Robotics into the millennium.

Automation in clinical laboratories is not new. Since the pioneering work of Skeggs in developing continuous flow systems, automated analysers have become standard in almost all laboratories. It will be diYcult to imagine a modern clinical laboratory without automation. This form of automation is sometimes referred to as “microautomation.” The next stage in automation is the automation of specimen processing and transport of specimens between analyser or workstations. This is called “macroautomation” or robotics, and typically consists of an inlet unit, sorter, transport system/tracks, automated centrifuge, level detector, bar code reader, decapper, aliquotter, recapper, and so on. This type of system was pioneered by the work of Professor M Sasaki in Japan. There are many possible reasons to implement a robotic system in a laboratory. Economic reasons—The cost of health care is rising universally owing to increased expectations, new technology, and the advancing age of the population. In many industrialised countries, hospitals have been closed or merged with neighbouring hospitals in order to reduce cost and to improve eYciency. Many hospital laboratories are also closed and replaced by centralised laboratory services. Macroautomation/robotics is a possible way to improve eYciency and to cope with the high workload in these centralised laboratories. To reduce errors—Errors in laboratories are a continuous source of problems and they are mainly due to human factors. It is estimated that the error rate in clinical laboratories may be 1–2%, although many errors go unnoticed. Some of these errors have clinical consequences. There are no data on the cost of these laboratory errors. One estimate puts this at 10% of all errors in hospital care, equivalent to more that $1.5 billion annually in the USA. Most of these errors are at the preanalytical stages of the sample processing. An important incentive for implementation of total laboratory automation is the opportunity it provides to reduce human errors which occur during labelling of specimen, aliquoting, order entry, and so on. Errors during the analytical stages are mainly “transcription errors.” The latter could be reduced or eliminated by direct interface of the analytical instruments with the laboratory information system (LIS). Improved quality—One factor determining the quality of a laboratory service is the timeliness of results. If the results can be produced at the right time and place, it will have a significant implication on health care cost. With increasing pressure on bed occupancy and attempts to reduce inpatient care, earlier availability of results is now expected. Macroautomation/robotics has the potential to significantly reduce the turnaround time of tests. It has been suggested that the introduction of robotics will improve the overall turnaround time such that an emergency laboratory becomes redundant.