Tight and terrible: Lab leaders on budgets and staffing

Michael Quigley, tell us what you’re dealing with in San Diego.
Michael Quigley, MD, PhD, vice president, diagnostic services, and medical director, Scripps Health core laboratory, San Diego: We are considering a request for point-of-care testing for troponin in the ED. The laboratory has concerns about the performance of POC troponin assays compared with current laboratory-based contemporary assays as well as the anticipated ultrasensitive assays that will likely become more widely available next year. The added cost of POC testing also has to be figured in.

We are working on the recently published recommendations to remove race from the eGFR equation.

The adoption of new equations is gaining momentum. Do you see that in Maine, Stan Schofield?
Stan Schofield (NorDx): We have such a small minority population, but our technical people are working on it and the quality people started making adjustments.

Dr. Quigley (Scripps): We are working on making the switch to the equation without race as soon as we can.

Dr. Breining (Northwell): We’re in the process now at Northwell.

What is happening in Little Rock with COVID cases, staffing, and laboratory budgets?
Angela Boast, CG(ASCP), MLS(ASCP), quality assurance laboratory manager, University of Arkansas for Medical Sciences, Little Rock: As far as COVID cases, we are on a decline. We only had six inpatients this week.

Amy Trickett, MBA, administrative director, laboratory and pathology services, University of Arkansas for Medical Sciences: We are having the same staffing issues as others. We’re still running a full-service lab, and a lot of our labs are 24/7. Our staff volunteer to work double shifts. We’re having trouble especially in histology, trying to find specialized employees for that area. We’ve been down about five histotechnologists for the past couple of months, so our managers and supervisors in those areas are working six to seven days a week. So yes, we’re struggling.

We will start on our budget at the end of December. We are under budget so far for fiscal year ’22 and staffing is about $1 million under budget. Our supply is about $1 million as well. That shows you the staffing issues we have with open positions and with COVID testing declining, because we budgeted for large amounts of COVID testing. Normally at this time we’re way over budget, which is normal for labs.

Peter Dysert, tell us about COVID rates and testing in Texas.
Peter Dysert, MD, chief, Department of Pathology, Baylor Scott & White Health, Dallas: At Baylor in north Texas, we see a continued decline in the number of tests and percent positivity. Our analysis of our variants shows a delta dominance, though we have a rare additional variant show up occasionally. We continue to see a low prevalence of influenza and adenoviruses.

Our laboratory staffing is challenging, and our nursing colleagues are equally challenged. Pre-COVID at Baylor University Medical Center, our vacancy rate in nursing was five percent. At a general nursing level, it’s now 20 percent. In our ICU areas, it’s more than 30 percent.

Arundhati Rao, tell us about those same issues at Baylor Scott & White in central-north Texas.
Arundhati (Ari) Rao, MD, PhD, senior VP, chief pathology and lab medicine officer, Baylor Scott & White Health, Temple: There’s been a pretty sharp decline in COVID numbers and tests. We are seeing the same challenges with staffing—up to a 30 percent vacancy rate.

Phlebotomy is being asked to increasingly cover, given the nursing shortage, but is also seeing a 15 to 20 percent vacancy rate. We’re also seeing shortages in PAs and grossing assistants on the AP side. Challenges everywhere as far as staffing goes.

Peter Dysert, do you suspect that another variant is imminent and will come into the population?
Dr. Dysert (Baylor Scott & White): Looking at the variant analysis we’re doing now in the Dallas area, and Dr. Rao is doing the same thing in central Texas, I don’t think we’ve seen a variant yet at a level that raises concern. I think everybody is speculating that under the pressure of vaccination and the virus itself, it’s a possibility in the future.

Dr. Rao (Baylor Scott & White): We are sequencing across the system looking for unexpected variants including AY.4. While we have not seen variants yet, monitoring is important.

Jim Crawford, have you seen any of the other variants?
James Crawford, MD, PhD, professor and chair, Department of Pathology and Laboratory Medicine, and senior VP, laboratory services, Northwell Health, New York: The New York area remains dominated by what might be called the traditional delta. The other variants have not gained traction more than single percents. So in terms of public health planning, there hasn’t been change.

One of the discussion points in the New York consortium is about the vast reserve of an unvaccinated world population and the travel patterns of the people in and out of the United States, especially in major metropolitan areas like New York, and how that has set us up for variant development elsewhere in the world and entry into the United States. We can talk about the pressure of vaccination in the United States, but the greater concern, at least among New York colleagues, is the incubators elsewhere in the world and the need for world vaccination, not just vaccination in the United States. The premise is, if there is a variant it’s going to land in our area, so the need for monitoring remains strong. Right now, we remain a delta environment.

Frank Beylo, can you tell us what’s going on in Virginia?
Frank Beylo, BS, MT(ASCP), director, operations and technology, Inova Health Systems, Falls Church, Va.: To help with staffing concerns like everyone else, we’ve started introducing shift bonuses for staff to take on extra shifts. We are not sure how well this will work until staff have a chance to look at the criteria needed to qualify and how that fits in with their current schedule. We are also looking at some 10-hour days or different kinds of shifts. Our histology department is extremely busy and they are also struggling to maintain much needed staffing levels with a nationwide shortage of histotechnologists. We have brought in some agency staff to assist in both our histology and core labs. We’re also in the midst of an Abbott automation line implementation.

Our budget cycle is almost done, and once that was submitted, administration came back with requests to cut our expenses as a clinical platform for 2022, in the $6 to $10 million range, which includes the laboratory services, respiratory, nutrition, and imaging departments.

Our COVID numbers have been steady. Our percentage rates are a little less than four percent for our PCRs and less than one percent for our ID Now. Our Liat testing is increasing, and we’re looking at perhaps putting ID Now testing in our urgent cares. They’re only using the Sofia combos now, but they’re looking into using the ID Now for additional testing.

The supply chain has been a big challenge with ID Now, and Liats are on allocation as well as Cepheid reagents. It’s almost a full-time job trying to manage what’s coming and what we have and trying to meet the providers’ various testing requests.

John Waugh, what’s the COVID rate in the Detroit area, and what is your gut feeling about the flu season?
John Waugh (Henry Ford): We’re running a six- or seven-week positive rate of about 12 percent.

We do not have flu in the Midwest yet and we’re not testing for it at this time. It is a background test on some of our Liat analyzers and we keep those results internally. It gives us the ability to surveil influenza, and we’re not seeing it even in the multiplexed testing that is going out.

The jury is still out on flu season. We’re seeing a positive influence from masking and distancing and people have gotten to be expert handwashers over the past two years. But influenza morphs just like COVID, and if it gets pressured we’ll potentially see variants.

Finally, where are you with PAMA reporting?
John Waugh (Henry Ford): We have the data accumulated from the prior year. I asked our revenue cycle people to make sure to archive so we have access to it. I don’t want it to get too far away from us. We expect we will have to do a submission, and it’s going to be a big one because it’ll be a six-month submission, a step up from the three-month submission last time. So no rest for the wicked.