FRONTLINE DILUTION FOR FERRITIN EXAMINATION IN А MIDDLEWARE SYSTEM REDUCES EXAMINATION REPETITION, TURNAROUND TIME, AND COST

Background: Automation and digitization are necessary in laboratories because of the increasing complexity of procedures and legal limitations. Middleware is a software that transfers data flow between laboratory instruments and the laboratory information system (LIS). Frontline dilution is a rule made to apply in the middleware of lab systems, specifically for facilitating automatic dilution of blood samples. The researchers aimed to explore the advantages of employing middleware to perform frontline dilution in ferritin testing. Methods: To examine the trend of ferritin testing following the deployment of frontline dilution, this study examined the effects of frontline dilution implementation on all ferritin samples tested between August 2018 and January 2019 (before frontline dilution) and February to July 2019 (during the first five months of frontline dilution application). The study was extended until November 2022. All samples with ferritin concentrations exceeding the upper limit of the measurement interval (≥ 1999 µg/L) within the last six months were assigned to ten-fold frontline dilution using the Alinity Management System as middleware. Information about turnaround time (TAT), cost, and the efficacy of using ferritin reagents (repeated examinations) was provided. Results: The rate of examination repeat after frontline dilution was found to be significantly lower than the rate before the installation of frontline dilution (8.23% vs. 14.20%, p < 0.001). A noteworthy TAT decrease of 65 minutes per day is also observed. Moreover, frontline dilution reduces monthly examination costs by around IDR 3510000, - (~US$ 223.57). Conclusion: A middleware system for frontline dilutions can significantly increase laboratory efficiency, as seen by lower costs, shorter turnaround times, and fewer repeat exams.