
Analyze your processes
Identify opportunities
Eliminate waste
Another tool we use in understanding your processes is process mapping. There are different types of process maps that we use to uncover different information, from flow charts and timing diagrams, to Value Stream Mapping and SIPOC illustrations. These different methods and tools all have three things in common, they help analyze your business and processes, 2) Identify opportunities for improvements, and 3) help to identify and uncover wasted efforts or steps that are not needed. Ultimately these drive the future processes.

14. Metrics for Success Tube Arrival Test/Tube Testing Volume TAT Analysis
Capacity Planning
Efficiency
The third step in our methodology is to collect measures and metrics for success. These metrics are used for understanding the current state and for designing the future solutions that will optimize the operations of the laboratory. Having a defined understanding of where you are will allow you know how far you need to go to reach your goals. The analysis performed for your laboratory is customized based on your workflow.

15. Laboratory Automation
New Generation of
Laboratory Automation

16. Laboratory Automation
New Generation of
Laboratory Automation

17. Automated Core Laboratory
New Generation of
Laboratory Automation

18. Core Lab
We need to have less text on the three bullit points to make the slide easier and be able to talk around it.

19. Regional Labs
We need to have less text on the three bullit points to make the slide easier and be able to talk around it.

20. Satellite Labs
We need to have less text on the three bullit points to make the slide easier and be able to talk around it.

26. ADVIA® Automation
Let me now provide you with a brief overview of what Siemens automation is. Siemens automation basically has three aspects: Sample Manager, Track and Instrument (in this case, IMMULITE, ADVIA 1800 and Centaur XP)
The sample manager is the heart of the system. It is the area in which you load and unload specimens…therefore, only one area to perform testing on three different platforms (in this example). The Sample Manager has capacity for 1000 tubes (separated into 10 trays of 100 tubes). Once you load a tray, which you see in the video in just a moment, the sole robotic arm within the SM loads the specimens, one at a time, onto the track. Once they are put onto the track, the barcode is read, the specimen is auto-received (or accessioned) and then it is routed to where it needs to go. Once it has travelled to the appropriate instruments and components, it is routed back to the SM for post-analytical sorting. In other words, when the SM unloads tubes from the track, it sorts them into pre-designated trays for archival.
Run Video

27. ADVIA® Automation
Next let’s look at the track. The track system is a two-lane, puck-based, system. In other words, tubes are handled individually (they go to where they need to go ONLY)..and the two lane system maximizes efficiency because the tube ahead is never impeding the one behind, as it all tubes are routed to “divert lanes” or service roads when a particular test is requested.
Run Video

28. ADVIA® Automation Solution User Outcomes
2004
2006
2007
2008
Reporting errors
60% reduction in error
And lastly, U of M also realize a 60% decrease in reporting errors from ’04 to ’08. How much is an error worth?
Individual results may vary.

29. Process Efficiency Tubes (thousands) 5 4 3 2 Primary tubes 1 % 100 7550 25
Aliquots
$1,600 savings
98% reduction
This slide represents outcome evidence from an existing customer of ours, ACM in Rochester NY…whereby they implemented ADVIA Automation and realized significant efficiencies…specifically surrounding this concept of maximizing their automated menu. By connecting multiple instruments to a common track, they were able to share tubes between systems without the need of creating incremental (daughter or aliquot) tubes. This saved them nearly 2,000/day, which totalled $1,600 in savings per month….just in tubes! They were able to accomplish this b/c of their decreased requirement to aliquot - by 98% (remember, tubes = work…the more tubes you create the more work you create). Not to mention the pure cost of creating tubes (tube costs, label costs, tips costs etc…) Prior to ADVIA Automation, they were virtually aliquotting everything!
Lastly, due to the fact that ACM was handling their tubes less (performing less aliquots and generating less tubes) they have reduced their chance of mis-labelling to a 1:1600 chance!
By the way, just like most ADVIA Automation peak performance labs, their workload nearly doubled to approx. 5MM tests/year!
Source: ACM
lthcare Diagnostics Inc.
Individual results may vary.

30. Technology Adoption Life Cycle

31. Thank You

32. Thank You