2.8 Managing resources

Question 1

What are some of the key points to consider when introducing a new test?
(clinician rings up to ask for this new assay to be performed)

Answer 1

1. Clarify w clinician regarding
   - clinical utility
   - if dissatisfied w current lab procedure regarding sendaway
   - opportunity for education
   - review literature
   - take it seriously
2. New assay considerations
   - preanalytical: sample collection, transport, storage, triage
   - analytical: platform, numbers, TAT/demand, staffing level/expertise,
   - post analytical: interpretation, LIS, data entry
3. Discuss with colleagues, EQA program, rv literature

If possible
4. Order kit- verification
5. Compare with current - cross validation
(kappa if binary, linear regression if correlation important, bland altman if agreement important)
6. SOP/ update/communicate/education/staff training
7. Documentation for NATA
8. QAP

Question 2

What are the factors which determine the cost of a test?

How does your lab do this?

Answer 2

• Predominantly done by lab manager
• consult financial advisor of laboratory services

Direct vs Indirect costs
Fixed (doesn’t vary with # tests performed) vs variable cost

Direct
Fixed
- equipment/ maintenance
- lab staff employed
- QAP program

Variable:

• lab staff time/after hours
• kits, reagents, consumables

Indirect

• utility (heating/lighting)
• building
• specimen collection storage/freezers
• cleaning
• administration
• IT
• QC housekeeping
• safety monitoring
• record keeping
• training, teaching, secretarial/clerical work
• salaries senor staff,

OTHER strategy is to take total indirect cost and divide by total number of request to calculate “handling charge per request””
total cost= cost per request (+per test)

Review

• number of tests reqested/demand
• medicare rebate 25% hospital
• charging patients privately
• other support for testing

Can divide indirect costs by total number of requests to calculate

Who signs off on the test at ACT Pathology?

Question 3

Who decides about Medicare rebate of a test? What are the regulations that govern this decision making?

Answer 3

MSAC- medical services advisory committee:

• expert panel decides on scientific quality of evidence /utility of test for a condition
• comprehensive evaluation
• recommends test to minister of health and ageing

PSTC- pathology services table committee

• panel determine dollar value
• make recomm to minister to sign off

Question 4

How do you manage your lab in the COVID pandemic?

Answer 4

Caveat

1. MDT input; institution wide but also heads of diff pathology disciplines
2. Health chief officer; instructions top -> down ensuring dissemination of information effectively
3. Planning for testing
   - urgent vs non urgent, rationalising tests
   - methods (ANCA IFA vs mpo/pr3)
   - samples having same test, serology on already diagnosed patients
   - alternative platforms
   - TAT; especially sendaways may not work
   - communication to clinicians
4. Stock take
   - suppliers/manufacturers
   - back up stock
   - prioritise test kits
5. Staffing
   - rostering different shifts; staggered shifts
   - expertise level
   - cross training of staff
   - cancel unnecessary leave
   - pathologists remote reporting
6. Staff safety
   - PPE
   - social distancing measures; meetings
   - contact web; unwell, calling in sick
   - psychological wellbeing
7. Contingency planning
   - if <50%, 75% staff
   - EQAP engagement
   - education programmes

Question 5

What are some of the strategies you would employ to try and reduce lab costs?

Answer 5

• reduce overheads ( unecessary lighting, space, electricity)
• tests offered vs sendaway tests- analysis
• competitive tender for courier services
• discontinue redundant tests
• reduce call back
• increase batching of tests/reduce waste from kits/reagents/controls

Question 6

What is a WELCAN unit?

Answer 6

1 min of scientific/technical/pathology assistant/clerical time

ave time involved in performance of ix including pre-a, a, post a work

divide salary of relevant staff by total number of welcan units worked

Question 7

Considerations when purchasing a new piece of equipment

Answer 7

1. Need
   - why is it needed
   - current platform
   - demand/requests
2. Equipment in question
   - pre-analytical: processing, sample storage, handling, test volume
   - analytical:
   - - methodlogy; any kits or company kits
   - - performance capacity, precision, performance eqa, colleagues
   - - practically: physical space, workflow, workload, TAT, random access, multi functions, LIS, automated vs manual- compatibility , waste disposal
   - post analytical:
   - - interfacing, LIS, data entry need, friendly programing /operations
3. Other
   - access to service, maintenance requirements, waste produce/disposal
4. EQA
5. Cost/financial
   - Direct fixed: outright purchase/lease/maintenance
   - Direct variable: test kits/reagents/consumables/Qc/labour/batch testing
   - indirect: specimen collection /processing/ transport/staff/space/other facilites
   - medicare rebate
6. Staff
   - training, expertise

Question 8

A patient was not made aware of a non MBS genetic profile test cost and doesnt want to pay, how would you resolve this?

Answer 8

1. Investigate
   - who requested, what, why, test performed already
   - non MBS rebate test consent (ACT Pathology)
2. • usually requester needs to discuss
   • awareness? policy/procedural? education?
     – send letter/update test guide/ consent
3. Either waiver OR discuss with patient
4. Document/ complaint/QIR, discuss at management meeting, monitor

Question 9

You have to set up a new lab in the a new city what are some of the points of focus?

Answer 9

• caveat: familiarise self with funding (Medicare/MBS), type of laboratory/supervision, staffing levels/disciplines
• also range of tests, purpose, client base, population, other labs in the area, space, funding

1. Quality manual for quality systems in parallel to test implementation
2. Organisational
   - hierarchy
   - facilities
   - safety
   - personnel
   - equipment
   - LIS
   - inventory
3. Services
   - test range/ scope of accreditation
   - QC
   - documents/records
   - information management
4. Post service
   - incident management
   - accreditation
   - QAP
   - billing
   - liaison/communication with requestors and customers

Question 10

What type of equipment related records are part of NATA requirements?

Answer 10

Retention of records- equipment records lifespan + 3years

• instructions (manufacturer, model, serial number, contact information)
• acceptance testing
  (date receiving, entering, condition when received)
• calibration
• maintenance/repair log
  (mx preventative q6-12months)
• adverse incident/troubleshooting

Question 11

How often do you have to maintain equipment?

Answer 11

• preventative maintenance q6-12months
• pipette q3-6monthly (but may depend on its indication for use) if fails sent to NATA accredited calibration facility
• scale monthly?
• temperature daily; thermometer check, acceptable range (refrid, freezer, incubator, water bath)

Question 12

What are some of the benefits and disadvantages of automation?

Answer 12

Benefits

• faster TAT
• high throughput
• less labour cost
• improved precision/accuracy
• ease of use/less training
• eliminate human error
• interface with LIS

Disadvantages

• set up cost/equipment/LIS/program
• dependent on servicing/maintenance third party
• Staff less competent/skill level decrease

Question 13

How to improve TAT

Answer 13

• ordering
• collection
• transport
• preparation
• analysis
• reporting
• release of result

At each step see where the delay could be/improved

Question 14

What does preventative equipment maintenance include?

Answer 14

systematic and routine cleaning, adjustment and replacement of equipment parts at scheduled intervals

daily, weekly, monthly or yearly tasks

Equipment plan

• assign responsibility
• logs
• policy/procedure
• train staff
• inventory log of all equipment