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Open access

Davide Villa

Automation, Lean, Six Sigma: Synergies for Improving Laboratory Efficiency

The Pathology Services worldwide, surrounded by products are today requesting solutions. The approach aims towards the brain-to-brain cycle between caregivers and laboratory professionals. Despite budgets limited to 2-3% of total healthcare expenses, Laboratories are providing information for > 70% of medical actions. »Perianalytics« is becoming the focus; understanding information and sample flow in the whole journey and processes. Process analysis is the main component to understand and shape the best combination of components in designing a truly cost-effective Laboratory solution. Methodologies like Lean (or Toyota Production System) and Six Sigma have started recently to be adopted also in healthcare and in the Laboratory environment. Those techniques showed already successful implementations in healthcare, after their development in other sectors. Their tools are addressing the definition of »value«, »waste«, »flow« as key drivers to improve performances. The synergy among the methods allows decision makers to identify the degree of automation really necessary in their laboratory, with streamlined processes. The different platforms made available by industries, for in vitro diagnostic testing, could become not cost-effective or efficient without a careful assessment of needs, pathways and value-related variables. Total laboratory automation or stand-alone islands for systems can be identified and chosen after process mapping and recommendations deployed with Lean and Six Sigma techniques. This article highlights some key concepts of Lean and their fit in laboratory organization, as methodologies to be implemented before selecting and adopting automated systems.

Open access

Jean-Michel Valid

Progressive Automation - The Solution of Choice for Improving Lab Efficiency

Today's hospital laboratory faces increasing pressure to improve turnaround time (TAT), while being required to handle an increasing number of test requests. At the same time, it must operate ever tighter cost controls. Using LEAN process improvement techniques is an effective way of identifying how to delivering greater efficiency and quality. LEAN focuses on identifying those processes that add value and on eliminating the ‘waste’ - those unnecessary, non value adding steps that cause bottlenecks and delay the delivery of results. Greater use of LEAN analysis also confirms that one of the most effective ways of achieving greater overall efficiency is by automating laboratory processes. With Beckman Coulter's progressive automation solution, a laboratory is likely to see a return on its investment within 18 to 36 months. Beckman Coulter uses a LEAN scorecard to enable the laboratory to easily assess its current testing processes and identify specific areas where improvement is needed. By doing this in advance, a laboratory can expect the implementation of its progressive automation solution to go smoothly. In addition, the average laboratory can automate its pre-analytic testing, using a high speed automated sorter, in as little as two weeks.

Open access

Fatma Ucar, Gonul Erden, Mine Yavuz Taslipinar, Gulfer Ozturk, Zeynep Ginis, Erdem Bulut and Namik Delibas


Bachground: Sample classification and registration have been recognized as important and time-consuming processes in laboratories. There is increasing pressure on laboratories to automate processes due to intense workload and reduce manual procedures and errors. The aim of the present study was to evaluate the positive effects of an automatic tube registration and sorting system on specimen processing.

Methods: An automatic tube registration and sorting system (HCTS2000 MK2, m-u-t AG, Wedel, Germany) was evaluated. Turnaround time (TAT), rate of sample rejection and unrealized tests were examined 12 months pre- and post-implementation of the automatic tube sorting and registration system.

Results: The mean TAT of routine chemistry immunoassay, complete blood cell count (CBC) and coagulation samples were significantly improved (P<0.001). The number of rejected samples and unrealized tests was insignificantly decreased post-implementation of the system (0.4% to 0.2% and 4.5% to 1.4%, respectively) (P>0.05).

Conclusions: By reducing delays and errors in the preanalytical processing and sorting of samples, significant improvements in specimen processing were observed after implementation of the system. These results suggest that an automatic tube registration and sorting system may also be used to improve specimen processing in a higher-volume core laboratory.

Open access

Sol Green

Improving the Preanalytical Process: The Focus on Specimen Quality

Trends in clinical laboratory practice place more demands on the quality of patient specimens. Advances in analytical performance (i.e., increased automation, reduced sample volume, increased assay sensitivity), as well as efficiency and cost reduction gains (i.e., throughput, test turnaround time) have improved medical practice. These changes, however, have caused an increased incidence of preanalytical errors, dictating the need for higher-quality specimens. The following paper addresses these errors in addition to methodologies for improving the quality of the preanalytical phase.

Open access

Mario Plebani


Laboratory medicine, as a specialty that had prioritised quality control, has always been at the forefront of error reduction. In the last decades, a dramatic decrease of analytical errors has been experienced, while a relatively high frequency of errors has been documented in the pre-analytical phase. Most pre-analytical errors, which account for up to 70% of all mistakes made in laboratory diagnostics, arise during patient preparation, and sample collection, transportation, preparation for analysis and storage. However, while it has been reported that the pre-analytical phase is error-prone, only recently has it been demonstrated that most of these errors occur in the »pre-pre-analytical phase«, which comprises the initial procedures of the testing process performed outside the laboratory walls by healthcare personnel outside the direct control of the clinical laboratory. Developments in automation and information technologies have played a major role in decreasing some pre-analytical errors and, in particular, the automation of repetitive, errorprone and bio-hazardous pre-analytical processes performed within the laboratory walls has effectively decreased errors in specimen preparation, centrifugation, aliquot preparation, pipetting and sorting. However, more efforts should be made to improve the appropriateness of test request, patient and sample identification procedures and other pre-analytical steps performed outside the laboratory walls.