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Sznol JA, Becher R, Maung AA, Bhattacharya B, Davis K, Schuster KM. Routine post-operative labs and healthcare system burden in acute appendicitis. Am J Surg 2023; 226:571-577. [PMID: 37291012 DOI: 10.1016/j.amjsurg.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Data from the National Health Expenditure Accounts have shown a steady increase in healthcare cost paralleled by availability of laboratory tests. Resource utilization is a top priority for reducing health care costs. We hypothesized that routine post-operative laboratory utilization unnecessarily increases costs and healthcare system burden in acute appendicitis (AA) management. METHODS A retrospective cohort of patients with uncomplicated AA 2016-2020 were identified. Clinical variables, demographics, lab usage, interventions, and costs were collected. RESULTS A total of 3711 patients with uncomplicated AA were identified. Total costs of labs ($289,505, 99.56%) and repletions ($1287.63, 0.44%) were $290,792.63. Increased LOS was associated with lab utilization in multivariable modeling, increasing costs by $837,602 or 472.12 per patient. CONCLUSIONS In our patient population, post-operative labs resulted in increased costs without discernible impact on clinical course. Routine post-operative laboratory testing should be re-evaluated in patients with minimal comorbidities as this likely increases cost without adding value.
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Affiliation(s)
- Joshua A Sznol
- Department of Surgery, P.O. Box 208062, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Robert Becher
- Department of Surgery, P.O. Box 208062, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Adrian A Maung
- Department of Surgery, P.O. Box 208062, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Bishwajit Bhattacharya
- Department of Surgery, P.O. Box 208062, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Kimberly Davis
- Department of Surgery, P.O. Box 208062, Yale School of Medicine, New Haven, CT 06520, USA.
| | - Kevin M Schuster
- Department of Surgery, P.O. Box 208062, Yale School of Medicine, New Haven, CT 06520, USA.
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Veiga E, Olmedo C, Sánchez L, Fernández M, Mauri A, Ferrer E, Ortiz N. Recalculating the staff required to run a modern assisted reproductive technology laboratory. Hum Reprod 2022; 37:1774-1785. [PMID: 35652237 DOI: 10.1093/humrep/deac121] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What number of staff is sufficient to perform increasingly complicated processes in today's modern ART laboratories? SUMMARY ANSWER The adequate number of personnel required for the efficient and safe operation of modern ART laboratories needs to be calculated. WHAT IS KNOWN ALREADY In today's modern ART laboratories, the amount of time required to perform increasingly complicated processes has more than doubled, with a downward trend in the amount of work an embryologist can do. Different workload unit values have been used to evaluate each workload task and efficiency in a particular ART laboratory, as well as to occasionally compare one laboratory with another. STUDY DESIGN, SIZE, DURATION Seven senior embryologists working at different IVF centers, three public and four private centers, participated in this multicenter study conducted between 2019 and 2020. We prepared a survey to create a calculator for staff using the average (of three attempts) time spent in every laboratory by each embryologist of the center to perform any ART process. PARTICIPANTS/MATERIALS, SETTING, METHODS Different laboratory processes and activities related to quality control, time spent and conventional human double witnessing were included in the survey. To calculate the number of processes that each embryologist can perform per year, an embryologist was considered to be having a full-time contract and working 7 or 8 h/day. The times included in the calculation of each task were those corresponding to the 95th percentile. For the calculations, Microsoft® Office Excel® Professional Plus 2019 was used. MAIN RESULTS AND THE ROLE OF CHANCE The survey showed that the time needed per embryologist to perform the different processes necessary for a classic IVF cycle without time lapse (TL) was 8.11 h, and with TL, it was 10.27 h. The calculated time also considered the time spent in documentation handling, cycle preparation, database management and conventional human double witnessing verification. An ICSI without TL needed 8.55 h, and with TL, it needed 10.71 h. An ICSI-PGT without a TL cycle needed 11.75 h, and with TL, it needed 13.91 h. Furthermore, 1.81 h should be added for every vitrification support needed. The time needed to control more than 200 critical steps, including equipment control and culture parameters, was 30 min per day plus 3.9 min per device to control.The time spent in semen analysis (including documentation handling, cycle preparation and database management) or intrauterine insemination with a partner sperm was 2.7 h. For donor sperm, an additional hour was required for the management involved. The time required to perform a testicular biopsy and cryopreserve the sample was 4 h. Similarly, the time required to perform seminal cryopreservation was 3.7 h. LIMITATIONS, REASONS FOR CAUTION The study was conducted considering a full-time contract embryologist working 7 or 8 h/day, 5 days a week, with days off according to the Spanish regulations. However, our findings can be adapted to foreign regulations using the developed online calculation platform. WIDER IMPLICATIONS OF THE FINDINGS A new advanced staff calculator allows any IVF laboratory to estimate the minimum number of embryologists necessary without compromising the security or success of the results. Nevertheless, we recommend a minimum of two qualified embryologists in every laboratory, regardless of the workload. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Asociación para el Estudio de la Biología de la Reproducción (ASEBIR). None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E Veiga
- Central Laboratory/Assisted Human Reproduction Unit, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - C Olmedo
- Reproductive Medicine Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Sánchez
- Assisted Human Reproduction Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - A Mauri
- Centro Procrear, Reus (Tarragona), Spain
| | - E Ferrer
- CREA, Centro Médico de Reproducción Asistida, Valencia, Spain
| | - N Ortiz
- Instituto Europeo de Fertilidad, Madrid, Spain
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Rudolf J, Jackson BR, Wilson AR, Smock KJ, Schmidt RL. Organizational Benchmarks for Test Utilization Performance: An Example Based on Positivity Rates for Genetic Tests. Am J Clin Pathol 2017; 147:382-389. [PMID: 28340161 DOI: 10.1093/ajcp/aqx019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Health care organizations are under increasing pressure to deliver value by improving test utilization management. Many factors, including organizational factors, could affect utilization performance. Past research has focused on the impact of specific interventions in single organizations. The impact of organizational factors is unknown. The objective of this study is to determine whether testing patterns are subject to organizational effects, ie, are utilization patterns for individual tests correlated within organizations. METHODS Comparative analysis of ordering patterns (positivity rates for three genetic tests) across 659 organizations. Hierarchical regression was used to assess the impact of organizational factors after controlling for test-level factors (mutation prevalence) and hospital bed size. RESULTS Test positivity rates were correlated within organizations. CONCLUSIONS Organizations have a statistically significant impact on the positivity rate of three genetic tests.
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Affiliation(s)
- Joseph Rudolf
- From the Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston
| | - Brian R Jackson
- Center for Effective Medical Testing, Department of Pathology, University of Utah, Salt Lake City
| | - Andrew R Wilson
- School of Nursing, University of Utah Health Sciences Center, Salt Lake City
| | - Kristi J Smock
- Center for Effective Medical Testing, Department of Pathology, University of Utah, Salt Lake City
| | - Robert L Schmidt
- Center for Effective Medical Testing, Department of Pathology, University of Utah, Salt Lake City
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Iturrate E, Jubelt L, Volpicelli F, Hochman K. Optimize Your Electronic Medical Record to Increase Value: Reducing Laboratory Overutilization. Am J Med 2016; 129:215-20. [PMID: 26475957 DOI: 10.1016/j.amjmed.2015.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/12/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study is to decrease overutilization of laboratory testing by eliminating a feature of the electronic ordering system that allowed providers to order laboratory tests to occur daily without review. METHODS We collected rates of utilization of a group of commonly ordered laboratory tests (number of tests per patient per day) throughout the entire hospital from June 10, 2013 through June 10, 2015. Our intervention, which eliminated the ability to order daily recurring tests, was implemented on June 11, 2014. We compared pre- and postintervention rates in order to assess the impact and surveyed providers about their experience with the intervention. RESULTS We examined 1,296,742 laboratory tests performed on 92,799 unique patients over 434,059 patient days. Before the intervention, the target tests were ordered using this daily recurring mechanism 33% of the time. After the intervention we observed an 8.5% (P <.001) to 20.9% (P <.001) reduction in tests per patient per day. The reduction in rate for some of the target tests persisted during the study period, but not for the 2 most commonly ordered tests. We estimated an approximate reduction in hospital costs of $300,000 due to the intervention. CONCLUSION A simple modification to the order entry system significantly and immediately altered provider practices throughout a large tertiary care academic center. This strategy is replicable by the many hospitals that use the same electronic health record system, and possibly, by users of other systems. Future areas of study include evaluating the additive effects of education and real-time decision support.
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Salas A, Blazquez R, Bullich S, Izquierdo S, López ML, Marzana I, Vilaplana C, Ramón F. [Benchmarking and Quality Management Indicators Programme. Spanish experience]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2015; 30:337-341. [PMID: 26304145 DOI: 10.1016/j.cali.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Affiliation(s)
- A Salas
- Comisión de Acreditación de Laboratorios.
| | - R Blazquez
- Comisión de Acreditación de Laboratorios; Unidad de Calidad de Bioquímica, Departamento de Laboratorio Médico, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - S Bullich
- Comisión de Aseguramiento Externo de la Calidad, Aseguramiento de la Calidad y Comité de Acreditación de Laboratorios, Sociedad Española de Bioquímica Clínica y Patología Molecular (SEQC), Barcelona, España
| | - S Izquierdo
- Comisión de Acreditación de Laboratorios; Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M L López
- Comisión de Acreditación de Laboratorios; Laboratorio Catlab, Departamento de Calidad, Terrassa, Barcelona, España
| | - I Marzana
- Comisión de Acreditación de Laboratorios; Laboratorio de Análisis Clínicos, Hospital San Eloy, Barakaldo, Vizcaya, España
| | - C Vilaplana
- Comisión de Acreditación de Laboratorios; Laboratori de Referència de Catalunya, El Prat, Barcelona, España
| | - F Ramón
- Comisión de Acreditación de Laboratorios
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Aesif SW, Parenti DM, Lesky L, Keiser JF. A cost-effective interdisciplinary approach to microbiologic send-out test use. Arch Pathol Lab Med 2014; 139:194-8. [PMID: 24758733 DOI: 10.5858/arpa.2013-0693-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. OBJECTIVE To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. DESIGN The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. RESULTS Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. CONCLUSIONS Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.
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Affiliation(s)
- Scott W Aesif
- From the Department of Pathology (Drs Aesif and Keiser), and the Divisions of Infectious Diseases (Dr Parenti) and Hospital Medicine (Dr Lesky), Department of Medicine, The George Washington University, Washington, DC
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7
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Melanson SE. Establishing benchmarks and metrics for utilization management. Clin Chim Acta 2014; 427:127-30. [DOI: 10.1016/j.cca.2013.09.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
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Lazzari MA. Can Continuing Medical Education Courses Supplied by the Clinical Laboratory Alter Provider Test-Ordering Practice? Lab Med 2012. [DOI: 10.1309/lmlwcdrbwbf6yrvf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jones BA, Darcy T, Souers RJ, Meier FA. Staffing benchmarks for clinical laboratories: a College of American Pathologists Q-Probes study of laboratory staffing at 98 institutions. Arch Pathol Lab Med 2012; 136:140-7. [PMID: 22288961 DOI: 10.5858/arpa.2011-0206-cp] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Publicly available information concerning laboratory staffing benchmarks is scarce. One of the few publications on this topic summarized the findings of a Q-Probes study performed in 2004. This publication reports a similar survey with data collected in 2010. OBJECTIVE To assess the relationship between staffing levels in specified laboratory sections and test volumes in these sections and quantify management span of control. DESIGN The study defined 4 laboratory sections: anatomic pathology (including cytology), chemistry/hematology/immunology, microbiology, and transfusion medicine. It divided staff into 3 categories: management, nonmanagement (operational or bench staff), and doctoral (MD, PhD) supervisory staff. People in these categories were tabulated as full-time equivalents and exclusions specified. Tests were counted in uniform formats, specified for each laboratory section, according to Medicare rules for the bundling and unbundling of tests. RESULTS Ninety-eight participating institutions provided data that showed significant associations between test volumes and staffing for all 4 sections. There was wide variation in productivity based on volume. There was no relationship between testing volume per laboratory section and management span of control. Higher productivity in chemistry/hematology/immunology was associated with a higher fraction of tests coming from nonacute care patients. In both the 2004 and 2010 studies, productivity was inseparably linked to test volume. CONCLUSIONS Higher test volume was associated with higher productivity ratios in chemistry/hematology/immunology and transfusion medicine sections. The impact of various testing services on productivity is section-specific.
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Affiliation(s)
- Bruce A Jones
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA
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10
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Sancho LG, Vargens JMDC, Sancho RG. [Effectiveness assessment of public clinical laboratories: the case of Belo Horizonte, Minas Gerais State]. CIENCIA & SAUDE COLETIVA 2011; 16 Suppl 1:1135-44. [PMID: 21503461 DOI: 10.1590/s1413-81232011000700045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 02/19/2009] [Indexed: 11/22/2022] Open
Abstract
The organization of public clinical laboratories is experiencing changes without, however, an organizational assessment of its effectiveness. The study aimed to determine a parameter of effectiveness for public clinical laboratories of Belo Horizonte, Minas Gerais State, and set cut-off points for the sections of these laboratories. In order to do so, the total production and number of hours worked during a period of 7 months in the year 2008 were consolidated. Due to the entrance of the workers in the mode of production in the laboratories network, it could be observed a variability regarding the performance of these workers. The effectiveness parameter of the network was established in 29.90 tests per hour. As a consequence of this first analysis, the cut-off points are: 15.50 for the hematology section; 67.29 for chemistry; 6.45 for parasitology; 11.35 for urinalysis; 4.94 for microbiology and 19.03 for immunology. From these results, it was concluded that the working process in laboratories can generate a decrease in effectiveness.
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Affiliation(s)
- Leyla Gomes Sancho
- Secretaria de Estado da Saúde de Minas Gerais, Belo Horizonte, MG 30150-050.
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11
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Abstract
BACKGROUND The aim of the study was to describe and evaluate longitudinal trends in laboratory test utilization over a 7-year period from 2002 to 2008. METHOD Retrospective study using test request data from the Clinical Chemistry and Pharmacology Laboratory at Akademiska Sjukhuset, a large tertiary care university hospital in Sweden. Changes in test utilization, charges, and expenditures during the study period were used as main outcome measures. RESULTS Laboratory test utilization increased by over 70%, with a mean annual increase of 9.3% during the study period. After adjustment for inflation, the laboratory expenditures increased by 20.2% during the study period but represented only approximately 2.0% of the hospital's total expenditure in 2008. The test menu comprised 663 tests in 2008, an increase by 146% from 2002. The mean inflation-adjusted unit price charged per test increased from €34.9 to €37.5 during the study period. The top 10, 20, and 30 tests accounted for, on average, 46.9%, 66.9%, and 75.5% of the total test volume during the study period, and 47.8%, 66.4%, and 75.7% of the total test volume in 2008. In 2008, 10 analyses, i.e. 1.5% of the number of tests on the menu, accounted for almost half the number of generated test results. CONCLUSIONS The total number of generated test results increased by over 70% in less than a decade. Even so, the laboratory's share of the hospital's total expenditure remained low and virtually unchanged. A very small number of tests accounted for a disproportionately large share of the total number of generated test results.
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Affiliation(s)
- Mirja Mindemark
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden.
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Ardisson L, Iafrate AJ, Lewandrowski K. An Analysis of Reference Laboratory Testing in a Large Urban Academic Medical Center: The Impact of New Molecular Diagnostic Technologies. Lab Med 2007. [DOI: 10.1309/g2mm69t9c4c97w0w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Linda Ardisson
- Department of Pathology, Massachusetts General Hospital, Boston MA
| | - A. John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston MA
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13
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Abstract
BACKGROUND Provider continuity (PC) occurs when a patient is treated by the same physician over time. A perceived benefit of PC is decreased test repetition. Repeat tests make up a significant proportion of overall laboratory utilization. This study determined whether test repetition increases when PC decreases. METHODS Cohort study of adults in eastern Ontario, Canada between September 1999 and September 2000 using population-based clinical databases. The primary study outcome was the probability that 7 common laboratory tests (hemoglobin, sodium, creatinine, thyrotropin, total cholesterol, ferritin, and hemoglobin A1C) were repeated at physician visits subsequent to the index test. We determined whether the probability of test repetition changed if the follow-up physician ordered the index test. We adjusted for multiple factors regarding the patient (age, sex, days in hospital, and number of physician visits in previous year), index test (normality and location), follow-up visit (location and time from index test), and follow-up physician (age and specialty). RESULTS The study included 881,353 patients, 1,419,438 index laboratory tests, and 7,622,938 follow-up physician visits. After adjusting for other important factors, we found that tests were significantly more likely to be repeated if the follow-up physician ordered the index test (adjusted odds ratio range 2.5-5.9). This association was consistent in most subgroups. CONCLUSIONS For these common laboratory investigations, PC was associated with increased, not decreased, test repetition. This suggests that increased PC alone will likely not decrease test utilization.
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Affiliation(s)
- Carl van Walraven
- Network of Eastern Ontario Medical Laboratories (NEO-MeL), Ottawa, ONT Canada.
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Valenstein PN, Souers R, Wilkinson DS. Staffing Benchmarks for Clinical Laboratories: A College of American Pathologists Q-Probes Study of Staffing at 151 Institutions. Arch Pathol Lab Med 2005; 129:467-73. [PMID: 15794668 DOI: 10.5858/2005-129-467-sbfcla] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Inadequate staffing of clinical laboratories may compromise quality and throughput, whereas excess staff unnecessarily increases the cost of testing.
Objectives.—To measure productivity of technical staff and management span of control in a large number of laboratories and to determine factors associated with favorable staffing ratios.
Design.—A total of 151 clinical laboratories provided information about technical and management staffing and output (workload) for 4 laboratory sections: anatomic pathology, chemistry/hematology/immunology, microbiology, and transfusion medicine.
Results.—For each laboratory section, there was wide variation in labor productivity (output per nonmanagement full-time equivalent) and in management span of control (nonmanagement full-time equivalent per manager). Productivity ratios for the 10th- and 90th-percentile laboratories varied more than 3-fold. Except in histology, laboratory sections with higher test volumes had higher labor productivity (P < .001 for cytology, chemistry/hematology, and transfusion medicine; P = .003 for microbiology). Even within peer groups composed of sections with similar volume, there was wide variation in labor productivity. A number of variables other than test volume were associated with labor productivity and management span of control. Staffing ratios for each laboratory section and for sections of different sizes are presented.
Conclusions.—Despite standardization of testing methods in the clinical laboratory industry, there is wide variation in staffing level among institutions. This variation suggests opportunities to improve staff productivity in many facilities.
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Affiliation(s)
- Paul N Valenstein
- Department of Pathology, St Joseph Mercy Hospital, Ann Arbor, Mich 48106-0995, USA.
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Valenstein PN, Wang E, O'Donohue T. Productivity of Veterans Health Administration laboratories: a College of American Pathologists Laboratory Management Index Program (LMIP) study. Arch Pathol Lab Med 2003; 127:1557-64. [PMID: 14632578 DOI: 10.5858/2003-127-1557-povhal] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. OBJECTIVE To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. DESIGN Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. RESULTS Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P <.001). Technical staff at the median VA facility were paid more than at non-VA facilities (28.11/h dollars vs 22.60/h dollars, salaries plus benefits; P <.001), VA laboratories employed a smaller percentage of nontechnical staff (30.0% vs 41.9%; P <.001), and workers at VA laboratories worked less time per hour paid (85.5% vs 88.5%; P <.001). However, labor productivity was significantly higher at VA than at non-VA facilities (30 448 test results/total full-time equivalent (FTE)/y vs 19 260 results/total FTE; P <.001), resulting in lower labor expense per on-site test at VA sites than at non-VA sites (1.79 dollars/result vs 2.08 dollars/result; P <.001). Veterans Health Administration laboratories paid less per test for consumables (P =.003), depreciation, and maintenance than their non-VA counterparts (all P <.001), resulting in lower overall cost per on-site test result (2.64 dollars vs 3.40 dollars; P <.001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P <.001) and non-VA (P =.02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P <.001), while in non-VA facilities the corresponding ratios showed no significant change. CONCLUSIONS Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.
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Affiliation(s)
- Paul N Valenstein
- Department of Pathology, St Joseph Mercy Hospital, Ann Arbor, Mich 48106-0995, USA
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