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Clinical hemostasis practice: the major impact of laboratory automation.

This article has reviewed basic disease states of hemostasis and thrombosis with an emphasis on laboratory technologic advances comparing manual and semiautomated techniques with new fully automated technology that is now available for both aiding in a diagnosis and monitoring efficacy of therapy. As these new automated methods become generally available, more and more information will be accumulated to determine exactly how precise many of these modalities will be for diagnosis and monitoring. Many of these newer modalities have already gained general acceptance as highly sophisticated tools that certainly belong in any clinical laboratory having to deal with patients with thrombohemorrhagic disorders.

Anticoagulants↗

Clinical laboratory automation: concepts and designs.

Compared with other industries, automation in the healthcare arena has been slow to evolve. Changes in reimbursement for services provided are forcing hospitals and other healthcare providers to look for more cost effective mechanisms to provide all forms of health related services. Clinical laboratory services are essential to the support of hospital operations and most clinic operations. The current paradigm for clinical laboratory operations is based upon a mix of both batch and random access testing and is highly dependent upon clinical laboratory personnel. Changes in the paradigm for clinical laboratory operations may result in a significant cost savings when fully implemented while maintaining a high level of quality and service for the patients. Several different laboratory organization structures are discussed. The Nebraska automation project is described including the development of a modular conveyor system, the use of automated guided vehicles, software, and network architectures. Future directions for the development of clinical laboratory operations including the creation of a "docking device" to link automation systems to instruments is proposed.

Clinical Laboratory Information Systems↗

Laboratory automation.

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Attitude of Health Personnel↗

The integrated blood-collection system as a vehicle into complete clinical laboratory automation.

A rationale is offered and methodology illustrated for integrating the fundamental steps involved in the collection and processing of blood for laboratory evaluation. The approach taken in the development of these concepts and components greatly extends the possibilities of laboratory systems integration without upsetting established modalities. A prototype design of the integrated blood-collection system integrates blood collection, cellular separations, sample transfer to stable storage without chemical mediators, and sample presentation for chemical analysis (e.g., precision metering) while preserving patient identification. A sophisticated, multi-chambered blood-collection container is the site of all blood sample processing and transfer steps. This device is supported by a compact, robotic centrifuge of unique design and a transfer mechanism to facilitate sample delivery for analysis within a diagnostic instrument. The confluence of these individual components into a single integrated system provides the means to completely automate the processing of blood samples, after sample collection, eliminating all manual transfer steps and any external exposure of blood interfaces outside the diagnostic instrument. Configurational derivatives of the Integrated Blood-Collection System offer choice of skin or venipuncture procedure, rapid plasma extraction for micro- or macro-collected volumes, and sample delivery by either aspiration or direct metering of discrete 10-microL samples from the collection container. The skin-puncture configuration provides the opportunity within a single device to collect and process up to 500 microL of sample by capillarity from a skin prick.

Automation↗