The Automated Laboratory: A new benchmark for Quality Standards and Patient Safety in the UAE

Published on : 3 April 2018
Location : Abu Dhabi

Worldwide, the aging population and their need to consume more healthcare-related services are on the rise. Coupled with the increased ability to diagnose chronic diseases and illnesses, the need for more cost-effective clinical laboratory results is now greater than ever before. Increasing the efficiency to maximize the productivity and manage costs has become critical for the long-term success of the clinical laboratory.

Years ago, it would have been difficult to imagine a time when a patient specimen would reach the laboratory and be logged-in, sorted, analyzed, resulted and stored without human intervention. With recent applicable advances in medical laboratory automation and exciting innovations this is now a reality.

In December 2016, National Reference Laboratory (NRL), a Mubadala Company created in partnership with and managed by Laboratory Corporation of America(R) Holdings (LabCorp(R)), became the first fully-automated referral laboratory in the UAE. With a continuous focus on quality, NRL is also the largest laboratory network in the Middle East accredited by the College of American Pathologists (CAP).

Arab Health Magazine spoke to Dr. Jay Murthy, Technical Director of NRL, who oversaw the installation of the total automation system.

PROJECT DEVELOPMENT

As Dr. Murthy explains, accurately defining the scope and task list for the project was essential in order to execute the installation in less than three months without disruption to the daily laboratory operations.
"The fact that we were able to achieve our implementation timeline was remarkable because of the logistical challenges involved in a project of this scale," Dr. Murthy says.

A key factor contributing to the success of the project was that NRL's main testing facility in ICAD, Abu Dhabi is a purpose-built laboratory with the necessary flooring infrastructure to accommodate the system.
Due to the special suspended flooring, no structural changes were required to install the new equipment. "Every square meter of flooring has its own water, drainage and electrical supply, thus making the equipment easy to install." Dr. Murthy explains.

BUSINESS AS USUAL

The laboratory operations flow continued throughout the installation as each automated module was installed one-by-one. The NRL team was able to manage the entire project without interruption to testing departments.

During the installation, the NRL team created a number of backup systems to ensure sustained operational processes. As a College of American Pathologists (CAP) and ISO 15189 accredited laboratory, validation was performed for each module as per international quality control guidelines.

A CUT ABOVE THE REST

The Total Laboratory Automation system implemented at NRL is one of the latest innovations by the diagnostics leader, Roche Diagnostics. The system greatly improved NRL's workflow by physically connecting the different instruments used throughout the three phases of the testing
process: pre-analytics, analytics and post-analytics.

The journey of the patient sample tube starts by traveling through the Pneumatic Tube System (PTS) to the Bulk Loader which sorts the incoming tubes based on size, weight and label color. If required, the sample is then sent to the centrifugation module followed by de-capping of the tube. CCD cameras capture images of the tube to identify sample integrity (HIL) and a laser light is used to assess the sample volume allowing for intelligent specimen handling. Next, an aliquoter module will create barcode labelled-aliquots from the primary tube. The computer controlled connected solution will then send each tube to the targeted analyzer for analysis. Following analysis, the tube is sent, through an automated track system, to the post-analytical unit which is a refrigerated sample storage unit. Any sample stored in the post-analytical module can be retrieved and sent to analysis again with just a mouse click.

Dr. Murthy finds that this solution, connected to pneumatic sample delivery system, is what really differentiates this project from others.

 

The brain controlling the operation of this connected system is a middleware innovative solution, designed to make the different parts of the system work flawlessly together and allows for the entire production line to be monitored and controlled efficiently.

NRL has also implemented a post-analytic Auto Verification System. This automated process allows the comparison of patient results to laboratory-defined acceptance criteria. If the results are within the accepted parameters they are automatically released without human intervention. "Therefore, the technical staff may focus on abnormal results that require manual verification. This operational efficiency increases the attention and focus given to the abnormal results, which in turn greatly enhances the standard of care and patient outcomes,"
says Dr. Murthy.

THE HUMAN ELEMENT

A frequently asked question, regarding the use of robots and automation technology, is whether it means that human input is no longer required; a topic that Dr. Murthy says was an important consideration when evaluating the feasibility of the project at NRL.

"While in the beginning there was an element of reluctance by the staff, as the robotic component dictated that staff and automation must work together on every process from technique to workflow. However, once trained, our staff quickly saw the benefits of the system," Dr. Murthy explains. "Creating efficiency doesn't mean that we need fewer people, it simply means we are able to free up the skill sets of the technologists, who can work in the esoteric testing areas in our various centers of excellence. Automation facilitated our ability to further develop our in-house technical talents."

Dr. Murthy gives an example of how NRL has been able to improve the testing turnaround time and free up resources. "Before the automation setup, the processing of high volume tests  was more labor intensive.
Our highly experienced and qualified medical technologists would have to manually de-cap, sort and load thousands of samples, which could take 8
- 12 hours. Automating these tasks reduced this time to less than an hour."

ENABLING FUTURE GROWTH

Through its network of ten laboratories NRL currently processes more than 500,000 tests per month for over 200 clients across the MENA region.  As Dr. Murthy explains, one of the key benefits of the automated system is the enhanced quality and accuracy it brings in the pre-analytical areas. It provides a standardized process that further enables NRL to streamline its operation and deliver high-quality patient results in the shortest time possible. Immediately after the go-live, there was an improvement of the turnaround time of up to 48%for some specific routine tests.

Dr. Murthy continues: "With respect to volumes our core laboratory is now able to accommodate significantly higher volume without the cost of additional equipment or manpower. Utilizing our current complement of analyzers more efficiently due to the streamlined pre-analytical processing will now allow us to exceed a total of 7 million tests in
2017 and have substantial room for growth in 2018".

Supported by the well-developed laboratory management systems, the Laboratory Information System and other advanced connectivity solutions in which NRL has invested, this Total Laboratory Automation system is one of the key components that drive the future growth of the company.

 

A LOOK INTO THE FUTURE

NRL plans to continue to evaluate quality, patient-focused technology in the areas of robotic automation. The future is bright for these enhancements, not the least of which are automated phlebotomy, transportation processes using drones and artificial intelligence. These advancements will provide greater access to health care for rural areas that are now challenged to attain the level of health care they need.

NRL remains true to its vision to increase the spectrum, coverage and overall efficiency of laboratory testing, to implement international best practices of reference laboratory processes and to set the benchmark for quality standards in the region. With the introduction of the first Total Laboratory Automation solution among the referral laboratories in the UAE, NRL continues to realize its vision.