Rethinking lab quality management in high-volume laboratories: Operational lessons from a US hospital lab

• High-volume laboratories face growing pressure from rising test volumes, workforce shortages, and increasing turnaround time expectations, making manual quality control processes unsustainable at scale
• Automating quality control can dramatically reduce manual steps, decision points, and review time, improving efficiency, standardization, and staff utilization
• Strategic implementation of integrated digital quality control solutions not only shortens turnaround times and reduces costs, but also strengthens laboratory resilience and improves patient care delivery

High-volume laboratories in hospital or healthcare settings are responsible for collecting, analyzing, and reporting results for a staggering amount of patient tests. In the US. alone, approximately 14 billion laboratory tests are performed each year.¹ With the ever increasing test volume, lab staffing problems, and turnaround time (TAT) expectations, lab leaders are faced with tremendous pressure to manage costs, support their workforce, and adapt with evolving care delivery models. 

However, many clinical laboratories continue to rely on outdated, manual sample processing methods that can create significant workflow bottlenecks. These delays are particularly pronounced during quality control (QC) processing of patient samples, a foundational step in ensuring reliable downstream analysis. QC is critically needed to ensure the accuracy of patient results, but the process is still complex and prone to error because many labs still perform this task by hand. For many institutions, improving lab quality management has become both an operational necessity and a strategic priority.

The time needed to QC samples by hand is not only complex, but time consuming.² The QC review for one sample can involve multiple manual steps, several decision-making tasks, and over 1,000 clicks on equipment. This alone can take several hours.³

However, when you include human error and trouble-shooting into the QC process, the use of time and resources can skyrocket. This increases the risk of quality control errors in laboratory workflows, compounding delays, and backing up additional specimen processing and utilization of lab instruments. Overall, labs end up dealing with lengthy TATs. When test results are needed rapidly to make a crucial decision for a patient, every second counts.

In addition to manual processing of samples and human error, workforce shortages are also adding to laboratory bottlenecks.⁴ An aging workforce combined with growing diagnostic demand is intensifying operational pressure across hospitals. Efforts to build and sustain staffing capacity are hindered by turnover and salary competition across health systems.

Together, these strategic challenges not only negatively impact laboratory performance, but also affect clinical outcomes. They constrain a lab’s ability to scale operations, retain skilled personnel, and maintain effective cost control. Today, lab leaders are taking action against these challenges by implementing automated, integrated digital solutions, ensuring that they can operate more efficiently, reduce errors, and scale with increasing test volumes.

For high-volume hospital laboratories, sustainable laboratory process improvement often begins with re-examining how QC workflows are structured and managed.

Huntsville Hospital Health System, the second largest health system in Alabama, US, processes over 13 million tests annually, from chemistry and hematology to coagulation and urinalysis, and as a Level 1 trauma center is responsible for the care of critically ill patients.

The health system has historically relied on manual QC processes of test results, but the approach was lengthy and tedious. Significant improvements were needed to improve efficiency across their lab operations. They first looked at their sample QC processes. 

Taking a data-informed approach, they discovered that their traditional QC processes involved 14 manual steps, two manual decision steps, and over 1,000 clicks, with review necessitating 2.6 hours staff time daily.³ This procedure was prone to error and wasted resources. Furthermore, instruments were unavailable to staff until QC results were finalized. The health system needed a more efficient way to QC test results so that physicians could make rapid decisions for their patients.

Many high-throughput labs are deploying integrated digital QC strategies as part of a broader move toward automated lab quality management, connecting pre-analytical, analytical, and post-analytical workflows to reduce variability and improve scalability. To streamline lab operations, Huntsville Hospital incorporated an end-to-end software workflow solution that can automate these three main areas of lab operations, including autoverification of the QC process and saw marked improvements:³

• Reduction in manual steps: After utilizing the new system, Huntsville Hospital reduced manual steps from 14 to five, cut decision steps from two to only one, and decreased clicks from over 1,000 to fewer than ten overall. In the end, the team reduced manual decisions and steps by over 60% and clicks by 99%.
• Reduction in staff time: On the first shift, total hours to complete QC results dropped dramatically from 2.6 hours to only 0.5 hours using autoverification. This stemmed from the reduction in total number of QC results needing review, initially 775 that then dropped to 13 with a pass rate of 98.3%. The results were also similar during the third shift. Before implementing QC autoverification, the team needed to manually review 533 QC results. This went down to 11 after using the software solution. Similarly, the total hours to complete QC results was four hours before, which then decreased to one hour with a 97.9% pass rate.
• Improvement in TAT: TATs also improved with the new software. During the first shift, routine TAT was reduced by 22 minutes and STAT TAT (urgent, time-sensitive tests) by 1.6 minutes. At third shift, routine TAT went down by 10.6 minutes and STAT TAT by 1.4 minutes. This means that physicians received patient results faster than before implementing the automated software, enabling them to make quicker diagnostic and treatment decisions.

Ultimately, the streamlined processes improved the daily workflow for lab personnel and led to over $USD 46,000 in estimated annual savings for Huntsville Hospital. Such cost savings could translate into improved operational scalability, optimized workforce utilization, and enhanced long-term financial stability.

Today’s modern labs are inundated with a tremendous number of patient samples, requiring managers to find solutions that improve operations. Introducing automated quality control systems can help lab leaders streamline workflows, reduce laboratory stress, and drive consistency, decreasing manual labor and potential errors.

Labs are increasingly implementing automated QC systems tailored to their operational needs. For Huntsville Hospital, implementing new QC workflow solutions led to significant time and cost savings. They found that the approach greatly expanded the capabilities of their staff by reducing manual workload. Streamlining and automating daily QC in labs can give staff freedom to focus on more complex tasks and troubleshooting, rather than worrying about routine checks. At the same time, it shortens TATs and reduces annual operating costs.

Since accuracy and timing are the two most important factors that can impact patient outcomes, lab leaders must find opportunities that can provide precise, real-time patient results so physicians can make decisions faster and with greater certainty.⁵ Taking a data-informed approach to lab quality management – supported by flexible digital workflows – can help build critical long-term resilience and scalability.