In this article:
- Choosing a test menu
- Presenting to administration
- Advice for building a molecular lab
- Measuring success
Success Story: Memorial Healthcare System
Location: Hollywood, Fla.
Opened: September 2008
Staff size: Five full-time medical technologists (three on first shift, full-time; two on second shift, full-time)
Main focus: Infectious diseases
Test volume: Approximately 3,500 – 4,000 a month
Patient community: Pediatric, adult and geriatric inpatients, and primary care outpatients
System size: Approximately 1,700 beds; six hospitals in the system
Current test menu: Herpes Simplex 1 and 2, enterovirus testing, CMV, MRSA PCR, combined gonorrhea and Chlamydia, respiratory virus panel.
Interview with Lab Director, Rodney C. Arcenas, Ph.D., D(ABMM)
How did you determine your original test menu?
“When I joined the healthcare system, we already had Chlamydia and Gonorrhea testing, but I helped get the basic menu started. I knew infectious disease was the easiest to get into, and that’s what our pediatric doctors were clamoring for. I worked with clinicians to understand what their priorities were, and I looked at our send-out volumes to the reference lab to identify the highest cost and highest volume tests. I tried to marry the two and came up with a priority list of tests to offer.”
What kind of space did you have to work with when developing your molecular lab?
“The lab space used for Chlamydia and Gonorrhea testing was very small. There was no room for expansion. At that time, the healthcare system acquired another hospital that had an open lab space. We went to the administration with a presentation and other plans. They were very supportive and got us the budget and equipment we needed. With minor renovations, we were able to create a clean room, a dirty room, and a main general molecular lab area.”
What was the key to success in your presentation?
“There is always the upfront sticker shock when the administration learns the cost of equipment, staff and purchasing tests. But we presented the benefit story in the light of quality patient care. With improved turn around times and faster results, patients receive better care and, in many cases, a decreased length of stay. This is a cost savings. In addition, there is not another molecular lab in South Broward County. This helps us better serve the community and adds recognition for the entire Memorial Healthcare system. Our expertise is good PR.”
Who did you turn to for advice when building your molecular lab?
“We hired a molecular lab consultant. It was my first big project, so that helped affirm my ideas. The consultant looked at our menu, equipment and space to see how it could be retrofitted for positive and negative pressure in the clean and dirty rooms. It helps to be in contact with your facilities person so all your plans for the space are accounted for, such as hoods, air handling, etc. We worked very well together. I also talked with colleagues and Clinmicronet listserv members who have molecular lab experience to get their perspectives and ideas.”
What advice do you have for lab directors just starting a molecular lab?
“My advice is to have back-up instruments. We have a nucleic acid extractor that has been a real workhorse for us, but it conked out one day right before a holiday weekend. We were dead in the water. The service company charged $700 an hour for weekend service. It was a very expensive lesson. We learned we should have back up instruments to get you through. We have added some duplication instruments for emergencies. It’s a huge disservice to our clinicians and patients to have malfunctioning equipment. “
How do you measure the success of your lab?
“It’s great when clinicians send emails or stop you in the hallway to say those results really helped their patient. We take pride in our positive effect on the outside. One program I am especially proud of is our MRSA screening program for high-risk patients. We wanted to show a cost avoidance by identifying high-risk patients and preventing transmission from one patient to another, or to a health care worker. We have seen a decrease in our nosocomial MRSA infection rates. This is a very positive thing and we plan to formally share this with the administration.
“As for success internally, I see the number of tests increasing. Our staff levels went from one full-time med tech to five, and one shift to two shifts in three years. My staff is eager to learn, and I like to spark their interest. They see we are growing. It’s always good to see that.”