Many medical institutions are deciding to automate laboratory testing in response to staff shortages or to eliminate time-consuming processes. What critical factors should a laboratory manager consider when deciding whether—and how—to automate the blood bank?
Shiny, space-saving analyzers can be alluring to exhausted clinical laboratory and blood bank staff. High staff turnover, continuous training of new personnel, the limited number of qualified laboratory professionals entering the field, the extensive quality assurance demands of the accreditation agencies, and the limited number of hours in a day have blood bank and transfusion service managers seeking answers. Is automation in the blood bank an answer?
Automation in the core laboratory has been utilized for decades, but the transfusion service has more recently emerged as an area to automate. As the only part of the laboratory that “distributes” a product as opposed to test results, it has long been viewed as a very personnel-dependent department, and it is. However, automation in the transfusion service allows laboratories to better utilize their personnel, while at the same time improving the overall quality of results by increasing standardization and reproducibility of results. The right technology may be able to optimize workflow efficiency for small laboratories or assist larger transfusion services with a high-throughput option.
Evaluating automation options
There are two approaches to automation in the blood bank: to automate everything; and to partially automate some things while evaluating the workload. For specific tests, manual methods may still be more cost-effective (e,g, ABO/Rhs). In some cases, manual and automated methods may work well together. For example, if a lab’s testing platform offers tests that are low-volume but highly technologist-dependent, its leaders may consider automating these tests and continuing to perform ABO/Rhs by a manual method. Manual methods release a test result faster than automated methods and may be less expensive.1 Some laboratories have adopted gel technology for antibody screens but decided to keep tube testing for ABO/Rh and antibody identification panels.
The automated platforms come in many different methodology varieties. Some methods employ a technology that is very sensitive.2 This can be a benefit depending on what type of antibody they detect. It will be an asset to be able to detect very weak or newly formed significant antibodies, but the insignificant antibodies such as cold or IgM antibodies may be an additional rule-out that the blood bank will encounter. Different automated methods may also result in higher or lower intensity antibody/antigen reactions that will be found by manual methods and which may surprise a lab’s staff and need to be explained.3 Automation may present stronger or weaker reactions than they previously tested and resulted for their patient population. It is important, then, for transfusion service managers to discuss the dynamics of that patient population with the manufacturers to ensure that their specific needs are being assessed.
When it comes to selecting one company over others, it is crucial for blood bank directors to define their workload. Do they primarily batch test, or is their workflow more continuous over the course of a day? Does their patient population center on specific areas, such as obstetrics? Will creating new processes such as batch testing on specific days of the week help take advantage of efficient use of reagents for an analyzer? It is critical for blood bank directors to discuss these plans with their medical directors and hospital providers to gain buy-in from the clinic and/or hospital departments about changing testing processes. The financial benefit to be gained from automation should be levied and driven by workload and the testing panels that are offered. There is more than bottom-line cost to consider.
Implementing automation
The personnel aspects of automation cannot be disregarded, and blood bank directors need to include them in their considerations. Depending on the experience and technical expertise of the staff, automation may be easier or more difficult to implement. Supervisors must recognize and plan for the realities of human nature; change is difficult for many people. If the new technology is presented effectively, with adequate training, transitioning, and time to become familiar with it, however, staff will come to appreciate the benefits of automation. It can streamline high-demand, high-volume testing and allow staff an option to complete testing in a shorter time, enabling them to perform other tasks—for example, assisting in accreditation preparations, standard operating procedure reviews, and competency assessment.
Recognizing that some laboratorians have more facility than others for multi-tasking, blood bank directors should include in their planning training on time management as it relates to automation. Some staff may require extra guidance in mapping their daily duties.
Night and day
Another consideration is day shift vs. night shift. Lab leaders may consider the possibility that the day shift, which is usually busier, will automate, while the evening/night shift may not. Will routine work wait until the next day? The laboratory manager and blood bank supervisors should assess the experience and comfort level of the night shift personnel. In most laboratories, the night shift will be a smaller crew but tend to cover multiple sections, usually performing the daily maintenance throughout the lab, and it can be overwhelmed with answering phones from the other hospital departments during high-volume traumas. Observing the workload flow and eliciting staff’s input opinion about automation will go a long way in gaining success for automating that shift.
Depending on the platform, work during the night shift is very limited; starting up the analyzer and running controls for 5 to 10 samples may be cost-prohibitive as well as labor-intensive for the smaller staff. If a previous shift can prepare the analyzer for the following shift, automation may benefit the smaller night shift and allow for increasing workflow efficiencies for the entire laboratory. In addition, lab leaders should remember that automating on the day shift but not the night shift will result in testing platforms of two different methodologies. Physicians and providers should be informed of that, as automated platforms may be more or less specific for picking up weak or insignificant cold antibodies that may not be picked up immediately with manual methods. Differing results from the day and night shift can lead to a lack of confidence in the testing results which is not a reflection on the testing personnel, but rather a result of two different processes.
Looking ahead
Issuing blood products to areas of the hospital has been considered as an area for automation. As futuristic as it sounds, there are vending machines that can be placed in operating suites that the blood bank can fill with cross-matched blood for specific patients. This makes travel time to the blood bank, and ultimately the amount of time before transfusion, almost nil. However, it requires numerous steps to ensure blood identification and training for all staff and integration with laboratory information systems software.
There are numerous platforms available to automate the blood bank and its pre-transfusion testing. With deliberate planning, a laboratory can determine the test menu that should be automated, find the best instrument to suit the patient population, and make efficient use of the number and technical experience of the staff.
References
- Shin KH. Economic and workflow analysis of a blood bank automated system. Ann Lab Med. 2013;33(4):268-273.
- Casina TS. In search of the holy grail: comparison of antibody screening methods. Immunohematology. 2006;22(4):196-202.
- Bajpai M, Automation in hematology. Asian J Transfus Sci. 2012. 6(2):140-144.
