title: A roadmap to defining the clinical reportable ranges of chemistry analytes: Increasing automation efficiency and decreasing manual dilutions.
abstract: BACKGROUND
  Proper utilization of resources is an important operational objective for clinical laboratories. To reduce unnecessary manual interventions on automated instruments, we conducted a workflow analysis that optimized dilution parameters and reporting of abnormally high chemistry results for the Beckman AU series of chemistry analyzers while maintaining clinically acceptable reportable ranges.
  
  
  METHODS
  Workflow analysis for the Beckman AU680/5812 and DxC800 chemistry analyzers was performed using historical data. Clinical reportable ranges for 53 chemistry analytes were evaluated. Optimized dilution parameters and upper limit of reportable ranges for the AU680/5812 instruments were derived and validated to meet these reportable ranges. The number of specimens that required manual dilutions before and after optimization was determined for both the AU680/5812 and DxC800, with the DxC800 serving as the reference instrument.
  
  
  RESULTS
  Retrospective data analysis revealed that 7700 specimens required manual dilutions on the DxC over a 2-y period. Using our optimized AU-specific dilution and reporting parameters, the data-driven simulation analysis showed a 61% reduction in manual dilutions. For the specimens that required manual dilutions on the AU680/5812, we developed standardized dilution procedures to further streamline workflow.
  
  
  CONCLUSIONS
  We provide a data-driven, practical outline for clinical laboratories to efficiently optimize their use of automated chemistry analyzers. The outcomes can be used to assist laboratories wishing to improve their existing procedures or to facilitate transitioning into a new line of instrumentation, regardless of the instrument model or manufacturer.
authors.affiliation: Department of Laboratory Medicine, Chemistry Division, University of Washington, Seattle, WA, United States.
authors.forename: Sheng-Ying
authors.initials: SY
authors.lastname: Lo
authors.affiliation: Department of Laboratory Medicine, Chemistry Division, University of Washington, Seattle, WA, United States.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Baird
authors.affiliation: Department of Laboratory Medicine, Chemistry Division, University of Washington, Seattle, WA, United States. Electronic address: dngreene@uw.edu.
authors.forename: Dina N
authors.initials: DN
authors.lastname: Greene
mesh_terms: D001331:Automation / Q000379:methods*; D002624:Chemistry, Clinical / Q000379:methods*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D006801:Humans; D007201:Indicator Dilution Techniques / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Automation; Beckman AU; Laboratory management; Manual dilution; Onboard dilution