Discover how Hospital Clinic of Barcelona transformed its pre-analytical process with ProTube™

In this webinar, Dr. José Luis Bedini, Core Lab Head at Hospital Clinic of Barcelona, shares his firsthand experience implementing Inpeco’s ProTube™ solution — a compact automation and traceability solution designed to eliminate pre-pre-analytical errors at the point of sample collection.

Joined by Riccardo Melis, Regional Distribution Manager at Inpeco, Dr. Bedini walks through the real-world challenges of managing a high-volume core laboratory in a complex, multi-campus hospital environment, and explains how ProTube™ helped standardize sample collection, reduce errors, and improve patient safety across the entire institution.

What you’ll learn:

• Why the pre-pre-analytical phase is the biggest source of diagnostic errors — and how to address it
• How Hospital Clinic of Barcelona successfully rolled out ProTube™ across all inpatient wards
• The operational and patient safety benefits achieved after implementation
• Practical advice on building the business case and driving change across departments

Presented by Labroots and sponsored by Inpeco.

Webinar Transcript:

Webinar Transcript — Presented by Labroots and Inpeco

Hello everyone and welcome to today’s webinar: *ProTube™: Success Story at Hospital Clinic of Barcelona*. My name is Kevin Flug of Labroots and I’m going to be your moderator for today’s event. Today’s educational web seminar is presented by Labroots and brought to you by Inpeco. To learn more about our sponsor, please visit www.inpeco.com.

We encourage you to participate today by submitting any questions you may have during the presentation. To do so, simply type them into the “Ask a Question” box and click Submit. We’ll answer as many questions as we have time for at the end of the presentation. You can also use the Ask a Question box to let us know if you’re having any difficulties seeing or hearing the presentation.

I would now like to welcome both of our speakers for today’s webinar. Dr. José Luis Bedini, Core Lab Head at Hospital Clinic of Barcelona, Associate Professor of Biochemistry and Molecular Biology at the University of Barcelona in Spain, and Riccardo Melis, Regional Distribution Manager, East Europe for Inpeco. Gentlemen, we’re so thrilled that you have joined us here today. We are greatly looking forward to your presentation. And with that, I’m going to turn it over to Riccardo to start. Riccardo, whenever you are all set, you can begin.

Inpeco Overview — Riccardo Melis, Regional Distribution Manager, Inpeco

Thank you, Kevin, and thank you all for joining us today. This will be a live event, so we apologize in advance if any issues arise. On behalf of Inpeco, it’s my great pleasure to welcome you to this webinar and to have with us Dr. José Luis Bedini, who will share his firsthand experience with the Inpeco solution and how it has helped address key pre-analytical challenges at Hospital Clinic of Barcelona.

To begin, I will provide a very brief overview of Inpeco — who we are and what drives our mission.

Inpeco’s journey started with a clear vision from our founder, Gian Andrea Pedrazzini: to improve patient safety by reducing human error in clinical diagnostics through automation, in the early 1990s. He introduced the concept of total lab automation — an approach that has since shaped the industry, with many of its original principles still in use today.

Today, Inpeco stands as a global leader in total lab automation, delivering advanced solutions worldwide both directly to end users and through our network of partners. We develop and manufacture automation technologies that enable healthcare institutions to control every step of the diagnostic process. Our mission is to support laboratories in improving efficiency, quality, and patient safety through automation, traceability, and continuous innovation. Today our solutions are installed in more than 2,800 laboratories worldwide and we are present in over 78 countries. This extensive global installed base provides us with strong experience, deep expertise, and a comprehensive understanding of market trends and dynamics.

Today, laboratories and hospitals are facing constant and increasing pressure. An aging population is driving higher demand for diagnostic testing, while the growing prevalence of chronic disease requires more and more frequent and continuous monitoring. At the same time, the shortage of skilled personnel makes it increasingly challenging to manage these rising workloads. In addition, financial pressure continues to grow, driven by declining reimbursement rates, and workflows are often still fragmented in hospitals, resulting in operational inefficiencies. Patient expectations are also evolving, with a growing demand for faster, more accurate, and more personalized services.

In summary, laboratories and hospitals are increasingly being asked to do more with fewer resources. The key question is: how can they achieve this?

At Inpeco, we chose to address this challenge by adopting a holistic approach to the entire diagnostic process. This means bringing automation and traceability across the entire workflow — not only within the laboratory, but also by optimizing everything that happens before it, which today represents the most critical phase — ensuring that every step is fully under control, from patient identification to result delivery.

All of this is made possible today through the combination of our solution ProTube™ for the pre-analytical phase and our new open automation platform FlexLab™ X within the laboratory.

With this overview in mind, I’m now pleased to hand over to Dr. José Luis Bedini, who will share his experience at Hospital Clinic of Barcelona. Thank you.

ProTube™ at Hospital Clinic of Barcelona — Dr. José Luis Bedini, Core Lab Head

Good morning. First of all, I would like to thank Inpeco for inviting me to share our experience with all the people attending this webinar. You can see my email address at the bottom right of the screen: jlbedini@clinic.cat. Please feel free to send me an email to ask whatever you need, or to visit our lab if you are in Barcelona.

About Hospital Clinic of Barcelona

I want to start by sharing some details about our hospital. Hospital Clinic is located right in the middle of the city of Barcelona — and this is one of the challenges we face, as we have no space to grow. The hospital is a very old building from the end of the 19th century, and we are totally surrounded by the city. When the hospital first opened, there was nothing around it — just farmers, fields, and forests. Now, as you can see, it is completely surrounded by the urban environment.

The hospital is not just one site. In fact, we have three hospitals belonging to Hospital Clinic. One is the Maternitat Campus, for mother and child, ophthalmology, and day surgery. Then we have the Platò Campus, which was integrated into Clinic in 2021, and the Villarroel Campus — the main site where the lab is located. Overall we have around 900 beds. We take care of 600,000 people around the city of Barcelona. The left side of the city belongs to us as a community hospital, but we are also the reference hospital for the whole region of Catalonia for some pathologies, and for some conditions we are even the reference hospital for the whole country of Spain.

The three sites are more or less within a distance of 3 kilometres from one another. We are connected by a transport system to send samples from each hospital to the main hub at Clinic Barcelona, on Villarroel Street. We are a university hospital — a third-level hospital, which represents the maximum complexity level of hospitals in Spain. Our 2024 activity data includes a significant number of beds, admissions, outpatients, ER visits, surgical procedures, along with a mean length of stay, a large number of employees, and a total budget of over €750 million.

Regarding the labs, all labs in our hospital are integrated in an organisation called the Biomedical Diagnostic Centre — we call it CDB — which includes all the labs belonging to our hospital. We have almost 500 employees across all labs, with a budget of around €60 million. The core lab performs almost around 90% of the total activity in our hospital.

Why We Decided to Work with ProTube™

After reviewing these figures, I want to start the real subject of my presentation: our experience with ProTube™ and why we decided to start working with it. It has been a challenging project to improve patient safety. This was the main idea behind the ProTube™ installation in our hospital — the objective of reducing errors in laboratory medicine.

There is an ISO definition for laboratory error: *a failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim, occurring at any part of the laboratory cycle.* And this is probably the most important idea I want to share with you today — “any part of the laboratory cycle,” from ordering examinations to reporting results and appropriately interpreting and reacting to them.

What does it mean, “any part of the laboratory cycle”? It means the total testing process — the combination of all processes and procedures, and all interactions with personnel and available technology involved in testing, from the moment the patient accesses the system to the moment a health professional acts on the result. Sometimes we think about the total testing process only within the lab walls, and this is not the right idea. We need to consider the whole process, from the very beginning to the very end.

This definition is closely related to the brain-to-brain loop described by Lundberg, which considers all steps of the testing cycle — from the initial clinical question of the physician ordering the test until the information is available from the laboratory. Everything starts with the physician’s brain and the need for a test for a critical decision, and then comes ordering, identification, collection, transportation, preparation, analysis, review, reporting, and interpretation of results — by both laboratory professionals and physicians — to make the right decisions and provide the right clinical care.

And the key point is that errors can occur at any step, in any phase of the total testing process: the pre-analytical phase, the analytical phase, and the post-analytical phase.

If we mark all the steps of the brain-to-brain loop that occur in the pre-analytical phase, you see that many of them fall there. Only analysis is related to the analytical phase, and just two steps relate to the post-analytical phase.

The Burden of Pre-Analytical Errors

For many years, our focus has been on reducing errors in the analytical phase through quality control methods and quality assessment programmes. We have achieved a huge success in reducing analytical errors through automation, improved technology, standardisation, information technology, and better-trained staff. Consequently, rates of analytical errors have been dramatically reduced over the last decades.

But the problem is that it has also been widely demonstrated that quality in clinical laboratories cannot be assured by focusing only on pure analytical or technical aspects. As Plebani — the father of studies related to pre-analytical errors — has shown, pre- and post-analytical phases of the total testing process are far more prone to errors than the analytical phase. Pre-analytical errors account for around 70% of total errors, post-analytical errors for around 20%, and the rest are analytical errors.

So we have invested enormous effort in reducing analytical errors, but we need to work harder and with more focus on reducing errors related to the pre-analytical phase.

Many errors in the total testing process are labelled “laboratory errors” even when they may be due to actions taken by others involved in the testing cycle — physicians, nurses, or poorly designed processes that are beyond our responsibility. So we are suffering errors that are not within our direct control, yet we need to work to correct them.

The concept of “extra-laboratory” versus “intra-laboratory” sources of error is important here. Errors can be found in ordering, identification, collection, transportation, and interpretation — all extra-laboratory steps. Plebani was the first to define the concept of “pre-pre-analytical steps”: initial procedures performed neither in the clinical laboratory nor at least in part under the control of laboratory personnel, including patient and specimen identification, sample collection, handling, and transportation. Similarly, “post-post-analytical steps” are defined as final procedures performed outside the laboratory, such as receiving, reading, or interpreting laboratory information for patient management.

Studies have shown that more than half of all errors — 56% — related to the total testing process occur in the pre-analytical phase. That means more than three-quarters of errors in the total testing process occur outside the lab. And I am truly convinced that we need to be involved in the solution to this problem.

This stresses the importance of interdepartmental cooperation in improving the quality of sample collection and handling. We need to work together with nurses and physicians to correct problems related to the pre-analytical phase, and that is why we decided to start the ProTube™ project.

The ProTube™ Project

Once we understood these numbers and the importance of the pre-analytical phase, we decided — together with our hospital administration — that it was time to invest time, money, and effort to improve quality in the total testing process. This is a challenging project about patient safety, quality, information technology, and cooperation between different hospital departments.

Everything started in 2017, when I had the chance to visit the Inpeco booth at the AACC meeting in San Diego, where I saw ProTube™ for the very first time. Later that same year, they had a booth at our national congress. We visited together with the lab director from our hospital, and we decided to start a project with Inpeco.

The project started in 2018 with the arrival of the first ProTube™ units. We launched a pilot in the Central Diagnostic Biomedical phlebotomy area in November 2018, with just a few units, before deciding to roll out ProTube™ across the hospital. We felt it was important to test the ProTube™ system in our facilities with our own patients and nurses.

The pilot project was highly complex. We attend more than 10,000 patients daily — ambulatory and in-hospital — with more than 950 patients and more than 3,000 samples collected on an average day. Our human resources at that time included 21 nurses, three nursing assistants, four administrative staff, one health assistant, and one coordinator, across 21 phlebotomy booths.

There were many challenges in adapting ProTube™ to our needs. As a third-level hospital, we deal with an enormous variety of samples — more than 600 different sample types and more than 70 different containers and tubes, all of which needed to be codified. We also had special sample requirements to transfer to ProTube™, such as informing us when a sample needs to be kept at a particular temperature or protected from light. Our label design is quite complex: the label contains a code indicating the tube type and its destination (for example, the letter “C” indicates a serum tube for the core lab), a black band indicating sample priority, and codes for special handling requirements such as CO₂ (do not decap), “L” (protect from light), or “H” (on ice). All of these requirements needed to be developed and included in the ProTube™ software.

Additionally, we have over 250 ongoing clinical trials requiring special conditions and additional tubes. We needed to integrate ProTube™ with the queue management software used for patient flow in the phlebotomy centre. It was, overall, a highly complex project.

The pilot project gave us a much better understanding of ProTube™ and how to install it later in the different wards. We gained experience to face the next steps, worked together with Inpeco to improve the hardware and software, achieved a significant reduction in incidents, redesigned our phlebotomy booths, and introduced pre-analytical workflow changes. We also learned how to train future ProTube™ users.

In November 2020 — two years after the pilot started — ProTube™ was fully operational in the phlebotomy area with 226 units. However, at that time we were in the midst of the COVID-19 pandemic, which forced us to slow down the installation. The next step therefore did not occur until May 2021, when we launched a pilot project in a small selection of wards — four wards and one day hospital — providing nine ProTube™ units.

The idea was this: once ProTube™ was fully operational in the phlebotomy area, once our own nurses were happy working with it, and once the number of incidents was very low, then it was time to involve the rest of the hospital wards.

There were also many challenges in the ward pilot project. Communication was critical: when we were working within our own phlebotomy area, we were working with 21 nurses we knew well. Now the project needed to be communicated to all nurses across the entire hospital. There is always a resistance to change: at the time, ward nurses were used to performing phlebotomy themselves without technological assistance, and at the beginning it was not easy to convince them to use a new device. We needed to train more than 3,000 ProTube™ users. We also needed to improve the hospital Wi-Fi network, integrate ProTube™ software with the Hospital Information System and the Laboratory Information System, and redesign the mobile cart — the original was too large for our old, space-limited hospital. Of course, we also needed to secure budget availability for the installation.

In July 2024, after the pilot, we began the full implementation of ProTube™ across all three hospital locations. In December 2022, ProTube™ installation was complete in all conventional wards, with 83 units in 76 locations. In May 2023, we re-evaluated our needs and found that some wards required more units than originally allocated. This is the current situation: in total, we have 108 ProTube™ units in 79 wards across the three hospital sites — 81 at Villarroel, 12 at Maternitat, and 15 at Platò. We have 29 ProTube™ units in the phlebotomy centre, and also 30 ProTube™ units at external locations such as primary care centres and partner hospitals that send us samples daily. In total, we currently have 167 ProTube™ units — making this the largest ProTube™ installation in the world.

The next step, happening this year, is the installation of ProTube™ Mobile in our emergency department. The mobile solution works like a smartphone-sized device paired with a small Bluetooth printer that prints labels. We are in the final steps of designing this phase of the project.

Results and Benefits

What improvements have we achieved with ProTube™?

We now have total traceability across almost the entire testing process. Samples from the phlebotomy centre go directly to FlexLab™ X — our total lab automation system — where check-in is performed automatically. We have eliminated the manual check-in step at the sample reception area.

I want to take a brief moment to describe FlexLab™ X. We decided to install it because of our previous and highly satisfying experience with Inpeco and Siemens, with whom we had worked for up to 10 years. The first FlexLab™ X installation in the world was at Hospital Clinic, launched in July 2024 — nearly two years ago. It has a flexible design that allows adaptation to changing lab needs, saves significant space (the track footprint was reduced by approximately 70%, from 108 metres to 71 metres), has improved workflow for priority samples (a 5.3-minute, or almost 10%, reduction in turnaround time), and has reduced noise levels by around 30%. The atmosphere in the lab is now much more relaxed and quiet. FlexLab™ X is an open TLA platform that allows connection to analysers from different vendors, and provides full sample traceability at every step.

The reason I mention FlexLab™ X is because we are moving from total laboratory automation to total testing process automation (TTPA). The idea is to merge information from ProTube™ and FlexLab™ X to manage and integrate all information from the total testing process.

Going back to the ProTube™ project: with both ProTube™ and FlexLab™ X in place, we now have traceability in ordering, identification, collection, preparation, analysis, and review and reporting. The only remaining gap is transportation — and we are currently working with Inpeco on a pilot project to close it.

This end-to-end traceability project works as follows: at the collection point, the nurse reads the label on the rack before starting phlebotomy, linking all patient identification and sample collection data to that specific rack. When phlebotomy is complete, she reads the rack card to begin the transportation mission, and the rack is then linked to its transport container. When the courier arrives at the laboratory, we record their identification and link it to the container. Upon arrival at the destination lab, we read the time and temperature data and verify exactly which rack and which tubes are in that container. We have now completed traceability across the entire total testing process.

 Other Key Improvements

We can now easily sort samples in the phlebotomy booth. Samples for the core lab (those with the letter “C” on the label) go in the left rack; samples for other destinations go in the right rack. We have simplified the delivery of samples to the core lab — there is no longer any need to go to the sample reception area — and we have reduced turnaround time by more than 33 minutes, a 61% improvement.

Training is now very simple. Nurses only need around five minutes of training, because they simply follow the instructions on the screen. There is also a significant reduction in workload at the sample reception area, since manual check-in of samples is no longer required.

Most importantly, there has been a significant reduction in pre-analytical errors. In a study we conducted from July to September 2020, comparing wards with and without ProTube™, we found that prior to ProTube™, 11% of samples had pre-analytical errors — including samples not drawn, previously submitted samples, or surplus tubes. After ProTube™ implementation, incidents were reduced to around 1.8%. Later studies demonstrate that we are currently below 1% pre-analytical errors, and in our most recent data we are approaching 0.5%.

With ProTube™, we have been able to address incorrect samples, incorrect identification, and sample handling and transportation errors.

How ProTube™ Works

For those who have never seen ProTube™ in action: the nurse scans the patient barcode and all patient data is loaded from the LIS to the ProTube™. The system shows which tubes are needed for that patient. The nurse places tubes into the ProTube™ system, which reads the colour cap and applies the correct label to the correct tube. If a wrong tube is inserted, the system detects it via the colour cap reader and discards it, displaying a warning on screen.

Once all tubes have been collected, the screen changes to show the correct filling order. This is key — ProTube™ tells nurses not only which tubes are needed, but also the correct order in which to fill them. That is why nurse training is so short: they simply follow the on-screen instructions. After collection, the nurse performs a checkout scan of the tubes, confirming that all data — check-in and check-out — has been recorded.

From Total Laboratory Automation to Total Testing Process Automation

Our evolution has been significant. In the past, we worked with total laboratory automation and managed only some parts of the analytical and post-analytical phase. Now, with ProTube™ and FlexLab™ X, we have moved to total testing process automation. We have information covering the pre-analytical, analytical, and post-analytical phases. Going back to the brain-to-brain loop, with ProTube™ we can trace identification, collection, and transportation; with FlexLab™ X we cover analysis and preparation; and with our LIS we have review and reporting. The only steps we cannot yet fully control are the ordering and interpretation steps on the clinical side — but now, for everything that belongs to us, even when it occurs outside the lab, we have full traceability and quality information.

IBIS: Inpeco Business Intelligence Service

I also want to briefly share another project we are working on with Inpeco — IBIS, or Inpeco Business Intelligence Service. Since we now have all the information from FlexLab™ X and from ProTube™, Inpeco is developing a cloud-based intelligence service that provides real-time KPIs, trend analysis, and root cause insights — including total turnaround time, sample quality indicators, tools utilisation, and bottleneck detection — across the complete total testing process.

This new tool will provide comprehensive information about the total testing process in real time. Ten years ago, knowing the TAT in real time or having access to all this information seemed impossible. Now, with IBIS, we are very happy to see this becoming a reality.

Nurse Satisfaction Survey

We conducted a survey with our nurses to understand their satisfaction with ProTube™, since this is fundamentally a cooperation project between nurses, physicians, and the lab. The response rate was high, and the results were very positive:

– Facilitates correct and unique patient identification:** 81% totally agree

– Provides information about tubes required and special sample characteristics:** 84% agree

– Avoids sample contamination:** 79% agree

– Avoided identification errors:** 81% agree

– Total automated sample traceability:** 75% agree

– Prevents order duplicity:** 86% totally agree

– Automatic labelling:** 80% agree

The nurses are very happy with the results. And this is a real quote from some of the wards that were initially reluctant to use ProTube™: once they started, they could not imagine working without it. Wards that had not yet received ProTube™ came to us asking for it, saying: “I have seen the ProTube™ unit in another ward — we also want this device.”

Closing Remarks

To summarise, I would like to borrow a quote from Mario Plebani: *”Good samples only make good assays”* and *”only good reports make good laboratory information.”* To ensure that the answer to a clinical question is reliable, five rights must be observed in the pre-analytical phase: right patient, right time, right test, right sample collection and handling, and right transportation.

But I would add that when we don’t have the tools to detect bad samples — because the error occurs outside the lab — we end up with five wrongs: wrong samples, wrong assays, wrong results, wrong reports, and wrong laboratory information. And the consequence is poor quality care.

Poor quality care is an overlooked epidemic that significantly threatens global health. Its consequences are far-reaching, affecting health outcomes, mortality, economic stability, and patient trust. To reduce adverse events and improve patient outcomes, healthcare organisations must strengthen safety protocols, enhance reporting and accountability mechanisms, invest in workforce training, foster a safety culture, and leverage technology and innovation.

And this is exactly what we have done. We have leveraged technology and innovation and focused our efforts on improving quality outside the lab — in the pre-analytical phase, where the majority of errors currently occur. I believe this is the real challenge we need to work on together, in order to improve the quality of care we provide to our patients.

Thank you for your attention, and I will be happy to answer any questions.

Q&A Session

Moderator: Thank you very much for your informative presentation. We are now going to start the live Q&A portion of the webinar. Dr. Bedini, we’ve already got a lot of great questions coming in, so let’s jump right in.

Q: Now that you have achieved such a high level of sample security, what additional operational improvements have you observed within the laboratory and more broadly in other hospital departments that rely on the efficiency of the core lab, following the implementation of ProTube™?

The benefits of ProTube™ are actually most felt by departments outside the lab. When we collect wrong samples, a bad result is produced in the lab — but the consequences of that bad result are experienced by the patient, who is located in the ward. So the benefits are ultimately for patients and for hospital departments.

For example, when a young nurse arrives for a summer substitution, before ProTube™ it could take two or three days to train them in sample collection — knowing the right tube for the right test, the correct filling order, everything. Now, with ProTube™, training takes just a few minutes. So I think ProTube™ is an initiative that comes from the lab but benefits the wards and patients. And that is the important thing: the lab’s commitment to improving quality, helping nurses collect samples correctly, significantly reducing errors, and of course preventing mistakes that can harm the patient.

Q: Your project demonstrates strong collaboration across multiple departments. In your experience, what was the key factor that really made implementation successful?

Communication. The only way to succeed in such a complex project is communication. You need to be able to convince hospital managers, nurses, and heads of nursing of the benefits of this project. And of course, you need a leading person from the lab side. In our case, that has been the head of nurses in the laboratories, Miss Hayen. She is brilliant — she organised all the meetings, informed the nurses, and came in many mornings at 5:00 a.m. to teach nurses before their shifts. You need both a leading person and a strong communication project with the wards in order to achieve that level of cooperation.

Q: Given the current pressure on hospital budgets, implementing innovative solutions can be challenging. What would you recommend as the first step to start a conversation with hospital management or procurement when proposing solutions like this?

Quality — or more precisely, non-quality. It’s all about non-quality, because when errors occur in the pre-pre-analytical phase, they generate non-quality costs: more phlebotomist visits, bad diagnoses, unnecessary complementary tests or procedures. It is difficult to help managers understand that this is about non-quality.

Everyone can easily see and quantify the costs of quality — quality controls, visible processes — but the cost of non-quality is much harder to evaluate. The cost of non-quality is sometimes the health of the patient, and it is very difficult to quantify in euros or dollars. So when I faced our hospital managers, we convinced them that this was a project about quality and non-quality — the quality you can see, and the quality you cannot see. Non-quality has costs you must prevent, and sometimes those costs are not measured in money, but in health.

Moderator: That is phenomenal. Thank you very much. Thank you again for your time today and your important research. I also want to thank Labroots for hosting this event and Inpeco for underwriting today’s educational webcast.

Before we go, I’d like to thank the audience for joining us and for their excellent questions. Questions that we did not have time for today, and those submitted during the on-demand period, will be followed up by either Inpeco directly or Inpeco’s local representative.

This webcast can be viewed on demand — Labroots will alert you via email when it is available for replay. We encourage you to share that email with colleagues who may have missed today’s live event.

Thank you all very much for your time today, and until next time, everyone.