Total Laboratory Automation for Microbiology Activities: An HTA Analysis in an Italian Laboratory Setting

Microbiology laboratories face increasing challenges related to rising sample volumes, workforce constraints, and the need for improved diagnostic accuracy and efficiency. Total Laboratory Automation (TLA) has emerged as a transformative solution to optimize workflows, enhance safety, and improve resource utilization. This study focuses on urine cultures and the follow-up of positive blood cultures and evaluates the impact of TLA implementation in a microbiology laboratory, assessing efficiency, economic sustainability, and healthcare professionals' perceptions.

A Health Technology Assessment (HTA) approach was employed, integrating real-life data from a single-center hospital laboratory in Italy before and after TLA implementation. Key performance indicators (KPIs) were defined through a literature review and expert consensus. Real-life data were collected over two time periods: the pre-automation phase (manual workflow) and post-automation phase (TLA) for urine culture and positive blood culture. The economic and organizational impact was assessed by quantifying human resource efforts, while a qualitative survey captured healthcare professionals' perceptions regarding automation.

TLA significantly reduced sample processing times, with a 67% decrease in check-in time and a significant reduction in inoculation (up to 100%) and plate reading (-69%) times, respectively. Economic analysis indicated a 67% reduction in costs for personnel time required to process urine cultures and perform initial workups of positive blood cultures on annual basis with consequent organizational benefits, in terms of time spent in sample processing (-71%). Healthcare professionals reported improved safety and reduced workload, making them more inclined to adopt TLA, perceived as useful and capable to offer high-quality and demonstrable results.

Findings emphasize TLA potentialities in the management of microbiology procedures overall improvement, empowering the laboratory efficiency and organizational capacity, allowing better investment of the human resources involved.