One of the biggest challenges related to diagnostic testing involves determining where the actual tests should take place. When an organization has multiple sites, for example, which tests should facilities attempt to manage on their own, and which should be sent to a central core laboratory? And when and where should point-of-care testing come into play? Are there situations where such testing makes the most sense?
We recently asked several laboratory leaders to discuss the strategies and criteria they use to determine testing locale. Here's what they had to say.
Tests that are in highest demand—and tests that don't require a fast turnaround—are often best handled in an off-site or central core laboratory equipped to process large volumes as efficiently as possible. Tests that must be completed extremely quickly, meanwhile, should probably be administered on-site to avoid delays that may arise in moving samples between facilities.
In certain situations, it's best to perform tests in the facilities where the test-requesting providers work. For instance, explains Michelle Barthel, MT(ASCP), MHA, System Director of Laboratory Services at Regional Health in Rapid City, South Dakota, if your obstetrics and gynecology department is in a different building than your core laboratory, it likely makes sense to do fertility testing on-site. At her facility, Barthel explains, “we put that in a laboratory where the OB docs are located and we could provide a faster turnaround time."
Point-of-care testing can be fast and efficient, but it's important to ensure that those who administer the tests understand how to do so safely and effectively. “There are significant challenges" with POC testing, notes Goldsmith. “You are going from the folks that are trained in laboratory testing in the central laboratory to folks that are not trained and don't have the experience or the expertise." In an inpatient environment, Goldsmith explains, nurses and medical assistants may handle most POC testing, but that's not the case when such testing is conducted off-site. “Point-of-care testing is done not only in the hospital, but increasingly in the patient's home, in the physician-office setting, in clinics, in schools, in colleges, etc. It is a rapidly growing field."
The last key step to consolidation involves securing buy-in from executives in the C- suite. This can be accomplished in part with assistance from your physician champion, who presumably can convey to budget-focused leaders how consolidation can improve care quality while reducing costs. Executives should understand how consolidation will generate revenue for the organization, as well as how it can improve operational efficiency. Most importantly, throughout the planning process, the leaders in the C-suite should recognize the specific needs and goals of the laboratory itself. If, for example, technology investments are required, executives should understand not only the costs, but why those technologies are critical to the lab's work.
At her organization and others, Goldsmith says, department leaders are required to justify requests for point-of-care testing services. “'We need this and this is why. This is what it will cost.' Then, of course, the lab has to decide if they have the resources to support that." In deciding whether point-of-care testing is the best approach in a certain case, Goldsmith recommends turning to a “point-of-care coordinator" who can ensure compliance with pertinent regulations.
In the end, says Eyas Hattab, MD, MBA, Chair of Pathology and Laboratory Medicine and the A.J. Miller Endowed Chair in Pathology at the University of Louisville, logistical, technical, and financial considerations should all factor into which tests are conducted where. “That's typically the question for us: How do you balance what tests go centrally, what tests stay local, and then what tests are point-of-care?" The answer, Hattab notes, will depend on the organization and the “balance you are trying to strike."
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