Successful consolidation depends largely on laboratory leadership's ability to make accurate assumptions about the future. If a healthcare organization is expanding, for example, how will that impact the laboratory's daily test volumes? Or consider the shift that many health systems are seeing from inpatient services to outpatient care. Where will the bulk of care be delivered in the coming years, and how should that factor into the laboratory's location?
While the answers to such questions can be difficult to come by, that doesn't mean that they should be ignored. Here, Eyas Hattab, MD, MBA, Chair of Pathology and Laboratory Medicine at the University of Louisville, offers some insight around laboratory test forecasting and explains why he believes it's so important to get it right.
Forecasting laboratory testing needs is critical, Dr. Hattab says, “because you want to make sure that you have enough resources and capacity to deal with the volume you're likely to see." Many organizations make the mistake of underestimating future testing volume, “and unfortunately what they find is scaling up is really tough."
Dr. Hattab's recommendation is to “come up with use-case assumptions you can plan around." Among other considerations to keep in mind, he explains, is the fact that testing volume for sick patients (typically inpatient) will be much higher than it will be for healthy patients (typically outpatient) coming in for annual checkups. Similarly, he says, community hospitals generally see healthier patient populations than do tertiary academic medical centers, and therefore should expect to conduct fewer lab tests. “You can't just assume that the average patient, across the board, gets five tests. It doesn't work like that. You have to understand the level of complexity of the patients that you expect to deal with and forecast accordingly."
One of the biggest keys to forecasting success, Dr. Hattab notes, is involving all stakeholders in the process. “This is where a lot of organizations go wrong—when it's just a bunch of executives making the assumptions without input from their clinical colleagues." Those executives can probably predict testing volumes, he says, but they're unlikely to understand which tests are the most common or which ones require the most laboratory resources. “Everyone needs to sit down together and talk about the needs of specific clinicians: What tests are they running day in and day out? What kinds of laboratory services have they required in the past, and how would they like things to be different in the future?" With questions like these on the table, accurate forecasting tends to take time. “It's usually not something you can do overnight. You have to be mindful of everyone's top concerns and realize there's no one-size-fits-all solution."
With stakeholder input in hand, organizations can go ahead and develop accurate forecasts they can use to design appropriate testing programs. Dr. Hattab recently worked with one hospital that required all inpatient laboratory testing to be completed by 7 am. “The challenge there involved staffing enough phlebotomists in those early hours to make sure they could meet that morning surge," he says. In another example, an organization with multiple facilities anticipated that one of its hospitals would see high demand for transfusion services, while another would offer no transfusions at all. “So that information was very important for us to have because it had an impact on the laboratory's design and especially on how we decided to staff it."
In Dr. Hattab's experience, it doesn't matter how much forecasting and planning you do, “you'll always have challenges to work out in the end." Understand that forecasting is not an exact science, he recommends, “and anticipate that you'll have to change things as you go to develop a design that will work for years to come."
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