Total Laboratory Automation: What to Consider

TLA allows clinical laboratories to streamline their operations, increase capacity, and minimize error

Ahmed Elewa, PhD

Clinical laboratories are always striving to improve their services through shorter turnaround times and higher-quality results. Total laboratory automation (TLA) helps labs meet these challenges by providing consistency, comprehensive quality control, and fewer manual steps, all leading to significantly improved laboratory performance. TLA systems are most commonly used in clinical chemistry and hematology laboratories, and increasingly in clinical microbiology. Here’s what you should consider when deciding whether TLA is right for your lab.

 What is TLA?

TLA is a system that automates clinical culture-based testing processes, including taking a specimen, applying it to a barcoded culture medium, streaking out plates, and moving plates to incubators. An important component of TLA is the incubation system, which includes a high-resolution camera system. Medical technologists select the intervals at which culture plates are photographed and images are viewed to determine what additional workup or interaction is needed, such as microorganism identification or antimicrobial susceptibility testing. TLA systems are most efficient when handling liquid specimens like urine but can also be used with solid samples like tissue or liquids that are available in a very small or limited quantities. 

 What are the main benefits of TLA? 

A key value of TLA is that it cuts down on the time spent performing manual inoculation, thereby allowing laboratory staff to work on other duties that require their specific expertise, or freeing more time for tasks carried out best by humans,1 such as troubleshooting and interacting with physicians and other health care professionals. 

 But perhaps the most valuable aspects of TLA are that it ensures consistent quality and efficiency. Manual processes generate more errors2 and artifacts compared to automated systems, making the latter more efficient and accurate, especially when there is a need to increase throughput. 

 When a laboratory manually processes tens of thousands of plates per year, a small error rate becomes a significant problem. TLA allows laboratories to process millions of plates a year while keeping error at a minimum. 

 Among the processes that are variable in manual clinical laboratories is specimen spreading. TLA ensures that specimens are spread across a plate in a uniform manner. 

 Another benefit of TLA is that it is ideal for troubleshooting and instruction because images are acquired on a regular basis, allowing staff to go back, compare actual results, and learn from mistakes.  

 What is it like to convert to TLA?

It is always best to have TLA in mind before building a lab. However, in the event of converting a manual clinical laboratory to a TLA system, some of the things that you should keep in mind include reinforcing the floor to accommodate the weight of the instruments and expanding computer server capabilities to sustain the larger data footprint. Another shift that must occur when converting to TLA is transitioning the institution’s specimen collection systems to containers that are best suited for TLA. This is a significant change and should be made well in advance of launching your automated laboratory. 

 Changing to TLA also affects staff. TLA requires staff training prior to implementation, where individuals go over the basics of the software, which may feel like having to learn a completely different laboratory information system. During this process, it is essential to foster a positive culture of change, since it can be frustrating. Some staff may decide that TLA is not for them and may leave the lab. Others may flourish because of the change and embrace the chance to learn, grow, and even discover hidden leadership abilities and creativity. 

 How does TLA change the workflow?

In a traditional clinical microbiology laboratory, a technologist might begin their day by getting plates from the incubator and examining them at the bench before deciding which tests are needed for each culture. A TLA setup can be very different. A popular TLA setup is to divide the lab into readers and workers and have each group operate in two physically distanced areas. In the reader area, a technologist sitting and looking at a screen goes through cultures and interprets their growth. This step may include marking colonies for further testing or flagging a plate for discussion or further incubation and reimaging. The outcome of this streamlined step is a list of plates and the tasks associated with each plate, which is forwarded to the workers area for execution. Workers then proceed with calling out each plate from the incubator so that they arrive to their workstation for processing. 

 Importantly, the division into readers and workers is a flexible one, and so once readers screen all plates, they can join the worker team to aid in carrying out the workload for that day. A different sense of ownership is therefore a defining feature of TLA systems; all cultures belong to everyone, as opposed to being in charge of a stack of plates from start to end after which your task is complete. This collegial and collaborative culture adds to the efficiency of TLA systems.

 What happens if the TLA system breaks down? 

Traditionally, if an incubator breaks down, the lab can move everything to another incubator. However, such instrument redundancy is not as easy with TLA systems. Most of the time, scheduled software upgrades are the main reason for a TLA system to shut down and can therefore be worked around by coordinating manual plate streaking, for example. Unexpected downtime can be crippling for a clinical laboratory. It is therefore critical to carefully develop a proper maintenance contract to ensure that the damage caused by unforeseen hiccups is kept to a minimum.

 Although it comes with a hefty price tag and a disruptive change in workflow and culture, TLA allows clinical laboratories to streamline their operations, increase capacity, and minimize error. In the long run, these benefits make the change well worth the investment. 

 References:

  1. Bailey, Adam L., et al. “Clinical microbiology is growing up: The total laboratory automation revolution.” Clinical Chemistry 65.5 (2019): 634-643. doi:10.1373/clinchem.2017.274522
  2. Croxatto, Antony, et al. “Towards automated detection, semi-quantification and identification of microbial growth in clinical bacteriology: A proof of concept.” Biomedical Journal 40.6 (2017): 317-328. doi:10.1016/j.bj.2017.09.001