Total Laboratory Automation and Three Shifts Reduce Turnaround Time of Cerebrospinal Fluid Culture Results in the Chinese Clinical Microbiology Laboratory

BackgroundTotal laboratory automation (TLA) has the potential to reduce specimen processing time, optimize workflow, and decrease turnaround time (TAT). The purpose of this research is to investigate whether the TAT of our laboratory has changed since the adoption of TLA, as well as to optimize laboratory workflow, improve laboratory testing efficiency, and provide better services of clinical diagnosis and treatment.Materials and MethodsLaboratory data was extracted from our laboratory information system in two 6-month periods: pre-TLA (July to December 2019) and post-TLA (July to December 2020), respectively.ResultsThe median TAT for positive cultures decreased significantly from pre-TLA to post-TLA (65.93 vs 63.53, P<0.001). For different types of cultures, The TAT of CSF changed the most (86.76 vs 64.30, P=0.007), followed by sputum (64.38 vs 61.41, P<0.001), urine (52.10 vs 49,57, P<0.001), blood (68.49 vs 66.60, P<0.001). For Ascites and Pleural fluid, there was no significant difference (P>0.05). Further analysis found that the incidence of broth growth only for pre-TLA was 12.4% (14/133), while for post-TLA, it was 3.4% (4/119). The difference was statistically significant (P=0.01). The common isolates from CSF samples were Cryptococcus neoformans, coagulase-negative Staphylococcus, Acinetobacter baumannii, and Klebsiella pneumonia.ConclusionUsing TLA and setting up three shifts shortened the TAT of our clinical microbiology laboratory, especially for CSF samples.

Total lab automation in microbiology: An overview of BD Kiestra InoqulA and Copan WASP

Total Laboratory Automation (TLA) is the future of laboratory diagnostics due to its efficiency, reproducibility, better turnaround time (TATs), precision, sensitivity, and specificity. Microbiology is generally considered a human dependent field and still, most of the microbiology world is confused with TLA implementation. Two better-claimed technologies BD Kiestra InoqulA and Copan WASP have emerged as a well satisfactory solution of microbiology automation in the last decade. Here we design a practical approach and reviewed all studies of BD Kiestra InoqulA and Copan WASP, assessed microbiology samples in a healthcare setting.

Designing a diagnostic Total Testing Process as a base for supporting diagnostic stewardship

To more comprehensively support clinical management of patients in our hospital, we redesigned the diagnostic Total Testing Process (TTP) from request to report. To that end, clinical needs were identified and a vision on Total Laboratory Automation (TLA) of the TTP was developed. The Delft Systems Engineering Approach was used for mapping a desirable laboratory testing process. The desirable “To Be” diagnostic process was tendered and the translation of a functional design into a specific TLA-configuration – compliant with the vision and the predefined functional design – was accomplished using a competitive dialogue tender variant (based on art. 29 of the EU guideline 2014/24). Realization of this high-end TLA-solution enabled a high-quality testing process with numerous improvements such as clear and supportive digital request forms, specimen consolidation, track and trace and non-conformity registration at the specimen level, better blood management (∼40% less blood sampled), lean and in line processing with increased productivity (42% rise in test productivity per capita), and guaranteed total turn-around-times of medical tests (95% of TLA-rooted in line tests are reported <120 min). The approach taken for improving the brain-to-brain loop of medical testing, as fundament for better diagnostic stewardship, is explained.

Impact on microbiology laboratory turn-around-times following process improvements and total laboratory automation

ABSTRACTIntroductionThe impact of workflow changes and total laboratory automation (TLA) on microbiology culture processing time was evaluated in an academic-affiliated regional hospital.Materials and MethodsA retrospective analysis of microbiological data in a research database was performed to compare turnaround time (TAT) for organism identification (ID) before and after implementation of TLA (2013 versus 2016, respectively). TAT was compared using χ2 test for categorical variables and log-transformed t-test for continuous variables.ResultsA total of 9,351 pre-defined common and clinically important positive mono-bacterial culture results were included in the analysis. Shorter TAT (hours) in 2016 compared to 2013 (p<0.0001) for positive result pathogen ID were observed in specimen types including blood (40.7 vs. 47.1), urine (30 vs 44), wound (39.6 vs. 60.2), respiratory (47.7 vs. 67), and all specimen types, combined (43.3 vs. 56.8). Although shorter TAT were not observed from all specimen categories for negative result pathogen ID, TAT for all specimen types, combined, was shorter (p≤0.001) in 2016 compared to 2013 (94 vs. 101).ConclusionsTotal laboratory automation and workflow changes—including process standardization—facilitate shorter organism ID TAT across specimen sources.