Expert Q&A: Lessons Learned from a Total Laboratory Automation Project

Though total laboratory automation (TLA) is not a new concept, it has become increasingly common in clinical laboratories as it can help solve their unique challenges. Recently, the clinical microbiology laboratory of London Health Sciences Centre (LHSC) and St. Joseph’s Heath Care London in London, Ontario, Canada, became the first in the world to install the 3rd generation of the BD Kiestra™ TLA system. Professor Jeff Fuller, PhD, FCCM, D(ABMM), division head of Clinical Microbiology, discusses why his organization opted for the new system, how it has performed so far, as well as lessons learned for other laboratory leaders considering TLA.

Q: What key lab automation trends have you noticed recently?

A: For the last decade and a half, automation of microbiology has been a growing industry and part of the reality of how to deliver a clinical microbiology service. Specifically, what I’m seeing, at least in Canada, is that the number of automation implementation projects in hospital laboratories and other clinical laboratories seems to be increasing, especially post pandemic. This is a predicted response to ongoing pressures to the increased service demands on the microbiology laboratory with respect to the current state of our healthcare system, as well as a depleted workforce of medical laboratory technologists.

Q: What were the main reasons your organization decided to go with a TLA system?

A: Implementing automation into microbiology has been a key part of our strategy to ensure future growth and sustainability of our clinical microbiology service in our local geographic area. Regardless of the vendor, in general, automation systems allow us to accommodate increased volumes in diagnostic testing. That’s a current pressure. The system itself also has a number of different technological innovations that will help us to optimize staff productivity, as well as assist with improving both our test accuracy and the time required for us to report a test result.

Q: What were the key challenges you faced in implementing the system?

A: When it comes to challenges, change management is very important. A project of this size requires support from a broad range of stakeholders, including your laboratory staff, senior leadership within your healthcare or hospital organization, the vendor of the instrument, and facilities management, with respect to all the physical changes and electrical connectivity issues that need to be addressed. Your information technology services (ITS) and the service provider for your laboratory information system (LIS) are also very important. Coordinating a project like this is truly transformational, and the needs are very complex. Setting yourself up to manage change with all the various stakeholder groups is a really important component of the initial planning.

During the project, we had three key specific challenges:

1) Preparing the physical space for the actual installation—these instruments take up a lot of space and most clinical laboratories are already pushed for space. Getting creative with your design and how this instrumentation would look in your existing footprint is going to present a challenge for most laboratory services.

2) Digital connectivity—ensuring the instrument connects successfully to the hospital infrastructure and information network so that the instrument is delivering testing and result information effectively. In a paperless environment, this instrument and all the information that it’s generating needs to effectively relay test results to ensure appropriate patient care.

3) The installation of the instrument—getting it in the door, installed, and training staff on their new environment and workday, all while maintaining the routine workflow in the same physical space is difficult. In our scenario, as would be the case for most laboratories, the clinical service couldn’t stop. We had to complete an entire construction and installation project over the course of about a year while maintaining our routine microbiology service in about half of the space. Those changes can present very real challenges that need to be accommodated through the planning and implementation.

Q: How did you solve those challenges?

A: How we structured our team was key to our success. We secured a full-time project manager for the length of the project, who has been responsible for leading and coordinating change and project milestones with all the stakeholders. A project manager may not be a typical human resource to have embedded within a clinical laboratory service or department within a hospital. In other industries, it certainly is, but making sure that you’ve got a certified, trained project manager is instrumental. Related to that, we also seconded a full-time medical laboratory technologist that was already part of our laboratory leadership team to work with the project manager to communicate the clinical laboratory needs for physical space, digital connectivity, and how to “lean” our new workflows as we transitioned onto the instrument. These and other team members also helped accommodate training schedules around daily work schedules to ensure that staff were trained on the new instrument and that we were otherwise ready to onboard our work onto the automation line.

Q: How have things been going with the new system so far?

A: It’s been a lot of work. Excluding the pause that we experienced through the pandemic, this has been a five-year journey from conception to implementation. It has taken a very dedicated team of people from all stakeholder groups to make this transformation successful. The installation was completed in November of 2023 and we are now in the early stages of transitioning our workflows onto the instrument. So far, that’s going very well.

Q: What are the biggest benefits you’ve seen?

A: The instrumentation doesn’t sleep. If you’re able to optimize your staff scheduling in alignment with your peak volumes of specimens received in the laboratory, and your culture processing needs, then you can use that to your advantage and significantly improve the general flow of specimens and work. That ultimately can improve your processing time. One of the specific benefits of TLA is related to the closed incubators and the digital imaging on these systems. These innovations have been previously shown to improve the detection of bacterial growth, and they can do this in less time. We’re now experiencing these improvements as well in the early stages of our onboarding. This is one of the more exciting parts of automation in microbiology. While these improvements may by themselves be significant, from a turnaround time perspective, when you combine the time savings from automation technology with other rapid identification tools that we already commonly apply in microbiology, this can lead to significantly faster delivery times for positive microbiology or culture results.

One of the other benefits is that by reducing hands-on time in our culture-based workflow, managers can now start to dedicate existing human resources in the laboratory to other areas within the lab service that are in need. For example, we can now more effectively deploy staff to support our molecular microbiology service and quality management program.

Q: What key advice do you have for other laboratories/hospitals that are thinking of implementing a total lab automation system in their facility?

A: This is transformative for your laboratory service and laboratory medicine department. Don’t approach automation as a standalone solution for whatever your challenges may be. Approach microbiology laboratory automation as a component of a larger health system transformation, for the sake of improved daily capacity, test accuracy, and timeliness on the patient report. There are obviously other things that need to be changed and improved alongside the implementation of automation to truly achieve these goals. Secondly, as far as lessons learned—build your team with effective and sustainable leadership. This has been a five-year journey for us, and a lot of people have moved in and out of roles—that is a reality for many laboratory services. Ensure that you build your team so that you have the right roles identified, and in a way that’s sustainable over the course of the plan timeline.

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Jeff Fuller, PhD, FCCM, D(ABMM), is one of six microbiologists leading the microbiology program at the London Health Sciences Centre, which provides laboratory diagnostic and consultative services to the hospitals in London and across southwestern Ontario, Canada. His primary responsibilities include clinical bacteriology and mycology, antimicrobial resistance detection and antibiogram development, and quality improvement of the microbiology service.

Dr. Fuller’s clinical research has focused on antifungal susceptibility testing and resistance detection. He recently coordinated a national prospective surveillance program, as part of the larger CANWARD program, to monitor the epidemiology and antifungal resistance development in invasive isolates of Candida and respiratory tract isolates of Aspergillus in Canadian hospitals. He currently serves as a member of the Clinical and Laboratory Standards Institute (CLSI) antifungal subcommittee and has contributed to improved practice standards and several multi-authored publications in this area over the years.