Helping lab professionals GoMolecular.

Success Story 2: Growing Pains

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In this article:

  • Memorial Healthcare System, Hollywood, Fla.
  • First test offerings
  • Planning for continued growth
 
 


By Frederick L. Kiechle, M.D., Ph.D.

Memorial Healthcare System in Hollywood, Fla., is a five-hospital system with 1,750 beds, including a children’s hospital. The molecular space in this case was approximately 400 square feet with inappropriate air handling for a clean room (see Molecular Lab Space and Design). In 2006, two molecular tests (CT/NG) were performed in a constricted space in MHS’ core laboratory. In 2007, the molecular lab was moved to the smallest hospital in the system, which had 1,500 square feet and adequate space (200 sq/ft) for clean room with two hoods, two extractors and preparation area.


Offerings to Date

As of July 2011, the molecular lab offered 18 assays (Table 1). The monthly volume from May 2011 (Table 1) shows the greatest volumes come from CT/NG and MRSA screening.1 The newest assay (C difficile) was introduced in late January 2011 to accommodate a request from the hospital administration to screen and treat patients with Clostridium difficile at admission or during hospitalization (hospital acquired infection).2

The test volumes and test menu from February 2011 to June 2011 have remained the same due to a hiring freeze system-wide and prohibition of overtime. As a consequence, the goal of one new test per month has not been achieved.


Planning for Continued Growth

The molecular lab already needs to add an assistant supervisor to help with efficient workflow assignments, scheduling, inventory control, procedures, quality control and proficiency testing oversight. These growing pains are not unique to this site and are common during these tight economic times. These circumstances have slowed the roll out of the work plan for phase II (Table 2) and Phase III (Table 3) test development.

These assays have been selected and are prioritized — with frequent review — by medical staff; medical and hospital administration; and molecular lab leadership. Equipment will be required to move these plans forward, as well as space and appropriate personnel. The frequent dialogue related to the future plans for molecular test development has helped keep these issues in the forefront of the array of similar hospital requests.


Table 1
Molecular Menu and May 2011 Volume
 Test  Specimen Type  Category

 May 2011
 Volume

 CT/NG  Vaginal/ Endocervical
 Swab
 FDA  1,182
 MRSA Screen  Anterior Nares swab  FDA  1,371
 Respiratory Virus
 Panel
 NP swab/ aspirate
 Bronchial wash/ aspirate
 FDA  355
 Enterovirus  CSF, plasma  ASR  25
 Quant CMV  Plasma  ASR  115
 HSV-1/2  CSF, lesion (swab in UTM),
 vesicle fluid (in UTM)
 ASR  55
 C. difficle  Diarrheal/ loose stool  FDA  77
     Volume total  3,180
UTM = Universal Test Medium


Table 2
Phase II (Near-Future State)
   • Evaluations: quantitative HIV platforms
   • Near-Future tests for 2011/2012
   • Factor II/V
   • Quantitative EBV
   • Quantitative HIV
   • TB
   • Varicella-Zoster Virus


Table 3
Phase III (Long-term future stats)
   • Test development (2013/2014)
   • Hepatitis C
   • Hepatitis B
   • Molecular Typing for infection control
   • Sequencing/ fragment analysis
   • Pharmacogenomics
   • Resources needed
   • Additional 1,200 square feet
   • Additional 2-4 molecular technologists


References

  1. Lazarevic V, Beaume M, Corvaglia A, Hernandez D, Schrenzel J, Francois P. Epidemiology and virulence insights from MRSA and MSSA genome analysis. Future Microbiol 2011; 6: 513-532.


    2.   Chapin KC, Dickinson RA, Wu F, Andrea SB. Comparison of five assays for detection of Clostridium difficile toxin. J Mol Diagn 2011; 13: 395-400.