While data on the prevalence of COVID-19 tests, confirmed cases and deaths are widely reported, another critical pandemic-related metric has stayed under the radar: the nation’s available blood supply has shrunk dramatically during this time period, placing ever greater demands on blood banking professionals throughout the United Sates.
The American Red Cross reports that while individuals avoided making donations out of fear of potential exposure to the highly infectious SARS-CoV-2, demand for blood became greater than ever. Elective surgeries that had been postponed over the past year are now being rescheduled at the same time that hospitals are dealing with exceptionally high numbers of traumas and emergency department visits, with red cell demand up 10% this year alone.1
The eye of the storm: unprecedented demand, declining human resources
Further magnifying the impact of the blood banking industry’s “perfect storm” is the pandemic’s endless, overwhelming demands on frontline laboratory professionals, exhausting many seasoned laboratorians who may already have been anticipating retirement before the pandemic struck. In addition to processing extraordinary volumes of COVID-19 assays, transfusion medicine professionals also play a central role in screening and qualifying convalescent plasma donations as a potential emergency treatment for severely ill COVID-19 patients. But in addition to the physical risks of contracting the highly infectious and often deadly virus, as well as the physically taxing demands of working during the pandemic, Cabarkapa et al. noted that “emotional stress experienced by frontline healthcare workers is severe and can be enduring.”2
Greenberg et al. stated that “healthcare staff are at increased risk of moral injury and mental health problems when dealing with the challenges of the COVID-19 pandemic.”3 At one major university health system, 1 in 5 healthcare workers reportedly was considering quitting because of the challenges of working during the pandemic, and an additional 30% of healthcare professionals were contemplating scaling back their work hours.4
The demands meted out by the COVID-19 pandemic again reinforced the urgent operational challenges clinical laboratories and blood banks were already experiencing as their everyday reality: addressing demands for increased throughput and efficiency, while simultaneously grappling with an ongoing shortage of trained, certified lab personnel.
The overall demand for blood testing was already increasing, as the global population ages and develops age-related health conditions, as well as multiple comorbidities.5 Pre-pandemic, lab and blood bank managers across the U.S. were already grappling with human resource shortfalls, and the clinical laboratory workforce has been documented as declining over the past several years. In 2019, Garcia et al. reported that vacancy rates for laboratory positions for professionals across all departments had increased over the prior two years. Blood banks were among the most acutely affected by the workforce shortfall, projecting an anticipated 17.25% overall retirement rate — and perhaps even more concerning, a 27.99% projected retirement among lab supervisors — by the year 2023.6
Automation platforms enhance safety, efficiency
With the prevalence of newer and even more highly contagious variants of SARS-CoV-2, including Delta and Lambda, it is clear that the pandemic is continuing to tax healthcare delivery systems and clinical laboratory operations around the world. In light of the dual challenge blood banks are facing to fulfill growing clinical demands with a declining workforce of lab professionals, one viable solution may be automation, including complete and semi-automated technology platforms that provide alternatives to manual tube testing and blood processing. As the need for rapid, efficient testing becomes ever more urgent, new automated and semi-automated diagnostic systems are now available that can help blood banks enhance efficiency, making it possible to automate more than 95% of all assays for patient blood samples. Networked systems are capable of accurately cross-matching blood with minimal waste, a consideration that is even more critical today due to the widespread donor blood shortage.
Even during pre-pandemic operations, human errors associated with manual pre-transfusion testing were a well-documented cause of transfusion-related mortality and morbidity. South et al. noted that most human errors can be eliminated by employing automated systems instead,7 while Mistry et al. reported results from a meta-analysis indicating that 93% of ABO/D grouping errors, which could lead to dangerous and potentially catastrophic patient outcomes, involved manual pre-transfusion testing, while zero cases of such errors were found when full automation was used.8
Balbuena-Merle reports that when compared to manual techniques, automation in blood banking may help increase testing capability and throughput, while simultaneously reducing human resource staffing requirements and the potential for human coding errors. Automation also can promote standardization of results interpretation, increased transfusion safety, specimen batching and efficiency in turnaround times (TATs), and faster release of units, while simultaneously improving test reproducibility, traceability and patient identification.9
The benefits of automation are further supported in a 2000 briefing document published by the U.S. National Institutes of Health (NIH) in which the authors assert that the use of automation in clinical labs should not only increase testing accuracy, precision and significantly reduce TATs, but also potentially enhance employee productivity, physician satisfaction and drive greater efficiencies in the delivery of patient care with the redistribution of workload.10
Automation also may be beneficial in locations where testing is not being performed by trained and certified blood banking professionals, but rather by generalists working in core labs. In short, regardless of setting, automation platforms can allow serologists to shift their focus to the most critical cases that warrant their attention, while the automated systems ensure that the right unit is being tested, for the right patient, at the right time.
Evaluating automation’s potential with workflow analysis and key metrics
Determining whether to adopt an automated approach in blood bank operations first involves clarifying the specific requirements of a site, which involves mapping a complete operational workflow to clearly understand which processes currently involve humans (such as handling, sorting, and distributing specimens), sample arrival patterns, current testing profiles, percent of routine versus non-routine testing, current footprint and lab setup, staffing patterns and so on. The workflow analysis typically identifies bottlenecks, waste, and other potential challenges that automation could address, and many independent consultants, as well as diagnostics systems manufacturers, perform these analyses.
In addition, it is also important to evaluate the applicability of automation by considering key performance metrics, such as average TAT; clearly defining operational processes, such as how STAT samples are categorized and prioritized; and evaluating whether sample storage and retrieval procedures might also benefit from automated approaches.11
Results reported with speed, efficiency and visibility
Finally, the newest lab automation solutions available today also feature integrated software programs that allow organizations of all sizes — from large university reference labs with multiple satellite operations, to small local, regional, or even neighborhood blood banks — to seamlessly access detailed data in real time with greater accuracy and visibility of results. Such systems facilitate consistent recording and secure storage of data, as well as instantaneous recall, review and analysis of results whenever needed, regardless of an institution’s location or size of operation.
The pandemic may have accelerated the urgent need for automation in blood bank settings, but the benefits can be long-lasting. When specified and operated correctly, a fully or semi-automated system should be able to deliver measurable improvements in overall diagnostic performance, accuracy, throughput, quality and standardization, while also helping managers address staffing challenges and show progress toward achieving cost management and other performance-based goals.
References
- American Red Cross. Nation confronts severe blood shortage: Blood donations urgently needed. https://www.redcross.org/about-us/news-and-events/press-release/2021/nation-confronts-severe-blood-shortage-blood-donations-urgently-needed.html. Accessed August 13, 2021.
- Cabarkapa S, Nadjidai SE, Murgier J, Ng CH. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health. 2020;8:100144. doi:10.1016/j.bbih.2020.100144.
- Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368:m1211. doi: 10.1136/bmj.m1211.
- Delaney R, Locke A, Pershing M, et al. Experiences of a health system’s faculty, staff, and trainees’ career development, work culture, and childcare needs during the COVID-19 pandemic. JAMA Netw Open. 2021;4(4):e213997. doi:10.1001/jamanetworkopen.2021.3997.
- Vásárhelyi B, Debreczeni L. Lab test findings in the elderly. EJIFCC. 2017;28(4):328-332.
- Garcia E, Kundu I, Kelly M, Soles R. The American Society for Clinical Pathology’s 2018 vacancy survey of medical laboratories in the United States. Am J Clin Pathol. 2019;152(2):155-168. doi: 10.1093/ajcp/aqz046.
- South S, Casina T, Li L. Exponential error reduction in pretransfusion testing with automation. Transfusion. 2012;52(8):81S-87S. doi: 10.1111/j.1537-2995.2012.03816.x.
- Mistry H, Poles D, Watt A, Bolton-Maggs P; SHOT Steering Group. Human errors in manual techniques for ABO/D grouping are associated with potentially lethal outcomes. Transfus Med. 2019;29(4):262-267. doi: 10.1111/tme.12616.
- Balbuena-Merele R. Transfusion medicine blood bank testing/automation, pathology outlines, 2020. www.pathologyoutlines.com/topic/transfusionmedicineautomation.html. Accessed August 13, 2021.
- Institute of Medicine (US) Committee on Medicare Payment Methodology for Clinical Laboratory Services; Miller Wolman D, Kalfoglou AL, LeRoy L, editors. Medicare laboratory payment policy: now and in the future. Washington (DC): National Academies Press (US); 2000. 3, Technology Trends in the Clinical Laboratory Industry. Available from: https://www.ncbi.nlm.nih.gov/books/NBK223043/.
- Covill L. The LEAN lab: automation, workflow, and efficiency. 2015. Medical Laboratory Observer. https://www.mlo-online.com/continuing-education/article/13008087/the-lean-lab-automation-workflow-and-efficiency. Accessed August 13, 2021
