Savings, schedules, new automation—labs weighing it all

We’re looking at expanding capital acquisitions, particularly adding in automation at sites where we would not have thought automation made sense, such as in 200-bed hospitals. As we renovate a few laboratories, expanding automation is, in general, part of the discussion. We’re adding more analyzers to lines and doing a lot with machine learning and robotic process automation, where we have computers reading acquisitions and keystroking. It’s working better with printed materials but not very well with handwritten materials. We’re trying to find savings opportunities wherever we can.

Steve Carroll, how are things in Charleston?
Steve Carroll, MD, PhD, chair, Department of Pathology and Laboratory Medicine, Medical University of South Carolina: COVID spiked significantly for us. Testing positivity in the last few days has been 25 to 26 percent. We seem to be on the way down.

The staffing problem is exacerbated by COVID as well as the overall marketplace and finding personnel—histotechnologists seem to be a particular problem.

Since COVID caught us so badly the last time around, we are being proactive with monkeypox. Julie Hirschhorn [PhD, director of molecular pathology] heads that unit and is getting quotes, and we are planning to set up testing in-house in case we do see a surge. I set up a test development lab within the department, and one of its tasks is to prepare testing for emerging pathogens. It also doubles as a resource for my faculty to do research, so it’s a win-win.

Are you masking in the laboratories now?
Dr. Carroll (MUSC): We had a period in which we did away with masks, then the spike came, so now masks are back in patient-facing areas and in the laboratory.

Frank Beylo, what’s the mask situation at Inova, and what else is top of mind for you?
Frank Beylo, BS, MT(ASCP), director, operations and technology, Inova Health Systems, Falls Church, Va.: Mandated masks for all staff—we haven’t relaxed anything yet.

Staffing is a huge concern. Our system is heavily recruiting international medical laboratory scientists, similar to what was done during COVID for nursing and other positions. We’re also looking at implementing alternate schedule options for our MLS team members that is similar to nursing—three 12-hour shifts covering Friday, Saturday, and Sunday, off four days, with full-time benefits plus additional shift differential—to see if we can get staff to help cover our weekends. The concern is whether we will be robbing Peter to pay Paul with any current team members wanting to transition to this role, so I don’t know how much we will gain or when this will be approved, but we are trying to be creative.

We have a robust medical laboratory science program. We graduated eight students and were able to hire all of them. Two years ago we started a histotechnology training program; three students graduated this year and we hired them. Last year we started a phlebotomy training school. It has seven applicants and we are hiring them all. We’re doing our best to grow those positions internally, but we’re still struggling.

Last month we talked about having to close patient drawing centers, service centers, or the possibility of having to do so. I’ve heard reports that some point-of-care laboratories have had to close in some of the large systems. Have you kept all your working sites up and running so far?
Frank Beylo (Inova): We haven’t closed any that I can think of. We recently opened a lab in one of our cancer centers, and we’re building three more hospitals in the next four to seven years. We’re planning for those, too, but we don’t know where staff will come from. We will try to grow staff while also looking to add automation. Many of our techs are approaching retirement, so we have to address that.

Lauren Anthony, what is the monkeypox situation in Minneapolis?
Lauren Anthony, MD, system laboratory medical director, Allina Health, Minneapolis: We had a probable case over the weekend. Several cases have been reported in Minnesota. The health department is local, and it has epidemiologists on call 24/7. They want to be notified of a suspected case.

We connected the clinician with the state health epidemiologist, who provided instructions about collecting swabs of the lesions. No lab testing or blood testing had been ordered on the patient, so the clinician recognized that and didn’t order tests.

We are communicating with the state health department for guidance on what samples to collect and tie them in with infection prevention.

We’ve been dealing with a critical shortage of metal-free tubes needed for collecting serum zinc, copper, and selenium, so we’ve put restrictions on those orders. You can use a lavender top for toxic metals, where you’re looking for an elevated level, but we have an alert to block orders for deficiency testing and we’re asking providers to wait three months. Usually they’re doing nutritional testing—you’re looking for a deficiency there, and it doesn’t make sense to collect it in a questionable tube.

As you work collectively at Allina toward your budgets for next year, how bad does it look? What is your wish list? And do you think you’ll be able to meet your administration’s demands?
Dr. Anthony (Allina): We’d like to replace our 10-year-old chemistry line. There’s increased downtime, and we’re waiting on it to implement high-sensitivity troponin.

Diana Weyhrauch and Milton Datta, tell us how you’re putting plans together for a new chemistry system at Allina.
Milton Datta, MD, chair of pathology, Abbott Northwestern Hospital, Allina Health, Minneapolis: I’ll talk big picture. One of the big pushes at Allina Health is to transition to moving care as close as possible to the house that patients live in. We’re trying to protect the ability to collect the specimens as close to home as possible and run those tests, but we’re running into the reality of staffing. Diana has been leading the charge to make difficult decisions on that. And we’d love to have the technology, as Lauren said.

There’s an emphasis on building out the Allina Health Cancer Institute; it is being pushed from the top. We feel like the support there is strong, as it is a keystone for our patients’ care. Lauren’s biggest job is to manage expectations. When there is a New England Journal of Medicine article about liquid biopsy results, you have to manage everybody who comes running in saying, “We have to have that yesterday, and it’s going change the world.” It may, but it will take a few years.

Our staff have been hit by COVID, even among pathologists. We’ve been short-staffed quite a bit and have been trying to adjust for these staffing levels. We now do more virtual cases, which has helped—intraoperative support for our staff and surgeons at our regional and community hospitals is up. Over 30 percent of our total visits are now done by pathology assistants virtually in real time with pathologists.

We have great pathologists who retired and we’ve asked them to help us cover for a couple of weeks, and they’re happy to do that.

Diana, what are some of your thoughts as you put these details together.
Diana Weyhrauch, MLS(ASCP), senior director of laboratory operations and technology, Allina Health, Minneapolis: We’re looking at it from multiple angles—staffing, clinical, and financial impacts. From a staffing perspective, we are looking at what we can do to improve efficiency for the current staff. We’re looking at different programs to get more people in the door and get them excited about laboratory medicine, and that includes working the education front, trying to get into junior high and high schools.

We are also looking at it from financial and clinical perspectives. We’re evaluating the three legs of the stool to ensure we make a good decision. These contracts are typically in place for a while, so you want to make the right decision. You don’t want to replace your automation every few years.