Reducing send out costs for high-volume analytes such as vitamin D testing and urine drug analysis is a big motivator for adopting mass spectrometry (MS) in-house. But beyond these straightforward business cases, “labs often face challenges expanding MS applications, despite the technology’s capability to uniquely address crucial clinical needs,” Yan Victoria Zhang, PhD, MBA, DABCC, FAACC, and Steven Cotten, PhD, DABCC, FAACC write in May’s Clinical Laboratory News.
Even if there’s a strong clinical case for bringing a test in-house using MS, it may not happen if there isn’t a strong business case, according to Zhang and Cotten. “Most often the problem boils down to limited financial return on a cost per reportable basis for low-volume testing,” they observe. A multidisciplinary team can enhance the institutionwide benefit of using MS assays. Zhang and Cotten cite two successful examples implemented at their respective institutions.
A variety of challenges had prevented the lab at the University of Rochester Medical Center from establishing in-house testing for the chemotherapeutic agent busulfan. Low test volumes didn’t support a strong business case, and the lab would need additional capital equipment to test in-house. Also, groups such as the College of American Pathology offered no traditional proficiency testing (PT) for busulfan. “That meant that to fulfill regulatory requirements the lab would have to establish unique assay-based PT programs,” the authors explain.
The tide changed when hospital and lab leaders formed a brainstorming group in response to a request by the pharmacy and bone marrow transplant group to move this test in-house.
“With further input from multiple groups, the lab discovered that in-house testing for busulfan would help not only the pharmacy and the bone marrow transplant groups but also offer significant benefits to the overall hospital,” write Zhang and Cotten.
In-house testing allowed doctors to administer the drug in an outpatient setting, reducing patient costs and days in the hospital. In turn, the hospital became more efficient in utilizing its inpatient space. Moving the test in-house also eliminated other timing and transportation challenges related to dose regimen and lab samples. Billing the drug under the 340b schedule under Medicare rather than an inpatient schedule also resulted in significant cost savings.
At Ohio State University Wexner Medical Center, an interdisciplinary team came up with an approach to reshape the institution’s workflow for neonatal drug testing. This type of testing poses specimen challenges for labs and result interpretation challenges for clinicians.
The university’s labor and delivery nurse manager “recognized that the hospital’s workflow was ineffective for identifying and testing newborns at risk for drug exposure during pregnancy,” according to Zhang and Cotten.
The team, which represented pathology, labor and delivery, obstetrics and gynecology, pediatrics, and social services, came up with a plan to improve continuity of care. The first step was to switch from meconium to umbilical cord tissue as the default specimen for evaluating drug exposures, which enabled nurses to collect samples at birth. As the lab worked to develop a new MS assay, the other clinical teams worked on redesigning the workflow around this test. “The goal was to develop a total testing process that began with properly identifying patients who need testing and ended with acknowledging the umbilical cord toxicology results—all within 24 hours,” the authors explain. After some bumps in the road, the lab was able to develop an MS assay that met performance expectations and reduced turnaround time of results by about 9 hours.
“We hope, through these cases, to shed some light on less traditional pathways for justifying MS testing, with the goal of seeing it expanded further to the benefit of patient care,” summarize Zhang and Cotten.
Pick up May’s CLN to learn about the role of multidisciplinary teams in MS.