University Medical Center of El Paso El Paso, Texas, United States
Background/Case Studies: As staffing constraints become more challenging, the balance of patient care and fiscal responsibility is grueling. Identification of antibodies (ABID) in samples with a positive antibody detection test (ADT) can be labor-intensive. Additionally, the process can be challenging for staff generalists and those less familiar with blood banking. The purpose of our inquiry was to evaluate the financial and patient impact if all samples requiring ABID were sent to a reference laboratory (RL) for investigation.
Study
Design/Methods: Our transfusion service utilizes two automated instruments (NEO Iris and Echo v2.0; Immucor, Norcross, GA). Current policies dictated that specimens be sent to a RL if they contain antibodies noted to be labor intensive such as multiple antibodies. Through a 1-year retrospective review of antibodies identified, 423 samples were found to contain a single antibody specificity and thereby testing was performed in-house. Hospital technologist labor/minute (Hosp labor/min) of $0.38, was based on our $23/hour salary. The hospital tech labor was recorded in minutes (Hosp Labor/Min) as timed and documented. Calculations compared reagent cost (Rgt), labor cost and result turn-around- time should these samples be sent to a RL in the future, due to limited staffing.
Results/Findings: Performing a single automated ABID test including 1 phenotyping (pheno) in-house was $34.07; while the cost to send out the same stat sample was $711.42 (Table 1). Based on annual volume, there would be a significant reduction in labor (36%) if all samples went to the RL. However, the cost for ABID would increase annually by $286,520 and extend the result-turn-around four-fold. Conclusions: RL benefit includes phenotype for 15 additional antigens, although our policy only requires phenotype for the antibody identified. The associated cost increase and delayed patient care is neither a financially responsible choice nor in the best interest of the patient. Our findings may be extrapolated for smaller hospitals to perform in-house ABID with an automated instrument to realize cost savings and improved patient care via a decreased turn-around time and possible reduction in an extended hospital stay.
Importance of research: Staffing challenges is a constant concern especially when techs retire or leave the field. This study was based on evaluating the financial and patient impact, if all single antibody samples requiring antibody Identification (ABID) were sent to a reference lab. Comparison included reagent cost, labor cost and result turn-around- time. Even smaller hospitals may determine performing automated in-house ABID might realize cost savings and improved patient care with decreased turn-around time.
