NRMC lab tests: moving from days to 2 hours
The wait time for three types of lab tests at Nevada Regional Medical Center is about to drop dramatically.
At present, results for a respiratory swab, a stool sample or a test for meningitis and encephalitis takes from three to five days. In about a month, NRMC will have their new system up and running.
"From sample to result should be two hours," said laboratory manager, Bobby Daugherty.
That significant time reduction will be due to the lease of a system consisting of two sample analysis machines connected to a computer loaded with special software and a printer.
The system is called FilmArray and is manufactured by BioFire, a subsidiary of a French medical equipment company.
"The present type of testing is a microbiological culture, where we literally have to grow out the organism and then perform further tests and examine it under a microscope," explained Daugherty.
The new system utilizes what is called a polymerase chain reaction technique, which duplicates trace amounts of DNA in the sample and compares them with the unique DNA patterns of bacteria, viruses and parasites on file in the computer software.
The respiratory panel can detect three bacterial and 17 viral infections. The gastrointestinal panel detects five kinds of viruses, four parasites and 13 types of bacteria. The cerebrospinal panel is set to detect one type of yeast, six types of bacteria and seven varieties of viruses.
Last November, NRMC's board of directors reviewed a presentation by the lab manager weighing the advantages and costs. Daugherty's volume and cost analysis reviewed the range of tests performed by the lab as well as costs and reimbursement rates.
While board members learned of the wide range of tests performed by the hospital's lab, statistics clearly indicated respiratory, gastro-intestinal and spinal fluid analysis were the three, which predominated.
The board was uneasy about leasing even one such machine -- let alone two -- due to cost until Daugherty shared the Medicare reimbursement rates.
Using previous year's statistics, Daugherty showed the lab had performed 198 tests for Clostridium difficile -- commonly called C. diff --, which releases toxins producing a form of colitis.
Reimbursement by Medicare for the conventional test method is $47.50 per test while payment under the new system is $567.75.
In 2015, the lab analyzed 238 nasal swabs -- testing for influenza -- at a conventional method reimbursement rate of $129 versus $711.15 under the new system.
Despite the cost of leasing the machine with a warranty and the steep cost of supplies the final numbers changed the board's attitude from why would we even consider such a purchase to why would we not.
"I explained to the board the high reimbursement rates for PCR test systems is a way for CMS [Center for Medicare and Medicaid Services] to get labs to switch over to this new system," said Daugherty. "But in a few years, when they drop those rates, we will still be way ahead."
CMS is encouraging labs to convert to a PCR test system as a way to tackle what is called antibiotic stewardship. The United States is facing an increasingly serious problem of drug resistant bacteria due to inappropriate use of antibiotics.
"I and my own kids were sick last week and while what we had turned out to be viral, as a dad, I would never want to hear a doctor tell me they can't kill the bacterial infection my kids have," said Daugherty.
The lab manager went on say that he understands how, when a child is sick the mom will make it clear she wants the doctor to do something quickly. Daugherty said a physician might go ahead and prescribe an antibiotic although more often than not, the cause will turn out to be viral and not bacterial.
Other benefits cited by the lab manager for the new system include decreasing length of stay and amount of readmissions, increasing patient safety as well as provides adherence to the Center for Disease Control's guidelines on flu testing.
"For our Emergency Department, I believe our new system will literally save lives," said Daugherty.
Meningitis and encephalitis are serious conditions demanding swift treatment.
Said Daugherty, "If a patient is in the ED and the doctors suspects this, we can get definitive results in two hours which means treatment begins that much sooner which leads to better outcomes."
NRMC's lab is leasing two machines and currently they are going through validation controls to ensure they are calibrated correctly, being tested to ensure each can pick up a single pathogen and pick out a particular bacteria or virus from a sample which commonly contains multiple varieties.
In addition, there will be the ordering of supplies and training for the staff, which consists of two lab assistants and eight technologists.
Daugherty reminisced about his training in medical technology at Wichita State.
"Part of my clinical work included a lab using the PCR system," said Daugherty. "Back then it took a huge sterile room and elaborate handling procedures but now we've got two units, a computer and printer which together, don't even take up an entire desk."
Mentioning that the nearest facility with such capabilities is Parsons, Kansas and St. Luke's in Kansas City, Daugherty related a marketing idea he has.
"Once we're up and running, I hope to market our fast turn around time to area hospitals such as in Fort Scott along with Bates, Cedar and Barton Counties," said Daugherty. "They'd get significantly faster results, earn the higher reimbursement rate and we'd increase our volume."
The most common tests performed by the lab at NRMC are a complete blood count, glucose and basic/complete metabolic panels.
Thinking of other tests Daugherty said, "While our present volumes don't yet justify it, the next one we'd like to get would test for sepsis, more commonly known as blood poisoning."
While that may be off in the future, in the near term, the lab at NRMC will be close to state of the art in three key areas.