Specimen collection is the process of obtaining tissue or fluids for laboratory analysis or near-patient testing. It is often a first step in determining diagnosis and treatment.1-2 The collection and handling of samples has to be carried out in a way which maintains the integrity of the sample and therefore eliminates the possibility of obtaining erroneous data or results.1 Additionally, the process should be organized so that it doesn’t pose a threat to the health and safety of the medical personnel involved.
The potential for misdiagnosis, misidentification, and other errors increases with the incorporation of human or manual processes, and that has been the spur for efforts to automate specimen collection. Economic factors are also pushing lab leaders to consider automated approaches. What inroads is automation making? Will some processes always require human involvement?
Automated specimen processing
Automated specimen collection must be differentiated from automated specimen processing. The latter has long benefitted from extensive automation.
In fact, automated specimen processing is already in wide use. Many Chemistry and Hematology labs have been fully automated for years. In Microbiology, automation has been limited due to the difference in the viscosity and other aspects of the samples being tested, but it has made significant inroads recently. Many systems and much machinery have already been designed to accomplish numerous laboratory specimen processing tasks. For example, Microbiology expert Gillian Jones, from Plymouth Hospitals NHS Trust, has published a study in the Journal of Clinical Microbiology which indicates that one automated system planted 50,000 plates from elution swab samples. She observed consistent isolated colonies with no evidence of cross-contamination.3
Automated specimen processing continues to be streamlined with the invention of modern equipment capable of accomplishing complex batch processes while ensuring data integrity. Lab personnel benefit in that repetitive and stress- or fatigue-inducing tasks are eliminated. Traceability and tracking are also improved with the use of barcode systems and automated specimen processors, which automate entry of data in laboratory information systems (LIS). Radio-frequency identification technology systems are also used to automate specimen tracking.
Why has it been more of a challenge to automate specimen collection? Part of the reason is the variety of sample types that must be collected—for example, blood, urine, throat swabs, bone marrow, nasopharyngeal and aspirate, and mucosal secretions. It is difficult to imagine a single technology that would be adaptable to all.
Robot phlebotomists
Despite the challenge of fully automating sample collection, some progress has been made. One vendor is developing a fully automated venipuncture solution.4 This “robot phlebotomist” incorporates infrared light, image analysis, and ultrasound to locate the right vein, confirm blood flow, and insert the needle. The patient slides an arm inside a padded archway; the device tightens a cuff around the arm and deploys an infrared camera together with software analysis—matching skin patterns with models—in search of a vein. It then uses ultrasound to ensure sufficient blood flow before aligning the needle and drawing blood with a vacutainer system. The vacutainer’s low pressure vacuum design allows for some level of automation in the volume of blood that is drawn. However, a nurse or phlebotomist is still needed to interact with the patient, and shepherd the process along.
Should this product ever come to market, do its results justify consideration? According to its developer, the device is successful 83 percent of the time, a rate which is on par with experienced phlebotomists and superior to newly trained staff, who typically draw blood successfully on the first attempt one-third of the time.4 When the procedure involves children, the elderly, or a dysmorphic patient, the failure rate, even for experienced phlebotomists, is 55 percent. The vendor plans to improve the device’s accuracy to 90 percent or above before starting clinical trials.
Another similar device, also in development, claims to have achieved close to 100 percent success.5 Relying on much the same technology, this robot automatically identifies, matches, locates, and exploits a vein without a human needing to come in contact with needles, or the specimen. Its makers tout its efficacy in hazardous environments, such as Ebola-challenged areas, where necessary medical rigor is combined with the dangers of exposure.5
Barcode collection systems
Barcode collection systems have also been used when collecting blood samples to limit positive patient identification (PPI) errors. There is no doubt that this system, in particular, has reduced the number of human errors in the collection process.6 Here is what is typically involved:
• A phlebotomy technician or nurse prepares to visit the assigned patient.
• The technician asks the patient to state his or her name and date of birth.
• The technician uses a barcode reader to scan the patient’s bracelet using the mobile scanning unit.
• An appropriate label is printed from the portable printer.
• The technician collects the samples in the order indicated by the machine and labels each tube.
• The technician scans the bracelet along with each tube again to signal to the machine that all the samples have been collected. This indicates to the LIS that all samples have been obtained.
• The technician submits the information to the LIS with the press of a button. The LIS then stores the state of the samples as being ready for transport but not yet delivered.
• When the samples reach the lab, they are scanned again in an automated processing track, and the LIS updates their status.5
The human touch
Until patients reduce morphological presentations, or some future medical development obviates the necessity of individual patient evaluation, the human touch will always be a part of specimen collection. Consider the collection of a particular type of sample from a baby, an adult, and an elderly person. For each patient, there are considerations which would be inapplicable to the hypothetical others. A patient’s current medical and physical state, along with environmental conditions, will also dictate individual interactions. For example, for a patient with an intravenous line, the blood sample has to be collected from the other arm or from a vein that is below the IV insertion point. Only a human may implement any such procedural modification that may be required.
Thus the use of automation in specimen collection will remain some distance behind automated specimen processing—at least, for some time to come.
References
- Dougherty, L, Lister, S. Royal Marsden Hospital Manual of Clinical Nursing Procedures. Nursing Standard. 2004; 19(2):29-29. doi:10.7748/ns2004.09.19.2.29.b120.
- Higgins D. Specimen Collection 1. Obtaining a Midstream Specimen of Urine. Nursingtimesnet. 2008. http://www.nursingtimes.net/nursing-practice/specialisms/infection-control/specimen-collection-1-obtaining-a-midstream-specimen-of-urine/1295662.article. Accessed April 24, 2015.
- Jones G, Matthews R, Cunningham R, Jenks P. Comparison of automated processing of flocked swabs with manual processing of fiber swabs for detection of nasal carriage of Staphylococcus aureus. J Clin Microbiol. 2011;49(7):2717-2718. doi:10.1128/jcm.00504-11.
- Perry T. Profile: Veebot – IEEE Spectrum. http://spectrum.ieee.org/robotics/medical-robots/profile-veebot. Accessed April 24, 2015.
- Patil S. Robot-assisted phlebotomy to assist and protect healthcare workers and researchers. OpenIDEO, 06 Nov. 2014. Web. 24 Apr. 2015. https://openideo.com/challenge/fighting-ebola/research/robot-assisted-phlebotomy-to-assist-and-protect-healthcare-workers-and-researchers.
- Trask L. Barcode specimen collection improves patient safety. MLO. 2012;44(4) 42-45. https://www.mlo-online.com/articles/201204/barcode-specimen-collection-improves-patient-safety.php. Accessed April 24, 2015.
