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In Quest of Laboratory Management Reform: Decoding Laboratory Diagnostics in COVID-19 Pandemic

Dr. Barnali Das

Journey of a laboratory may not always come with a planner and a roadmap, as showcased by the Covid-19 pandemic. As unexpected and unprecedented health care needs push cost-burden onto hospital systems, laboratories are faced with budget constraints while managing demand for higher quality and competitive turnaround time (TAT).

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Efficiently managing these intensifying pressures is critical to the sustainability of laboratory management, and requires new strategies to reduce cost burden, while also maintaining quality. Total Cost of Ownership is a concept that can help laboratories and hospitals identify factors that drive increased costs, with the goal of identifying the source of operational inefficiencies throughout your laboratory operations and improving productivity.

The impact of direct and indirect costs on a laboratory’s budget can be significant, and proper management of these costs is crucial to making operational improvements. By taking a more holistic approach to managing laboratory operations, dramatic impact on the performance of a laboratory can be attained and also deliver greater value to health care institution. One needs to use current state value stream maps to identify opportunities for building resilient diagnostic strategies in the laboratory process flow. This can be achieved by implementation of Total Cost of Ownership; Harmonisation and Standardization Protocol in Decoding Laboratory Diagnostics in COVID 19 Pandemic and Lab Automation and Implementation of Digital Technology Transformation System.

Few measures are needed to shrink the timeline of ongoing pandemic, combating the current challenges with speed, efficiency and flexibility and also be ready to respond to future pandemics. These measures are critical elements of mitigating the health, economic and social burdens of COVID-19 pandemic. They include:

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1) Scaling up the capacity of testing for COVID-19: There are two main testing technologies: molecular assays, which identify viral genetic material and signal the presence of a viral infection and immuno assays, which identify antigens or antibodies. Scaling up the capacity of testing for COVID -19 diagnosis by reverse transcripasepolymerase chain reaction (rRTPCR) and also rapid antigen testing, if required, is the need of the hour. Innovative and flexible approaches are must to maximize the diagnostic capacity. Also scaling up the Antibody testing for sero surveillance and mass screening is required. This will ensure that high throughput of Corona virus test results are delivered in faster turnaround time (TAT) and accurately, allowing people to either quarantine or get back to work. The critical role of laboratory medicine in this pandemic extends far more than etiological diagnosis of COVID-19, by rRTPCR. Routine laboratory monitoring of COVID-19 patients through testing is critical, for assessing disease severity and progression, as well as monitoring therapeutic intervention. The main laboratory changes encompass an array of increased inflammatory biomarkers, coagulation parameters, tissue specific tissue injury indicators (liver, kidney, cardiac) and derangement of the complete blood count. Based on severity of disease, host inflammatory response to virus may lead to cytokine storm that can cause multi-organ damage.

2) Bridging the supply–demand gap: The challenges in the testing process worldwide suggest focusing on the opportunities and bridging the supply–demand gap. Involvements require different level of investments: both short-term measures and long term measures for incremental improvements in diagnostic care domain.

3) No delay in testing and other health screening: COVID-19 has hit the healthcare and patient care sector with reports indicating that overall 60.9% clinical activity was reduced at the peak of the pandemic, while nearly two-thirds showed under-treatment as a major concern and there is significant drip in clinical trials. Another study showed that the vast majority reported facing challenges in providing care during the pandemic with alarming increase in cases of coronavirus among their patients and staff. There is a need to create awareness among chronic patient group (Cardiac, Cancer, Diabetes and general illness) about the need to get their periodic blood tests which might be pending due to COVID pandemic.

4) Introducing total laboratory automation and artificial intelligence in routine laboratory testing: Rapid changes in diagnostic sector coupled with parallel advances in technology have stimulated the evolution of approaches for total laboratory automation (TLA), artificial intelligence (AI) and robotic elements in routine laboratory process flow. The above measures offer promise in streamlining the clinical laboratory process flow. Increasing cost-containment pressures make the application of this technology highly approachable.

The implementation of artificial intelligence (AI), cloud computing, machine learning, adoption of paperless workflows are instrumental in the transformation of the laboratory, more specifically, influencing clinical validation, procedure efficiency, data handling, data analysis, and much more. AI helps in computing risk stratification score of laboratory data and clinical data using expert system and evidence based guidelines. Increasing cost-containment pressures make the application of this technology highly approachable.

5) Support and connect with team: Resilience and humanity hold the key to shorten the curse of the current crisis.

The road map for laboratory medicine involves strategies for harmonizing, communicating and integrating with all stakeholders to formulate guidelines for assisting in correct measurement, diagnosis and management of diseases & reduce the cost burden while maintaining quality

 

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