The American Society for Clinical Pathology 2020 Vacancy Survey of Medical Laboratories in the United States

Estimation of Numbers of Testing Personnel and Test Volume in the Clinical Laboratory Improvement Amendments of 1988 Certificate of Accreditation and Certificate of Compliance Laboratories in the United States

CONTEXT.—

Two major categories of laboratories performing nonwaived testing under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) are the Certificate of Accreditation (CoA) and Certificate of Compliance (CoC) laboratories. Accreditation organizations collect more detailed laboratory personnel information than the Centers for Medicare & Medicaid Services (CMS) Quality Improvement and Evaluation System (QIES).

OBJECTIVE.—

To estimate total numbers of testing personnel and testing volumes in CoA and CoC laboratories, by laboratory type and state.

DESIGN.—

We developed a statistical inference method by using the respective correlations between testing personnel counts and test volume by laboratory type.

RESULTS.—

QIES reported 33 033 active CoA and CoC laboratories in July 2021. We estimated testing personnel to be 328 000 (95% CI, 309 000-348 000), which is supported by the count of 318 780 reported by the US Bureau of Labor Statistics. There were twice as many testing personnel in hospital laboratories as in independent laboratories (158 778 versus 74 904, P < .001). Independent laboratories had the highest test volume per person, which was twice as high as physician office laboratories (62 228 versus 30 102, P < .001). Hospital and independent laboratories comprised 34% of all CoA and CoC laboratories but performed the largest portion of testing (81%). Physician office laboratories, accounting for 44% of all CoA and CoC laboratories, performed a comparatively low proportion of total tests (9%).

CONCLUSIONS.—

Numbers of testing personnel vary considerably by laboratory type and across states. These data can provide valuable insight when assessing laboratory workforce training needs and planning for public health emergencies.

Cytotechnology schools: Future outlook

Recent changes in the standard and guidelines governing the education of cytotechnologists herald in a new era of cytology education. The long-discussed move to master level education and name change of the professional to cytologist signifies an alignment with current and projected scope of mid-level diagnostic cytology practice. Cytotechnology programs going forward are charged with implementing curricular changes that prepare practitioners to perform tasks such as computer assisted screening, and cell block interpretation as well as to perform evidence-based research methods. Cytotechnology education programs are sure to face challenges particularly in student recruitment and the hiring of expert faculty. There are however opportunities for programs to develop innovative teaching techniques, recruit from underrepresented groups and collaborate to develop needed curricular resources. The future outlook for cytotechnology programs is that they are at a turning point, poised to educate the next generation of pathology extenders who will continue to be integral members of the patient care team.

Intraoperative margin assessment for basal cell carcinoma with deep learning and histologic tumor mapping to surgical site

Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.

Telecytology rapid onsite evaluation, with real-time communication between cytopathologist, cytotechnologist, and proceduralist, offers better adequacy rates for lymph node, but not thyroid, fine-needle aspirations

INTRODUCTION

Rapid onsite evaluation (ROSE) decreases rates of inadequate fine-needle aspirations (FNAs). Telecytology allows pathologists to perform ROSE without being physically "on site", thereby saving cytopathologists' travel time and allowing them to perform ROSE for multiple institutions. Little research exists comparing telecytology to non-telecytology ROSE for FNA inadequacy rates.

MATERIALS AND METHODS

Using previously obtained quality metrics, we compared inadequacy rates for lymph node and thyroid FNAs with and without ROSE and with non-telecytology ROSE compared with telecytology ROSE. Use of ROSE was determined by the proceduralist. Type of ROSE was location-based, as only certain locations at our institution have telecytology capabilities. Chi-squared testing was used to compare proportions of populations and P value was set to 0.05.

RESULTS

A total of 1168 lymph node and 1177 thyroid FNAs were included in our adequacy analysis. We found any ROSE decreased our inadequacy rate for both lymph node (20.4% to 12.7%, P = 0.002) and thyroid (34.7% to 4.8%, P = 7.4 × 10-18) FNAs. We found telecytology further decreased our inadequacy rate for lymph node (13.8% to 5.9%, P = 0.016), but not thyroid (3.3% to 5.0%, P = 0.34), FNAs.

CONCLUSIONS

At our institution, when using telecytology, slides are read in real time with the cytotechnologist and the proceduralist looking at slides together near the patient bedside, while the cytopathologist is on the phone looking at slides on the computer screen via Dameware. When non-telecytology ROSE is performed, the cytotechnologist evaluates a slide, brings it to the cytopathologist's office and then the cytopathologist calls the proceduralist to discuss the slide. We believe telecytology offers an opportunity for more inclusive communication thereby improving adequacy rates for more complex cases, like lymph nodes, without affecting adequacy rates for cases where assessment of adequacy is less complex, like thyroid. This research supports use of telecytology especially for complex cases.

How do we… direct a transfusion service/blood bank with limited laboratory staff

BACKGROUND

Transfusion services and blood banks in the United States have struggled with staffing shortages for decades. Unfortunately, the COVID-19 pandemic and other factors have exacerbated these challenges to the point of crisis for many. Meanwhile, providing quality patient care continues to demand accurate test results and safe blood products delivered in a timely fashion.

MATERIALS AND METHODS

A group of academic Transfusion Medicine Physicians and a Medical Laboratory Scientist from five academic medical centers in the United States met and discussed the steps we explored and took during the staffing crisis that hit during the pandemic. Our goal was to assist our colleagues and the community by detailing the strategies that helped keep us operational during the most extreme staffing shortage we have experienced to date.

RESULTS AND CONCLUSIONS

We provide both short-term solutions to include hiring temporary and per diem technologists, consolidating testing, and sending out non-time-sensitive testing; and long-term strategies such as recruiting and hiring laboratory assistants, providing retention and referral bonuses, and increasing compensation. The objective is to address the staffing shortage on multiple fronts (e.g., personnel management, testing, and organization) with the objective of not compromising safety, quality, or patient care. The ultimate long-term goal is to advocate for and build a stronger laboratory workforce for tomorrow.

Artificial Intelligence for Clinical Flow Cytometry

In this review, the authors discuss the fundamental principles of machine learning. They explore recent studies and approaches in implementing machine learning into flow cytometry workflows. These applications are promising but not without their shortcomings. Explainability may be the biggest barrier to adoption, as they contain "black boxes" in which a complex network of mathematical processes learns features of data that are not translatable into real language. The authors discuss the current limitations of machine learning models and the possibility that, without a multiinstitutional development process, these applications could have poor generalizability. They also discuss widespread deployment of augmented decision-making.

Update on programs for achieving Specialist in Blood Banking certification in the United States: 2023

A person who has achieved the Specialist in Blood Banking (SBB) certification is a medical laboratory scientist who receives advanced training in blood banking and transfusion medicine and has passed an examination given by the American Society for Clinical Pathology. There are several pathways or "eligibility routes" to qualify for the examination to obtain SBB certification, with the most common route involving enrollment in a Commission on Accreditation of Allied Health Education Programs-accredited SBB program. The goal of this study was to compile information about the current accredited SBB programs in the United States and SBB exam statistics for purposes of assessing changes in the programs and detecting trends in SBB exam takers and pass rates. SBB program coordinators were surveyed about qualitative and quantitative aspects of their programs. Current data, changes over time, and nationally available data were tabulated for comparison. This information may be helpful for all medical laboratory scientists interested in considering further studies and certification in blood banking and transfusion medicine.

Workplace Bullying in Pathology and Laboratory Medicine

OBJECTIVES

The specific aims of the study are to explore the prevalence of workplace bullying and to understand the impact of bullying on individual wellness in order to facilitate the development of future organizational solutions to mitigate workplace incivility.

METHODS

Cross-sectional data were collected via a web-based survey to gather exploratory demographic information and to assess the relationships between intensity of the exposure to the negative acts with laboratory productivity. Associations between laboratories offering resources to employees and their impacts on productivity and professional job fulfillment were also explored.

RESULTS

Results of the survey showed that over two-thirds of laboratorians (68.56%) were classified as victims of workplace bullying, and the perpetrator is most likely a peer of the victim (55.3%). The study revealed the intensity of workplace incivility was positively correlated with the number of sick days taken by the laboratory practitioner (F(2, 217) = 24.245, P < .001). Facilities with a supportive work environment were also associated with a reduction in the number of sick mental days taken (P < .001), a proxy for improved work and health outcomes.

CONCLUSIONS

The results of this study shed light on the prevalence of incivility at the workplace and offer evidence on the importance of providing a supportive work environment toward reducing workplace bullying.

Blood conservation strategies at United States hospitals during the COVID‐19 pandemic: Findings from a multi‐institutional analysis

Background

Due to the coronavirus disease 2019 (COVID‐19) pandemic, the transfusion medicine community has experienced unprecedented blood supply shortages since March 2020. As such, numerous changes to everyday practice have occurred with a specific emphasis on blood conservation. We sought to determine the strategies used to mitigate blood shortages and promote blood conservation during the pandemic.

Methods

An anonymous, 37‐question survey was developed using Research Electronic Data Capture and distributed via e‐mail to transfusion medicine specialists across the US obtained via publicly available databases.

Results

Amongst surveyed [41.1% response rate (51/124 institutions)], 98.0% experienced a product shortage, with the greatest number reporting red blood cell (RBC) shortages (92.0%). This led to 35.3% of institutions altering the composition and/or number of blood product suppliers, including a 100% increase in the number of institutions acquiring blood from organizations that connect hospital transfusion services with blood collection centers (e.g., Blood Buy) compared to before March 2020. Prospective triaging of blood products was the most common blood conservation strategy (68.1%), though 35.4% altered their RBC exchange or transfusion program for patients receiving chronic RBC transfusion/exchange. As a result of these changes, 78.6% of institutions reported that these changes resulted in a reduction in blood product usage, and 38.1% reported a decrease in product wastage.

Conclusions

Most hospitals experienced the effects of the supply shortage, and many of them implemented blood conserving measures. Conservation strategies were associated with decreased blood utilization and waste, and future studies could evaluate whether these changes persist.

The Hidden Crisis in the Times of COVID-19: Critical Shortages of Medical Laboratory Professionals in Clinical Microbiology

The COVID pandemic has put a spotlight on laboratory medicine, showcasing how vital diagnostic testing is for society and the health care system. It has also brought to light and accelerated the critical shortage of trained and experienced laboratory personnel that has been felt for decades. The need for laboratory professionals is expected to grow by 11% between 2020 and 2030, a higher rate of growth than the overall average for all other health care occupations. Here, the background to this workforce shortage is reviewed. Some proposed actions to help address the issue are put forth, including increasing awareness of the medical laboratory science profession along with bolstering training opportunities and awareness of alternate routes to obtaining certification as a medical laboratory scientist. In addition, recent survey data specifically related to the employee shortages in microbiology are presented which demonstrate that 80% of microbiology laboratories have vacant positions and that filling these positions is challenging for a number of reasons, including a lack of qualified applicants.

The Impact of Total Automaton on the Clinical Laboratory Workforce: A Case Study

Background

There has been a significant concern that total automation can decrease the need for laboratory personnel at all levels. The objective of this study was to investigate the impact of total laboratory automation on the clinical laboratory workforce.

Methods

A one-year data including the demographical features of laboratory workforce and technical productivity of laboratory tests were provided by two medical laboratory departments of similar profile and different equipment setup; one adopting a total automation system and the other utilizing discrete analysis system. The technical productivities of the two laboratories were compared and statistically tested.

Results

A similar technical productivity per single laboratory worker was noted in the hematology section in each of the two sites with no significant difference (average odd radio = 0.9, p = 0.79). However, with total automation, the number of tests performed per single worker has increased to an average of 1.4 and 3.7 times with total automation in the clinical chemistry and serology sections, respectively (p ≤ 0.001).

Conclusion

Total laboratory automation improves the productivity of the laboratory, leading to a decreased laboratory workforce. The laboratory workload has increased steadily therefore, the existing laboratory workforce, in the absence of automation, could not have been able to maintain the current volume of service. Adoption of automation reduces repetitive manual labor, thereby allowing the redefinition of the job roles of the laboratory workforce. TLA is ideal for laboratories that suffer from workforce shortages or managing high volume testing with less staff.