What Does ARUP's Automation
Initiative Mean for ARUP's Clients?
ARUP continues to grow at a very rapid rate. A typical question from a prospective client is: "How will ARUP be able to handle our work when ARUP's total testing volume is increasing by 10% per year?" In fact, ARUP's automation initiative has enabled ARUP to handle these increased volumes, not just by keeping up, but by actually improving both the quality and speed of ARUP's service to unprecedented levels. In addition, this expanded automation system has capacity for many more years of sustained growth . Its design is very flexible and would support two doublings of ARUP’s current volumes without reaching capacity. Thus, as ARUP continues to grow, the automation systems will keep up, and there will be continual improvements in quality and speed. The systems ARUP has implemented are clearly leading-edge developments not to be found in other laboratories anywhere in the world. ARUP's automation has been recognized for its leadership, thoughtful design, and outstanding performance by a major award from the Association for Laboratory Automation and by lecture invitations from the American Association of Clinical Chemistry, College of American Pathologists, American Society of Clinical Pathologists, Clinical Laboratory Management Association, the 4th Cherry Blossom Symposium on Laboratory Automation (Tokyo, April 2004), and the 5th International Conference on Laboratory Automation and Robotics (Seoul, April 2006). Two major reports describing various aspects of the AutoLab system and its performance were published in Clinical Chemistry, Vol. 48, October 2002, pages 1751-1760 and 1761-1767.
Many factors such as newer and faster analyzers, improved handling processes, increased volume, and information systems can improve turnaround time. We believe ARUP’s automation initiative has been a significant factor. In the period of time since these systems were implemented at ARUP, turnaround time, which was already excellent, was further reduced by 23 hours ( 37% improvement) at the 95th percentile for the top 70% of ARUP's testing volume. Likewise, the median turnaround time was also further reduced by 8.5 hours ( 31% improvement) for these same tests.
This chart measures the 95th percentile turnaround time from the completion of order-entry to a change in tracking status to "In Lab" (green line) and then from In Lab to Verified for test results (blue line). It also shows the sum of these two measures (pink line). This chart includes turnaround times for the top 70% of all of ARUP's volume, which includes many lower volume batch tests, some performed as seldom as 3- 4 times per week. Many factors including automation can improve turnaround time. Since ARUP's automation systems were implemented, the 95th percentile time from completion of order-entry to verified has decreased by 23 hours (an improvement of 37%), because more specimens are arriving at the labs in time for scheduled runs. An similar improvement of 8.5 hours ( 31%) has been seen for median turnaround time.
ESP and the Automated Transport and Sorting System have also combined to reduce the rate of lost specimens at ARUP by approximately 70% overall.
This chart shows ARUP's lost specimens relative to total specimens received since 1998, the year prior to automation. It includes all specimens known to have arrived at ARUP, but for which one or more tests were not reported because the specimen was found to be missing at some time after its arrival. The data for total lost specimens vary from month to month, but a clear downward trend is evident in the chart. The data were therefore analyzed by trend analysis. A third order polynomial (blue line) suggested that, since 1998, total lost specimens have dropped by about 70%. We believe automation is clearly having an impact on total ARUP quality.
The elimination of the many redundant sorting and handling steps as a result of ESP and the Automated Transport and Sorting System has greatly improved ARUP's productivity. The rate at which ARUP has historically hired new employees to keep up with testing volume has slowed dramatically, simply by eliminating repetitive, unnecessary handling steps.
This chart shows (line with solid blue squares) total billed units per FTE for the 12 different laboratory sections that receive most of their specimens via the Automated Transport and Sorting System. Also shown (dashed red line) is a prediction of the billed units per FTE that these 12 laboratory sections might now have without automation. This estimate was determined by regression analysis based on the rate of productivity improvement for two years prior to automation. Despite a continuing increase in workload, the rate of hiring of new staff was significantly lowered as a result of ARUP's automation initiative. This chart estimates that ARUP has saved approximately 81.1 FTEs that we have not had to hire because of automation. Since automation was implemented in 1998, productivity of these 12 lab sections has improved by 27.8% over and above the annual 5% improvement predicted by the regression line. The combined productivity improvement from both sources is 71.3%.