Improving Laboratory Processes With Total Laboratory Automation

Hoi-Ying Elsie Yu, PhD; Harold Lanzoni, MS; Tracy Steffen, BA; Warren Derr, BS; Kim Cannon, BS; Jeanene Contreras, BS; Jordan Erik Olson, MD


Lab Med. 2019;50(1):96-102. 

In This Article

Abstract and Introduction


Background: To further improve workflow efficiency, our laboratory implemented a total laboratory automation (TLA) system that connected our preanalytic processing system with various testing (hematology, coagulation, and chemistry).

Methods: Detailed time and motion studies were performed to create process flow maps before and after TLA. The before maps identified opportunities for workflow improvements. We used postimplementation studies to quantify efficiency gains.

Results: The implementation of our TLA system resulted in 86% fewer discrete processing steps in specimen handling, even when starting from a partially automated laboratory. Instrument consolidation reduced the testing footprint by 45% and reduced the number of testing personnel by 2.5 full-time employees (FTEs). An 82% reduction in hands-on time associated with add-on processes was achieved. Combining STAT and outreach work on the testing system did not impact turnaround time.

Conclusions: With careful planning, a TLA system can effectively optimize laboratory processes and efficiency.


In recent years, multiple vendors, who traditionally have focused on analytics, released second-generation automation systems[1] that provide new options for the clinical laboratory to automate front-end processing with core laboratory testing, including in chemistry, hematology, and coagulation. Many of these systems make total laboratory automation (TLA) more accessible to the mid- to high-volume clinical laboratory. These TLA options are thought to improve workflow, quality, and efficiency, and to reduce errors.[2–6] However, few laboratories[2,5] have quantified the efficiency gains resulted from TLA.

Geisinger Medical Center is a hospital in Danville, PA with more than 500 beds. In addition to servicing its patients at the hospital, the core clinical laboratory at the hospital serves as a reference laboratory for other Geisinger facilities. As a result, our laboratory performs more than 7 million tests (hematology, coagulation, and chemistry) annually, including inpatient and outpatient testing. To continue to improve our operational efficiency and support the growth of the health system, we recently implemented a new-generation automation system in the core laboratory at Geisinger Medical Center. Our new automated system connects front-end processing, hematology testing, coagulation testing, chemistry testing, and a refrigerated specimen storage unit. In addition to connecting these 3 primary testing areas to the automation line, we also consolidated 2 other testing areas (glycated hemoglobin [HbA1c] and hepatitis) onto the connected chemistry analyzers. Before this, the laboratory used an automated system that only connected the front-end processing with chemistry analyzers.

To determine whether a TLA system improves operational efficiency, we identified various metrics to understand and monitor our workflow. Also, we used process mapping to document productivity before and after implementation.