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Irina Lutinger |
By Judy O’Rourke
Pathology and lab medicine experts worldwide will soon trade lab coats for suit coats when they convene at the American Society for Clinical Pathology’s (ASCP) annual meeting in Boston. Molecular pathology may take center stage, but in the meantime, the West Nile Virus outbreak refuses to quit. Summer’s fading, but with no cure or vaccine in place, the outbreak’s hogging headlines and straining already overworked staff in clinical labs. Reuters, citing health officials, says this outbreak is on the fast track to becoming the most acute West Nile outbreak on record. CLP spoke with Irina Lutinger, MPH, MASCP, H(ASCP)DLM, FACHE, ASCP, for a closer look.
CLP: Is the longstanding, unresolved shortage of laboratorians expanding beyond being an industry-only concern into a concern for society at large with the recent rise in mosquito-borne West Nile virus cases and immediate, increased demand for testing?
Irina Lutinger: There has been a surge of about 20% in the demand for the treatment of West Nile virus during August 2012. During the increase in frequency, we have encountered issues related to lags in turnaround time because of delays in reagent availability at our testing facilities and staffing training. Since West Nile is an uncommon virus, many facilities are not prepared for this challenge, including manufacturing plants for reagents and supplies for treating patients.
Furthermore, the manpower shortage of the laboratory professionals becomes more apparent when a virus has an unexpected surge. A growing laboratory workforce shortage presents a problem for a society as a whole because 70% of physicians’ decisions are based on the laboratory outcome. However, the American Society for Clinical Pathology is working on several solutions to attract students and second careerists to become laboratory professionals.
The ASCP Career Ambassador program, sponsored by Roche, promotes the laboratory profession to junior high, high school, and junior college students. Many students interested in science do not even know these professions exist. Over the last 4 years, ASCP Career Ambassadors have reached more than 14,000 students in the United States through classroom presentations and demonstrations. Additionally, ASCP has a network of regional representatives and local representatives who attend career fairs and STEM (Science Technology Engineering and Math) forums to promote careers in laboratory medicine.
ASCP has made a Commitment to Action with the Clinton Global Initiative and several State Universities of New York to increase the number of medical laboratory graduates by 10% for 5 consecutive years. This program was launched as a pilot program for other states to adopt nationwide.
Thus far, during 2012, the New York City Department of Health (NYC DOH) reports 275 positive mosquito pools distributed across all five city boroughs, six cases of West Nile fever, and 11 cases of neuroinvasive disease. To date there have been approximately 1,993 cases of West Nile fever nationally with about 70% of the patients coming from Texas, South Dakota, Mississippi, Oklahoma, Michigan, and Louisiana. Perhaps, the West Nile outbreak is not as dramatic as on the East Coast because the NYC DOH, in addition to rigorous environmental testing, employs a comprehensive program of aerial pesticide spraying. This could explain why the situation in the New York area is not as severe as in other locales.
CLP: How are clinical labs, already weighed down with increasing testing volumes, handling the added demand?
Lutinger: The added demand for West Nile Virus testing and food borne outbreaks presents an additional level of complexity to already dwindling manpower. The laboratory staff has to work more overtime hours to reduce wait time. But this approach has its limitations because the individuals who perform these vital tasks cannot continuously perform under such stressful conditions. As a result, increased wait time for test results could potentially lead to inability to provide clients with critical treatment details if the West Nile Virus becomes much more widespread.
CLP: Is the flood of tests affecting timely reporting of results to patients, and ultimately, the level of patient care?
Lutinger: A flood of any diagnostic test not normally performed to any great degree could easily influence TAT, as well as the efficiency and quality of patient care. This occurred initially with the Influenza H1N1 virus, and prior to that, with SARS. It takes time for labs to adapt and scale up the processing to meet the sudden surge in demand. This happened with West Nile Virus testing years ago as well, when our New York area was the first domestic city to encounter the virus. Since then, our city is far better prepared and has gained insights about what to do and not to do during outbreak.
CLP: What role have testing platforms played in helping labs handle testing volumes?
Lutinger: The availability of reasonably priced, low-complexity, rapid PCR assays on random access platforms has had a huge impact on the quality of laboratory diagnostic services. Molecular nongrowth dependent technology enables laboratories to provide highly sensitive and specific results round the clock for an increasing variety of dangerous pathogens that during earlier times could take days or weeks to detect and report. Multiplexing expands this capability even further, for example, by simultaneously detecting a wide array of viral and bacterial respiratory pathogens from a single specimen, in a single run, in as little as 1 hour.
CLP: Does ASCP offer tips to laboratorians to help handle this outbreak?
Lutinger: ASCP offers timely access to various resources to enhance the knowledge and ability to develop efficient action plans, including but not limited to educational opportunities, publications, networking, face-to-face educational events, teleconferences, and a directory of ASCP members for consultations.
CLP: Has the lab industry learned lessons that can be applied to future outbreaks?
Lutinger: Yes indeed. More and more, we are seeing products emerge or placed in development that are designed to efficiently manage an influx of specimens that might be associated with outbreaks of infectious agents, eg, PCR multiplexing assays that rapidly detect the pathogens that are commonly associated with respiratory disease, sepsis, gastroenteritis, and even bioterrorism.
CLP: What big-picture steps is your facility taking to bolster the dwindling workforce, and to help minimize the expected future impact of increasing testing volume on hospitals and patient care?
Lutinger: It is critical to seek and select technological applications that eliminate cumbersome, inefficient time- and labor-intensive processes, especially those that dramatically increase the ratio of the added value to the invested resources of time, labor, and money. We continuously implement various elements of automation, integrated results flow with autovalidation, so that the laboratory personnel time can be used for tasks that require didactic reasoning and decision-making.
Furthermore, developing educational and training programs with laboratory training programs is another important step in the ability to select and hire much-needed laboratory professionals.
At the New York University Hospital Center in New York City, we also negotiated additional annual salary enhancements for all laboratory professionals who are, or will become certified by, ASCP. This also allowed us to retain more staff and to attract new medical laboratory professionals of all types.
As a society, we are in a crisis situation with a manpower shortage due to an aging workforce, lack of public awareness about our profession, and a decrease in the number of accredited clinical laboratory training programs. We will continue to face the challenge of health care need versus staffing availability. For the patient, whose life depends on the speed and accuracy of the laboratory outcomes, medical laboratory professionals are a critical link in providing physicians with required data for treatment.
This is Part 1 of CLP‘s two-part Q&A series on West Nile virus.
Judy O’Rourke is editor of CLP. She can be reached at [email protected]
