Development of a robotic near patient testing laboratory.

Many laboratories have centralized critical care services to conserve resources, but centralization has often been at the expense of providing optimized patient care. We have created a remotely controlled clinical laboratory that provides whole blood analysis of blood gases (PCO2, PO2), pH, electrolytes (Na+, K+, Cl-), glucose, and hemoglobin near the patient's beside, while maintaining the distinct advantage of central laboratory control. The automated remote laboratory provides extremely rapid turnaround times, eliminates the cost of labor for specimen processing, reduces the risk from contaminated specimens, reduces staff training, and results in improved patient care.

Robotics in the medical laboratory.

Robotic systems specifically designed for the automation of laboratory tasks are now available commercially. Equipped with computer, analytical hardware, and supporting software, these devices may soon revolutionize the concept of the clinical laboratory and usher in a new era in laboratory testing. We review the types of robots and motion-control software currently available and discuss examples of their applications that extend across many analytical areas. Several ongoing projects are concerned with the systematic integration of robotic devices with other laboratory automation. The integrated robotic laboratories emerging from this work portend a bright future for robotic automation. Many challenges remain, however, in training the individuals needed to develop and manage robotic laboratories, and in making this new technology cost-efficient.

A standard clinical instrument interface for robotic applications.

Many clinical laboratory instruments are not designed for robotic compatibility, hence the need for standardization of data communications and analyzer interface hardware. We developed an interface with supporting software that simplifies communication between a microcomputer and clinical instruments. Our interface establishes a standardized bidirectional communications protocol, which is useful in many clinical laboratory robotic projects. Instruments targeted for interfacing require no prior on-board communications capabilities. Additionally, modifications to the clinical instrument are minimized. Once installed, the interface translates input commands to codes or actions recognizable by the analyzer. Features not normally available to the user, such as electrode real-time response and full instrument status, are also reported by the interface, thereby establishing a remote monitor and control mechanism for the interfaced instrument. We have written an operating system to control the interface microcomputer, which in turn commands and monitors the clinical analyzer. A host computer controls the information flow to the interface and provides (a) requests to the interface for instrument operation and status and (b) commands to the interface to initiate the desired instrument operation. This arrangement maintains complete instrument functionality as designed by the manufacturer while allowing remote monitoring and operation of the instrument.

Robotics in the clinical laboratory.

We are beginning to see the potential of robotics in the clinical laboratory through integration with automated analyzers and computer systems. However, there is a need for training programs that will prepare technologists to design and implement robotic systems for clinical laboratories. What will the robot laboratory of the future look like? We will see hospital laboratories begin to be located some distance away from the main facility because the labor component of staffing satellite laboratories will have been greatly reduced. Instrument manufacturers will see the need for analyzers that are robot-friendly and allow for simplified interfacing, both electronic and mechanical. Robots will become more versatile even to the point of performing complete instrument repair. Laboratories will be equipped with many task-oriented robotic stations, including, for example, accessioning and processing robots that prepare samples for transport by robotic carts. Analysis will be performed by a combination of robot and dedicated analyzer. Laboratory results will be reviewed by algorithms in the larger laboratory computer, which will alert the laboratory worker to unusual results. A large variety of analyses will be available to the patient with rapid turnaround. The end result will be more efficient health care delivery at reduced cost.

Enzymatic assay for creatinine with fixed-time kinetics on a centrifugal analyzer.

A method is described for enzymatic measurement of serum creatinine using a centrifugal analyzer. The method employs fixed-time kinetics and a true serum blank. The method required 100 microliters of serum and is linear to 90 mg per L. Day-to-day precision studies revealed a standard deviation (coefficient of variation) of less than +/- 0.5 mg per L (7.4 percent) at a mean creatinine concentration of 6 mg per L and +/- 0.5 mg per L (1.8 percent) at a mean value of 28 mg per L. The method was free of interferences from acetoacetic acid, ascorbic acid, bilirubin, and hemoglobin. The speed, precision, and accuracy of the method suggest that it represents a useful alternative to methods using the alkaline picrate procedure.