Test Turnaround Time Research Articles

Comparison of the Automated OvaCyte Telenostic Faecal Analyser versus the McMaster and Mini-FLOTAC Techniques in the Estimation of Helminth Faecal Egg Counts in Equine.

Gastrointestinal helminth parasites continue to be a significant threat to the health of equine. OvaCyte Telenostic (OCT) (Telenostic Ltd., Kilkenny, Ireland) has developed an automated digital microscope utilising Artificial Intelligence to identify and count the clinically important helminth species in equine, bovine, and ovine host species. In this paper, the performance of the OCT analyser was evaluated for the detection and counting of equine helminth species parasites and its performance compared to the currently accepted benchmark methods of faecal egg counts being the McMaster and the Mini-FLOTAC techniques. A pairwise comparison of tests was assessed based on the correlation of egg counts and Cohen's kappa agreement statistics for dichotomized outcomes. Bayesian latent class analysis was used to estimate the sensitivity and specificity of all three techniques in the absence of a gold standard for four helminth parasites (strongyles, Anoplocephala spp., Parascaris spp. and Strongyloides westeri). Based on the analysis of 783 equine faecal samples, we found a high level (ρ ≥ 0.94) of correlation between each pairwise comparison of techniques for strongyle egg counts. Cohen's kappa agreement between techniques was high for strongyles and S. westeri, moderate for Parascaris spp., and low for Anoplocephala spp. All three techniques had a high sensitivity and specificity (>0.90) for strongyles. Across helminth parasites, the sensitivity of the OCT was the highest of the three techniques evaluated for strongyles (0.98 v 0.96 and 0.94), Anoplocephala spp. (0.86 v 0.44 and 0.46) and Parascaris spp. (0.96 v 0.83 and 0.96); but lowest for S. westeri (0.74 v 0.88 and 0.88), compared to McMaster and Mini-FLOTAC, respectively. In terms of specificity, OCT was the lowest in two species (Parascaris spp. 0.96, Anoplocephala spp. 0.95). In conclusion, OCT has a sensitivity and specificity statistically similar to both McMaster and Mini-FLOTAC, and had a higher correlation with Mini-FLOTAC. The OCT point of care faecal analyser offers improved workflow, test turn-around time and does not require trained laboratory personnel to operate or interpret the results.

Validation of an HIV whole genome sequencing method for HIV drug resistance testing in an Australian clinical microbiology laboratory.

Detection of HIV drug resistance (HIVDR) is vital to successful anti-retroviral therapy (ART). HIVDR testing to determine drug-resistance mutations is routinely performed in Australia to guide ART choice in newly diagnosed people living with HIV or in cases of treatment failure. In 2022, our clinical microbiology laboratory sought to validate a next-generation sequencing (NGS)-based HIVDR assay to replace the previous Sanger-sequencing (SS)-based ViroSeq. NGS solutions for HIVDR offer higher throughput, lower costs and higher sensitivity for variant detection. We sought to validate the previously described low-cost probe-based NGS method (veSEQ-HIV) for whole-genome recovery and HIVDR-testing in a diagnostic setting. veSEQ-HIV displayed 100% and 98% accuracy in major and minor mutation detection, respectively, and 100% accuracy of subtyping (provided > 1000 mapped reads were obtained). Pairwise comparison exhibited low inter-and intrarun variability across the whole-genome (Jaccard index [J] = 0.993; J = 0.972) and the Pol gene (J = 0.999; J = 0.999), respectively. veSEQ-HIV met all our pre-set criteria based on WHO recommendations and successfully replaced ViroSeq in our laboratory. Scaling-down veSEQ-HIV to a limited batch size and sequencing on Illumina iSeq. 100, allowed easy implementation of the assay into the workflow of a small sequencing laboratory with minimal staff and equipment and the ability to meet clinically relevant test turn-around times. As HIVDR-testing moves from SS- to NGS-based methods and new ART drugs come to market (particularly those with targets outside the Pol region), whole-genome recovery using veSEQ-HIV provides a robust, cost-effective and "future-proof" NGS method for HIVDR-testing.

An organization-wide analysis of laboratory test cost variables and costs as displayed in the electronic health record: first steps

Abstract Displaying the cost of laboratory tests and medications in the electronic health record (EHR) at the time of order may influence ordering practices. Our organization’s EHR was configured to display a semi-quantitative value adjacent to laboratory orders: “$” tests imply relatively little cost and “$$$$” tests imply resource intensive tests. Cost display is associated with charges from hospital or clinic fee schedules by default but can also be configured to reflect direct laboratory costs. To understand our system’s configuration and potentially improve the information being provided to our clinicians upon ordering, all the test ordering data was compiled and analyzed for all individual “orderable” tests within the year of 2021 (Jan 1st 2021 – Dec 31st 2021). Variables analyzed included frequency of test ordering, average test turnaround time, and each of the various possible measures of “cost”: direct costs based on labor and reagents/supplies (when available), reimbursement from the Clinical Laboratory Fee Schedule, and pricing from the fee schedule of the largest hospital in our organization (chargemaster). Results showed an extensive rightward skew in each of the “cost” variables, with most routine tests, like the complete blood count (CBC) or complete metabolic panel (CMP), falling in the lower price range and a number of outlier tests with much higher costs (newer forms of molecular testing). There was minimal linearity in correlations between the various price variables. Correlation between chargemaster price by quintile and actual dollar signs displayed in the EHR showed that the two often disagree. No definitive discernable logic was thus identified for the number of dollar signs shown in the EHR based on the possible “cost” variables analyzed here. Between the lab’s best estimate for direct costs and chargemaster pricing, a rough correlation with slope greater than 1 was identified, suggesting that chargemaster pricing is systematically higher than the cost of running each test. Between the cost of running each test and reimbursement via the Clinical Laboratory Fee Schedule, a rough correlation with slope less than 1 was identified, suggesting that lab costs are systematically higher than reimbursement. The current lack of strong correlations between these various “cost” variables is helpful as a first step in examining how to improve our organization’s EHR system, assessing our laboratory’s cost effectiveness, and discussing potential future considerations for hospital chargemaster pricing as well as the US system of reimbursement. Further work is needed to clarify the relationship between cost displays in EHR and physician ordering practices.

814. Impact of Testing Turnaround Times on Clinical Outcome in Hospitalized Patients with Histoplasmosis and Blastomycosis

Abstract Background Patients (pt) with histoplasmosis (histo) and blastomycosis (blasto) requiring hospitalization have unacceptably high mortality rates. In part, this is due to a delay in diagnosis. Serum (S) and urine (U) antigen (Ag) testing are often crucial for timely antifungal therapy. Clinical observations suggested delays in ordering samples to be sent to reference labs upon admission and prolonged turnaround time (TAT) for test results can lead to delays in starting therapy and poor outcomes. We sought to determine the impact of TAT for histo and blasto Ag testing on clinical outcomes of hospitalized patients (pt) at our institution. Methods Retrospective evaluation of all adult inpatients with histo or blasto diagnosed by positive U or S Ag tests from 1/1/15-12/31/22 was conducted. TAT from admission to result (TAT-AR) and from sample collection to result (TAT-CR) for the earliest positive test were calculated. Clinical data, including treatment & outcomes were collected. Only pt who received antifungal therapy or had a postmortem diagnosis were included. The relationship between TAT-AR and TAT-CR and outcome was evaluated. Results Of 39 pt (mean age 47±19 yr), 26 (67%) were men and 33 (85%) were immunocompromised: solid organ transplant recipients, 15; hematologic malignancy, 3; autoimmune/inflammatory disease on treatment, 12; others, 3. Thirty-five pt had pulmonary (8) or disseminated histo (27); 4 had disseminated blasto. Nine pt (23%) died within 4 months of diagnosis, including 8 pt with histo and 1 with blasto. Mean TAT-AR for these 9 deceased pt was 14.7± 19.5 days (d) vs 6.1±3.1 d for 30 survivors (p=.02). Mean TAT-CR for these 9 deceased pt was 5.4±1.5 d vs 3.9±1.3 d for 30 survivors (p=.003). Of the 32 pt who required IV amphotericin B (29) or died before any antifungal therapy was given (3), mean TAT-CR was 5.4±1.5 d for those who died vs 3.7±1.1 d for those who survived (p=.0013). ICU transfers, 30-d readmissions, and length of stay were not impacted by TAT-AR or TAT-CR. Conclusion Delays in TAT for initiating testing and obtaining results were associated with increased mortality of hospitalized pt with newly diagnosed histo or blasto. These findings highlight the importance of early testing and timely test results to guide treatment for hospitalized pt with these diseases. Disclosures Marisa H. Miceli, MD, Astellas: Advisor/Consultant|F2G: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support

576. Comparison of Three Blood Culture Testing Models at a Tertiary Care Hospital: Does Laboratory Centralization Work?

Abstract Background Centralization of laboratory testing has become increasingly common in US hospital systems. One criticism of centralization is increased test turnaround time leading to potential delays in care. Methods In this study, we analyzed three microbiology laboratory testing models for blood cultures at a tertiary care hospital. These models were: 1) full workup in a hospital-based microbiology laboratory; 2) incubation, Gram stain (GS), and molecular blood culture identification (BCID) in a hospital-based microbiology laboratory followed by subculture identification and susceptibility testing (AST) at a centralized core laboratory; and 3) full workup in the centralized microbiology laboratory. Blood culture samples were transported 33 miles from the hospital to the core laboratory. We evaluated these three models for time from collection to positivity, time from collection to GS result, time from collection to BCID result, time from collection to organism identification, time from collection to AST, and patient length of hospital stay. Results We observed no statistical difference in time to blood culture positivity, time to GS result, or time to BCID result. There were shifts in the median time to AST between Model 1 (53.6h) and Model 2 (73.9h) and Model 2 and Model 3 (63.8h), but these were not statistically significant. Of note, time to AST and time to final result in Model 3 were more uniform, with fewer outliers than in the other two models. This is likely a result of the greater degree of laboratory automation in place at the core laboratory and reduced time spent in transit before culture workup. Finally, there was no difference in length of hospital stay between the hospital and decentralized models, though the hybrid approach (Model 2) resulted in increased length of hospital stay compared to either of the other models. Conclusion Our results suggest centralization of blood culture testing does not significantly impact timely reporting of laboratory results and has no impact on length of patient hospital stay. Interestingly, these data demonstrate potential delays when blood culture workups are split between hospital and centralized laboratories. Additional work is needed to fully understand the role of centralization of laboratory testing on treatment decisions and patient outcomes. Disclosures All Authors: No reported disclosures

Long term stability of lactate in uncentrifuged sodium fluoride/potassium oxalate blood collection tubes.

Delayed time from collection to centrifugation may cause erroneously high lactate levels in vitro (from continued blood cell metabolism under anaerobic conditions in the collection tube) if not collected in appropriate collection devices, consequently increasing the risk for inappropriate patient care or harm. We undertook a study to determine the turnaround time for lactate testing in a tertiary care setting and also performed short- and long-term lactate stability studies in blood collected in sodium fluoride/potassium oxalate (NaF/KOx) collection tubes. The hospital lab information system was mined for 6 months to determine patient samples that may have exceeded the time from collection-to-receival in lab of 15-min. Lactate stability was evaluated in unspun NaF/KOx collection tubes at 15min intervals for to 2h; and separately at 2, 6, 12, 24, and 48-h post-collection. A total of 8,929 plasma samples were collected in 6 months, and 1/3 were not received in the lab within 15min from collection. In NaF/KOx additive, lactate levels had minor increases over 2h, and incremental increases at an average rate of 0.0035mmol/L/h over 48h with maximum increase of 9.8% at 48h. However, the average change across all time points were within local allowable performance goals (at ≤4mmol/L ± 0.5mmol/L; at >4mmol/L ± 12%). A small proportion of lactate specimens may experience delay in processing. Although lactate levels may incrementally increase over 48-h at room temperature in unspun NaF/KOx collection tubes, the changes may not be clinically impactful.

Characterization of add-on testing before and after automation at a core laboratory

ObjectivesAdd-on testing refers to the process that occurs in clinical laboratories when clinicians request that additional tests be performed on a previously analysed specimen. This is a common but inefficient procedure, highly time-consuming, especially at core laboratories and could be optimised by automating these procedures. The aims of this study are: 1) To describe patterns of add-on testing at a core laboratory at a tertiary hospital, 2) To evaluate turnaround time (TAT) before and after automation of the pre-, post- and analytical phases. MethodsRetrospective, observational study conducted at the biochemistry area of a core laboratory of all add-on orders received in two different months (pre-automation and post-automation). ResultsA total of 2464 add-on orders were analysed, representing around 5 % of total requests. Most orders were for either one (>50 %) or two (≈20 %) tests. Most orders were received during the week (from Monday to Friday), particularly during the morning shift (>50 %). More than 50 % of requests were made by the Emergency Department. The two most common add-on parameters were C-reactive protein and N-terminal pro-brain natriuretic peptide. After automation, the median TAT decreased by 42.3 % (from 52 to 22 min). The largest decreases in TAT were observed for routine samples (58.89 %) and fully automated analyses (56.86 %). ConclusionsAutomation of our core laboratory substantially reduced turnaround time for add-on testing, indicating an increase in efficiency. Automation eliminated several manual steps in the process, leading to a mean reduction of 15 work hours per day (more than 2 full-time equivalents).

Impact of point-of-care HIV viral load and targeted drug resistance mutation testing on viral suppression among Kenyan pregnant and postpartum women: results from a prospective cohort study (Opt4Mamas).

Lack of viral suppression (VS) among pregnant and breastfeeding women living with HIV poses challenges for maternal and infant health, and viral load (VL) monitoring via centralized laboratory systems faces many barriers. We aimed to determine the impact of point-of-care (POC) VL and targeted drug resistance mutation (DRM) testing in improving VS among pregnant and postpartum women on antiretroviral therapy. We conducted a pre/post-intervention prospective cohort study among 820 pregnant women accessing HIV care at five public-sector facilities in western Kenya from 2019 to 2022. The pre-intervention or "control" group consisted of standard-of-care (SOC) centralized VL testing every 6 months and the post-intervention or "intervention" group consisted of a combined strategy of POC VL every 3 months, targeted DRM testing, and clinical management support. The primary outcome was VS (VL ≤1000 copies/ml) at 6 months postpartum; secondary outcomes included uptake and turnaround times for VL testing and sustained VS. At 6 months postpartum, 321/328 (98%) of participants in the intervention group and 339/347 (98%) in the control group achieved VS (aRR 1.00, 95% confidence interval [CI] 0.98, 1.02). When assessing VS using a threshold of <40 copies/ml, VS proportions were lower overall (90-91%) but remained similar between groups. Among women with viraemia (VL>1000 copies/ml) who underwent successful DRM testing in the intervention group, all (46/46, 100%) had some DRMs and 20 (43%) had major DRMs (of which 80% were nucleos(t)ide reverse transcriptase inhibitor mutations). POC VL testing uptake was high (>89%) throughout pregnancy, delivery, and postpartum periods, with a median turnaround time of 1 day (IQR 1, 4) for POC VL in the intervention group and 7 days (IQR 5, 9) for SOC VL in the control group. Sustained VS throughout follow-up was similar between groups with either POC or SOC VL testing (90-91% for <1000 copies/ml, 62-70% for <40 copies/ml). Our combined strategy markedly decreased turnaround time but did not increase VS rates, which were already very high, or sustained VS among pregnant and postpartum women living with HIV. Further research on how best to utilize POC VL and DRM testing is needed to optimize sustained VS among this population.

Can high procalcitonin levels be a biomarker for detecting multidrug-resistant Gram-negative bacteremia?

Aims: Clinicians prefer broad-spectrum empirical antibiotic therapy in patients with suspected bloodstream infection (BSI) due to long test turnaround times of conventional methods. We aimed to assess the contribution of procalcitonin (PCT) to the selection of antibiotics to be used in empirical treatment.&#x0D; Methods: The results of inpatients whose blood cultures and samples for PCT tests had been sent simultaneously between 2018 and 2022 were analyzed retrospectively. Antibiotic susceptibility results of Enterobacteriaceae, Acinetobacter baumannii complex and Pseudomonas aeruginosa, were evaluated for multidrug-resistance (MDR). &#x0D; Results: Results of 1206 patients who met the inclusion criteria were included in the study. The PCT median value in BSIs caused by the Gram-negative bacteria found to be statistically significantly higher than those caused by the Gram-positive bacteria, fungal and polymicrobial infections (p

Mpox in the Emergency Department: A Case Series.

We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1-August 1, 2022. We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2-16 hours, median 4 hours) and test turnaround time (range 1-11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat. Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.

A-189 Volume Matters: Continuous Improvement to Reduce Blood Collection Volumes and Collection Tube Utilization

Abstract Background Clinical laboratories are constantly changing with automated analyzers and total lab automation (TLA) implemented and replaced over time. Some benefits of newer technologies include decreased specimen volume requirements, less need for repeat testing, and greater throughput. Recent implementation of new analyzers and replacement of TLA in the Central Clinical Laboratory (CCL) at Mayo Clinic, Rochester, MN, prompted the laboratory to reassess blood collection volumes for commonly ordered tests. Objectives The aim of this study was to evaluate whether updating the blood collection volumes for clinical chemistry and immunoassay tests performed in the CCL could reduce the volume of blood collected from patients and the number of blood collection tubes utilized. Methods Nearly 100 different serum assays from the CCL test menu were reviewed including the basic and comprehensive metabolic, hepatic function, renal function, electrolyte, and lipid panels as well as thyroid function tests, enzymes, hormones, electrolytes, and iron status tests. Cortisol, ferritin, folate, and Vitamin B12 testing were performed on the Beckman DxI800; all other testing was on Roche Diagnostics Cobas 8000 chemistry (ISE, c701, c502) and immunoassay (e801) analyzers. Updated blood volumes for each assay were calculated utilizing manufacturer’s analytical volumes and “dead volume” requirements. Baseline data retrieved from the laboratory information system (LIS) included blood collection volumes and number of tubes collected for 128 patients with physician-orders for laboratory testing on 5/2/21. The collection logic was then updated in the test LIS environment using the new blood volumes requirements and applied to the same 128 orders. Blood volumes and number of tubes collected per order were compared before and after the volume updates. Results Baseline data from 128 unique orders showed that 414 total tubes were collected with a median(range) of 3 (2–6) tubes per order and 5 (1–18) tests per tube. The total volume of blood requested at baseline was 2065 mL. Post-intervention, 197 tubes were needed with a median(range) of 2 (1–3) tubes per order and 13 (1–30) tests per tube. The total volume of blood requested after updating volumes was 851 mL. Conclusions The practice of reviewing and updating specimen volume requirements when replacing or implementing new analyzers or TLA can greatly reduce the volume of blood collected from patients and the number of blood collection tubes per order. In this study of 128 physician orders for common laboratory tests, updating blood collection information in the LIS reduced the requested blood collection volumes by 59% and decreased the number of blood collection tubes required by 52%. This not only benefits patients because less blood is collected but also conserves blood collection tubes and reduces supply chain demands. Additionally, fewer tubes on the TLA system has the potential to improve throughput and test turnaround time.

A-164 Key Performance Indicators (KPIs) Can be Polluted by Add-on Tests

Abstract Background Key Performance Indicators (KPIs) are a measurement of service performance which are measured frequently and can demonstrate the clinical effectiveness of services. We undertook a review of a subset of KPIs following feedback from clinicians in the emergency department that was at odds to our reported KPIs. Our reported KPIs suggested that we were not meeting the turnaround times (TATs) required (1 h from receipt in the laboratory to result availability), however the view of the clinicians was that we were achieving the KPIs needed to manage their patients. We undertook an exercise to quantify the impact of add-on tests to our published KPIs as our laboratory information systems are not able to discriminate tests that are added on at a later time from those that go though as a first pass. Methods We reviewed all data (February 2022) for 4 common tests requested in the Emergency Department at King’s College NHS Foundation Hospital: amylase, CRP, paracetamol and high sensitivity troponin. Through a laborious process, we reviewed all records where a test had been added on to compare the turnaround time (TAT) for tests that pass through the first time and those that are added on so that we could quantify the impact of add-ons. Results In the month of February 2022, we processed 754 amylase, 4014 CRP, 121 paracetamol and 1414 high sensitivity troponin tests. The highest proportion of add-on tests was experienced with troponin (9.7%), amylase (9.4%) and paracetamol (8.3%). The lowest percentage of add-on tests was CRP (1.9%). Figures to be presented will demonstrate the impact of add-on tests as compared to those that go through as a first pass yield in whisker box plot format, non-truncated. Conclusion Add-on tests were polluting the KPIs that we were reporting. The service was delivering a TAT that the clinicians required, however our legacy internal reporting systems were not able to discern the date/time of add-on from that of the receipt of the tube into CSR or strip out the add-ons from the KPI reports and hence the negative impact that they have on reporting.

A-377 The Selection and Implementation of POC Illicit Drug Toxicology Testing in Hamad Medical Corporation - Doha, Qatar

Abstract Background In 2013, Qatar launched the National Mental Health Strategy which is further supported by National Health Strategy 2018–2022 and Qatar National Vision 2030, where the mental health has been identified as a priority area of development. In doing so, the Ministry of Public Health worked closely with the Ministry of Interior in providing the appropriate treatment rehabilitation. With all considerable advantages of point-of-care testing (POCT) in rapid diagnosis, POC toxicological test has been implemented and used in screening of patients for drugs of abuse. In this study, we highlighted the challenges in selection and implementation process of POC toxicological test in Hamad Medical Corporation (HMC). Methods Due to unavailability of all required drug panels, it had to be customized and tested for the verification purpose before starting the evaluation process. Maintaining HMC procurements regulations and Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathologist (CAP) standards for POC toxicology tests, two POC illicit drug toxicology screening tests has been evaluated, comparison study has been performed against the HMC central laboratory. POCT team conducted training session ensuring the appropriate practice in place. The Extendable Laboratory Information System (LIS) functionality has been utilized for seamless data management and reporting for the automated analyzer. Results QUIDEL triage meter pro is an automated drug testing analyzer which detects Amphetamines, Barbiturates, Benzodiazepines, Cannabinoids, Methadone Metabolite, Methamphetamine, Opiates, Tricyclic and Cocaine Metabolites, while the customized manual testing kit FASTEP detects Tramadol (TRA), Methylenedioxymeth-amphetamine (MDMA), Phencyclidine (PCP), Buprenorphine (BUP), Oxycodone (OXY), Fentanyl (FYL), Ethyl Glucuronide (EtG), Cotinine (COT), Pregabalin (PGB) and Gamma Hydroxybutyrate (GHB). Both analytical performances were verified. Rapid bedside testing performed for more than 100 patients in last 8 months during admission, observation, and pre- discharge process. There is An Obvious improvement observed in testing turnaround time compared to the laboratory, easy results interpretation and reporting as well as cost-effective. Conclusion The implementation of POC illicit drug toxicology testing in HMC aligned with core pillars of the Qatar vision 2030 to deliver the right treatment at the right time and place. Its enhancing patient outcomes and overall Satellite health care sector in Qatar.

Use graphene coated silica core shell particles to provide rapid, precise, and equivalent chemical composition distribution analysis for polyolefin materials by high temperature thermal gradient interaction chromatography

High temperature thermal gradient interaction chromatography (HT-TGIC) has been widely used to measure chemical composition distribution due to its applicability to separate crystalline and non-crystalline amorphous polyolefin materials. The compatibility of HT-TGIC with various detectors (infrared (IR), light scattering (LS), and viscometer) has also allowed a comprehensive analysis of molecular architecture of polyolefin and recycled plastics. The introduction of an easy-to-fabricate graphene coated onto non-porous silica particles as HT-TGIC column in 2020 showed a superior chromatographic performance over the traditional graphite column. A reduction in peak broadness (∼47 %) under identical experimental conditions was demonstrated in that research. This paper similarly uses a graphene column but with the focus on optimization of experimental parameters (concentration, and thermal cooling and heating rates etc.). Equivalent chemical composition distribution (CCD) data to that obtained by the incumbent graphite column over a wide range of polyolefins products was achieved, in addition to a shortened analysis time from 120 min down to 88 min per sample. The materials studied included semicrystalline linear low-density polyethylene (LLDPE), elastomers, terpolymers, model blends to mimic recycled plastics. The results also suggest that the elimination of substrate pores enable a better HT-TGIC separation. Coupling the ease and reproducibility of the graphene column fabrication process enables long term chromatographic robustness. This not only results in equivalent CCD data compared to the traditional graphite column but also a 27 % reduction in analysis time. These results demonstrate a substantial advancement of technology in the high throughput industrial laboratory setting where fast testing turnaround time is critical. In addition, simple fabrication with commercially available silica particles and graphene nanopowder provides a cost-effective approach to make HT-TGIC columns reproducibly.

Antifungal Therapeutic Drug Monitoring Practices: Results of an Emerging Infections Network Survey.

In a survey of 523 infectious disease specialists, a moderate to high percentage reported using any antifungal therapeutic drug monitoring (TDM) during itraconazole (72%), posaconazole (72%), and voriconazole (90%) treatment, and a low to moderate percentage reported using any antifungal TDM during prophylaxis (32%, 55%, and 65%, respectively). Long turnaround times for send-out TDM testing and logistical difficulties were frequent barriers.

Reflex Hepatitis C Virus Viral Load Testing Following an Initial Positive Hepatitis C Virus Antibody Test: A Global Systematic Review and Meta-analysis.

Many people who have a positive hepatitis C virus (HCV) antibody (Ab) test never receive a confirmatory HCV RNA viral load (VL) test. Reflex VL testing may help address this problem. We undertook a systematic review to evaluate the effectiveness of reflex VL testing compared with standard nonreflex approaches on outcomes across the HCV care cascade. We searched 4 databases for studies that examined laboratory-based reflex or clinic-based reflex VL testing approaches, with or without a nonreflex comparator, and had data on the uptake of HCV RNA VL test and treatment initiation and turnaround time between Ab and VL testing. Both laboratory- and clinic-based reflex VL testing involve only a single clinic visit. Summary estimates were calculated using random-effects meta-analyses. Fifty-one studies were included (32 laboratory-based and 19 clinic-based reflex VL testing). Laboratory-based reflex VL testing increased HCV VL test uptake versus nonreflex testing (RR: 1.35; 95% CI: 1.16-1.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI: .81-2.67) and HCV treatment initiation (RR: 1.03; 95% CI: .46-2.32). The median time between Ab and VL test was <1 day for all laboratory-based reflex studies and 0-5 days for 13 clinic-based reflex testing. Laboratory-based and clinic-based HCV reflex VL testing increased uptake and reduced time to HCV VL testing and may increase HCV linkage to care. The World Health Organization now recommends reflex VL testing as an additional strategy to promote access to HCV VL testing and treatment. PROSPERO CRD42021283822.

COVID-19 Testing of United States-Bound Agricultural Workers in Mexico

The COVID-19 pandemic presents global health, welfare, and economic concerns. The agricultural workforce has experienced adverse effects, placing the U.S. food supply at risk. Agricultural workers temporarily travel to the United States on H-2A visas to supplement the agricultural workforce. Approximately 300,000 agricultural workers enter the United States with H-2A visas each year; over 90.0% are from Mexico. During February–May 2021, a COVID-19 testing pilot was performed with Clínica Médica Internacional (CMI), a clinic that performs medical examinations for US-bound immigrants, to determine the SARS-CoV-2 infection status of H-2A agricultural workers in Mexico before entry to the US. The CerTest VIASURE Real Time PCR Detection Kit was used. Participants’ demographic information, test results, and testing turnaround times were collected. Workers who tested positive for SARS-CoV-2 completed isolation before US entry. During the pilot, 1195 H-2A workers were tested; 15 (1.3%) tested positive. Average reporting time was 31 h after specimen collection. This pilot demonstrated there is interest from H-2A employers and agents in testing the H-2A community before US entry. Testing for SARS-CoV-2 can yield public health benefit, is feasible, and does not delay entry of temporary agricultural workers to the US.

Long-term alliance for pathology equipment and technology acquisition: a paradigm shift for improved quality and efficiency.

Personnel costs are the largest single budget item in the clinical laboratory, other major expenses being equipment, analyzers, blood and blood components, and cost of day-to-day consumables. This report describes our experience with developing a long-term relationship with a single major vendor as a paradigm shift from the traditional multiple vendors, multiple contracts, and recurrent extended negotiations. Our objective was to develop a long-term approach for replacement of effete equipment and upgrades to operations in a pathology and laboratory medicine department in collaboration with vendors providing equipment and services. Major vendors were invited to visit the department to analyze the workload and workflow and suggest integrated solutions to meet the goals of the department. Multiple iterations of the proposals were evaluated, and a recommendation made to the medical center leadership. The vendor, the medical center, and the department jointly developed a 15-year partnership plan to improve the operations of pathology services. The agreement encompasses a range of management and performance criteria for both sides. The salient items discussed were laboratory staffing, turnaround time, workload change, test insourcing, reference laboratory costs, and scholarly productivity and teaching. The agreement reduced laboratory staffing by 21%, eliminated stat tests by reducing the turnaround time for routine tests to less than 45 minutes for 90% of tests, with an increase of 9.1% in the number of tests, Cost avoidance in salary and reference laboratory costs was $3,424,136/year against an expected target of $2 million in total savings, despite not including cost avoidance from promoting appropriate use of laboratory testing for inpatients and increase in revenue from increase in ambulatory testing. Vizient score in laboratory utilization improved from the 94th to 76th percentile. Scholarly output increased by more than 100%. This model of a long-term alliance with a chosen vendor led to improvements in quality and efficiency.

Application of Agile and Simulation Approaches for the Maximal Benefits of Reduced Turnaround Time from the Point of Care Testing

This paper uses simulation to explore improvement opportunities in the orthopaedic care process. Secondly, this study used a combination of simulation and agile strategies to explore agile operational plans that can be adopted to maximize the benefits of reduced turnaround time. Data used for this study was collected by observing the entire orthopaedic care process. A total of 635 observations were obtained, with 179 out of these observations undergoing the whole care process. The actual collected patient data were compared with the simulation output to validate the developed simulation. Different scenarios were developed to test operational plans for the maximal benefit of reduced turnaround time. Deployment of point-of-care platforms reduced turnaround time for sample tests. Flexibility was introduced as an agile operational plan to ensure the maximal benefit of the reduced turnaround time. The effect of flexibility on the orthopaedic care process was significant. The simulation results showed a significant decrease in patient waiting time by 86%. This study was limited to orthopaedic patients. Studies focusing on other clinical settings are encouraged. This study recommends using agile operations practices to maximize the benefit of reduced turnaround time in healthcare processes.&#x0D; Keywords: Point of care, Turnaround time, Agile and simulation

Fast In-House Next-Generation Sequencing in the Diagnosis of Metastatic Non-small Cell Lung Cancer: A Hospital Budget Impact Analysis

Background: Targeted therapy for cancer is becoming more frequent as the understanding of the molecular pathogenesis increases. Molecular testing must be done to use targeted therapy. Unfortunately, the testing turnaround time can delay the initiation of targeted therapy. Objective: To investigate the impact of a next-generation sequencing (NGS) machine in the hospital that would allow for in-house NGS testing of metastatic non-small cell lung cancer (mNSCLC) in a US setting. Methods: The differences between 2 hospital pathways were established with a cohort-level decision tree that feeds into a Markov model. A pathway that used in-house NGS (75%) and the use of external laboratories (so-called send-out NGS) (25%), was compared with the standard of exclusively send-out NGS. The model was from the perspective of a US hospital over a 5-year time horizon. All cost input data were in or inflated to 2021 USD. Scenario analysis was done on key variables. Results: In a hospital with 500 mNSCLC patients, the implementation of in-house NGS was estimated to increase the testing costs and the revenue of the hospital. The model predicted a $710 060 increase in testing costs, a $1 732 506 increase in revenue, and a $1 022 446 return on investment over 5 years. The payback period was 15 months with in-house NGS. The number of patients on targeted therapy increased by 3.38%, and the average turnaround time decreased by 10 days when in-house NGS was used. Discussion: Reducing testing turnaround time is a benefit of in-house NGS. It could contribute to fewer mNSCLC patients lost to second opinion and an increased number of patients on targeted therapy. The model outcomes predicted that, over a 5-year period, there would be a positive return on investment for a US hospital. The model reflects a proposed scenario. The heterogeneity of hospital inputs and the cost of send-out NGS means context-specific inputs are needed. Conclusion: Using in-house NGS testing could reduce the testing turnaround time and increase the number of patients on targeted therapy. Additional benefits for the hospital are that fewer patients will be lost to second opinion and that in-house NGS could generate additional revenue.