title: Total laboratory automation: Do stat tests still matter?
abstract: During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.
authors.affiliation: Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy. Electronic address: dolci.alberto@asst-fbf-sacco.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dolci
authors.affiliation: Clinical Chemistry and Hematology Laboratory, "San Bortolo" Hospital, Vicenza, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Giavarina
authors.affiliation: Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pasqualetti
authors.affiliation: Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy.
authors.forename: Dominika
authors.initials: D
authors.lastname: Szőke
authors.affiliation: Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan Medical School, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Panteghini
mesh_terms: D057205:Automation, Laboratory / Q000295:instrumentation / Q000379:methods / Q000592:standards; D019411:Clinical Laboratory Techniques / Q000295:instrumentation / Q000379:methods / Q000592:standards / Q000639:trends; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration / Q000592:standards / Q000639:trends
keywords: Clinical governance; Core-lab; Stat testing; Total laboratory automation