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Background: Advance technology and diagnostic approach to disease has increased workload burden on laboratory and timely reporting as well as reliable results provision to physicians is another challenge of laboratory. Objective: To compare pre-analytical errors, peak volume, flow rate and turn around time before and after total lab automation in clinical laboratory. Study type, settings & duration: A cross-sectional study was carried out at Shifa International Hospital, Islamabad from January 2018 to December 2020. Methodology: Present study assesses the key performance indicators based on the Total Lab Automation (TLA) work flow. Frequency and percentage was used to calculate increase in test volume before and after TLA implementation while one way ANOVA was used to test the difference in Turnaround Time (TAT). Results: Prior TLA average turnaround time (TAT) for routine chemistry was 4 hours while immunoassay TAT average reported was 6-7 hours. Post TLA average TAT for routine chemistry is 1-2 hour while for immunoassay it 3-4 hours. There is 5-10% increase in test volume after the TLA implementation. TAT shows significant mean difference before and after TLA installation (p value=0.00). Conclusion: In current study, findings prove that overall efficiency, turnaround time overall workload and optimize workflow occurred after implementation of TLA. Monitoring of key metrics help in continuous process improvement. Advance technology in laboratory makes work easier which was previously laborious. [ABSTRACT FROM AUTHOR]