Are you doing diagnostics—or logistics?

This simple question cuts to the heart of a fundamental principle refined over centuries in healthcare: prioritization based on need, not just arrival time. Think about the emergency room. Inspired by figures like Jean Dominique De Larrey on the battlefield in the late 18^th century,¹ medical professionals have employed the concept of triaging patients based upon need. This system doesn't process patients based on the order they walk through the door (First In, First Out: FIFO). Instead, a patient’s condition is rapidly assessed and routed according to severity, ensuring priority to those needing immediate attention. It isn't just about managing a queue; it's about applying intelligence for timely and accurate outcomes no matter what the workload. Shifting from a simple chronological FIFO process—or, as we might call it in a modern context, moving towards a "First In, Smart Out" (FISO), where the "Smart Out" is defined by clinical urgency, availability, and impact—allowing for dynamic prioritization.

Let's look at the clinical laboratory from the perspective of FIFO. Every tube arriving in the lab represents a patient, their family, and physician who are anxiously awaiting results to inform critical decisions about care. Yet, for too long, laboratory automation, while well positioned for handling large volumes of samples and reducing manual steps, has operated primarily as FIFO to improve logistics. Automation can efficiently transport samples from point A to point B, processing them largely based on the order that they are loaded. While a significant improvement over purely manual processing, the FIFO approach falls short of the dynamic, intelligent prioritization characterized by modern patient care methods. It raises the question: Are labs truly advancing diagnostics or merely improving logistics?

Modern labs are dealing with multiple pressing challenges. Globally, they are contending with continuously rising sample volumes, increasing test complexity, and the persistent drive by healthcare organizations to standardize workflows across their networks. All of this comes alongside an escalating demand for faster, more accurate results. Simultaneously, labs must navigate significant resource constraints, including labor shortages, budgetary pressures, and limited physical space.² These compounding pressures create bottlenecks, extending the time between sample collection and result delivery, potentially delaying diagnosis and treatment, impacting patient outcomes, and straining costs.

Applying an intelligent approach

Addressing these challenges effectively requires a new approach leveraging flexible instrumentation, scalable automation, and integrated, intuitive informatics solutions, designed for labs to handle the demands of modern patient care. This powerful combination is key to achieving what can be termed Advantaged Workflows.

How do we turn standard workflows into Advantaged Workflows? By focusing on four key areas: optimized workflows, flexible instrumentation with scalable automation, integrated, intuitive IT and middleware, and advancing clinical capabilities. While scalable automation handles the physical movement and processing of samples—reducing repetitive tasks, minimizing human error, and increasing throughput—it's the integration with sophisticated clinical informatics, particularly through powerful middleware, that inspires the automation system with the intelligence required for a truly Advantaged Workflow.

Unlike traditional automation's sequential FIFO processing, Advantaged Workflows leverage the intelligence of both the automation system combined with middleware—the “embedded intelligence.” Advantaged Workflows harness this embedded intelligence to understand not just where a sample needs to go, but how it can get there and how quickly it can be processed.

This is where the shift from FIFO to FISO—priority-driven logic, the laboratory equivalent of clinical triage—becomes possible. Advanced automation and middleware process beyond "first loaded" to understand each tubes origins, use sample tracking events to write workflow rules, and consider lab defined priorities.

Imagine the automation track as a complex network, like a city's road system. Traditional FIFO is like every car following the exact same path in the order they entered the highway. The challenges with this approach are the roadblocks or extended travel time impacting the car’s ability to reach its destination on time. Advantaged Workflow’s use of intelligent routing, on the other hand, is similar to employing a sophisticated GPS system that continuously analyzes traffic conditions, prioritizing emergency vehicles (STATs), and dynamically calculating the most efficient route for every car based on its destination and urgency. If one route (analyzer) is congested or temporarily unavailable (due to QC drift, for example), the system’s intelligence immediately detects this and reroutes samples around the issue, ensuring minimal delay, especially for high-priority tubes. Similarly, if a different route (assay) is unavailable (due to an empty vial, for example), available testing is done until that assay is refilled. This algorithmic approach provides truly "Intelligent Sample Routing."

Turning intelligence into real-world impact

The impact of intelligent routing on turnaround time (TAT) is profound, extending beyond mere speed to focus on vital consistency and clinical relevance. By prioritizing urgent samples and dynamically managing the workflow based on real-time conditions, the system delivers rapid and predictable TATs, often eliminating cumbersome manual STAT processes. Real-world examples underscore this impact: In a study undertaken by Beckman Coulter, Bethesda North saw significant TAT reductions, achieving 98% of samples completed in under 40 minutes.³ Even more strikingly, an observational study by Beckman Coulter at Worcestershire Acute Hospitals, in Worcestershire, UK demonstrated dramatic decreases not only in mean TAT for both STAT samples (from 59 to 26 minutes) and routine samples (from 1 hour 25 minutes to 35 minutes) but also a remarkable 91% reduction in the standard deviation of STAT TATs (from 42 to just 4 minutes).³ This sharp drop in variability is a powerful indicator of predictable, reliable service—ensuring clinicians have results when they expect them.

The sophisticated integration creating the Advantaged Workflow means automation no longer needs to be simply a logistics system confined to improving sample transport efficiency. Powered by the intelligent synergy between automation and informatics, Advantaged Workflow elevates laboratory automation from a processing system focused primarily on logistics to a dynamic, intelligent partner in patient care. With embedded intelligence mirroring clinical triage logic, it can optimize, automate, and simplify processes, delivering precise, comprehensive data tailored to each patient's unique needs. This transition from simple FIFO logistics to FISO operations—intelligent, priority-driven processing—is not just an operational improvement; it is a fundamental shift that directly impacts the speed and accuracy of diagnosis, enabling clinicians to make faster, more informed treatment decisions for patients who need it most.

By embracing Advantaged Workflows, labs can confidently navigate the complexities of modern diagnostics, ensuring that every sample is treated with the intelligence and prioritization it deserves, ultimately helping to power the moments that matter most for patients.

References

1. Turner MD, Shah MH. Dominique-Jean Larrey (1766-1842): The founder of the modern triage system. Cureus. 2024;16(6):e62375. doi:10.7759/cureus.62375.
2. ASCLS. Addressing the Clinical Laboratory Workforce Shortage . The American Society for Clinical Laboratory Science. July 2, 2020. Accessed September 2, 2025. https://ascls.org/addressing-the-clinical-laboratory-workforce-shortage/.
3. Beckman Coulter. Breaking Status Quo—Continuing Success at Bethesda North with Total Lab Automation: A case study. 2025. Accessed September 2, 2025. 2025-13854-auto-dxa5000-cs-glb-en---bethesda-r4.pdf. 
4. Beckman Coulter, Inc. Advancing Patient Healthcare in Worcestershire: One-Year Impact of DxA 5000 Track Installation (2025) Available upon request. Accessed September 2, 2025. https://www.beckmancoulter.com/learning-and-events/webinars/automation-and-cimt-webinars/advancing-patient-healthcare-in-worcestershire.