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Huq Ronny FM, Sherpa T, Choesang T, Ahmad S. Looking into the Laboratory Staffing Issues that Affected Ambulatory Care Clinical Laboratory Operations during the COVID-19 Pandemic. Lab Med 2022:6772484. [PMID: 36282479 PMCID: PMC9620378 DOI: 10.1093/labmed/lmac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Our New York City Municipal Public Health System-based multisite ambulatory and school-based Gotham Health clinics offer waived point-of-care tests and provider-performed microscopy to the local communities. Our Gotham Health laboratory service conducts system-wide centralized implementation, monitoring, and oversight of the POCT operations. Laboratory staffing has always been an issue for us as there is a decades-long shortage of laboratory staff, primarily licensed medical technologists and technicians, in New York, like many other states. Our clinical laboratory operations team struggled to hire qualified people even before the COVID-19 pandemic onset. It has faced more significant challenges with the emergence of SARS-CoV-2 pandemic cases in New York City and across the country since mid-March 2020. METHODS As staffing continues to be a struggle, it directly affected the POCT performances and a system-wide reduction in the test numbers during the pandemic. We investigated to identify the factors that made staffing more challenging. RESULTS The impact on our POCT started after laboratory staff relocated to the acute care hospital laboratories to provide testing support during the pandemic's peak. That caused significant delays or complete cessation of POCT operations in the clinics due to a lack of oversight support. We also experienced the risk of more vacated positions where staff already feel overworked, overwhelmed, and emotionally drained, causing professional burnout. The significant challenges identified are noncompliance with vaccine mandates resulting in job dismissal and voluntary resignations in exchange for higher-paying laboratories. Finally, the other challenges identified were frequent sick calls due to mental fatigue, retirement of seasoned staff, and inability to attract qualified technologists to meet the demands of increasing test-ordering patterns. CONCLUSIONS Determining the factors that culminated in the staffing issues becoming more challenging during the COVID-19 pandemic in our ambulatory care clinic laboratory operations will help us in future crisis planning and mitigation.
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Affiliation(s)
| | - Tshering Sherpa
- Laboratory Services, Gotham Health New York City Health and Hospitals Corporation, New York, NY, USA
| | - Tenzin Choesang
- Laboratory Services, Gotham Health New York City Health and Hospitals Corporation, New York, NY, USA
| | - Shana Ahmad
- Laboratory Services, Gouverneur DTC, Gotham Health New York City Health and Hospitals Corporation, New York, NY, USA
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Sherpa T, Choesang T, Ahmad S, Huq Ronny FM. Challenges of Conducting Point-Of-Care Testing Operations During The COVID-19 Pandemic In The Municipal Public Health System Based Ambulatory Care And School Health Clinics In New York City. Am J Clin Pathol 2021. [PMCID: PMC8574507 DOI: 10.1093/ajcp/aqab191.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction/Objective Our New York City Municipal Public Health System based multisite ambulatory clinics and school-based clinics, offer various waived POCT (point of care tests) and provider performed microscopy (PPM). To ensure standardization and quality of POC testing across our health system, our laboratory service conducts system wide centralized implementation, monitoring and oversight of the POCT operations in regard to regulatory compliance, test performance, quality control and training. With the emergence of the COVID-19 infection in the New York City, like all other clinical laboratories, our ambulatory care clinics encountered numerous hurdles and challenges. Here we elaborated the issues that we encountered and how we managed to overcome during the COVID-19 Pandemic. Methods/Case Report We categorized the challenges that affected our managers as well as field level laboratory operations and have devised a plane to deal with COVID-19 related predicaments. Results (if a Case Study enter NA) Among the staffing issues, staff relocation to the acute care hospital laboratories during the peak of the pandemic caused massive delay or cessation of POCT operations in our ambulatory care clinics. Manual result entry, for COVID-19 testing, at the patient portals due to lack of interface with the reference testing labs, staff shortages and frequent absences due to illness and fatigue were primary issues noted at technical level. Furthermore, there were notable delays in the processing of paper works and new staff recruitments. The lack of and significant delays in the critical laboratory supplies was another major management issue. Conclusion Given the vastness and complexity of our multisite ambulatory care network, the COVID -19 pandemic impacted our ambulatory care clinic POCT operation in a very challenging way. However, our timeliness, coordinated interventions, close communications and initiatives handled the obstacles that arose very effectively to the ensure quality of POC testing, patient safety and quality care across our health system.
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Affiliation(s)
- T Sherpa
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
| | - T Choesang
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
| | - S Ahmad
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
| | - F M Huq Ronny
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
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Sherpa T, Choesang T, Ahmad S, Huq Ronny FM. Ensuring Standardization, Quality Management And Improvement Of Point-Of-Care Testing In The Municipal Public Health System Based Ambulatory Care And School Health Clinics In New York City. Am J Clin Pathol 2021. [PMCID: PMC8574504 DOI: 10.1093/ajcp/aqab191.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction/Objective Operated under different acute care hospital clinical laboratory limited-service laboratory (LSL) licenses, our New York City five borough spanning multisite ambulatory clinics and school-based clinics have been offering various waived point-of-care tests (POCTs) and provider-performed microscopy (PPM) to the local communities. A wide range of variability existed among the clinics concerning regulatory compliance, test performance, quality control and training. To ensure standardization and quality of POCT across the health system, our laboratory service adopted and implemented a plan for systemwide LSL transfer from the acute care hospitals to ambulatory care laboratory service for centralized implementation, monitoring, and oversight of the POCT operations. Methods/Case Report Having over 60 clinics, while transferring the LSLs, we chose multi-site license with ten or more sites on each license and by phase transfer from NYSDOH. Since the commencement of the transfer, system wide our qualified laboratory personnel have been updating and providing standard operating procedures (SOP), performing quality assurance and validation of new tests/devices, providing competency assessments and helping clinical staffs maintain compliance with state and other regulatory agencies. Results (if a Case Study enter NA) After the final phase of the transfer and POCT standardization implementation in 63 clinics, currently the clinical staffs performing POCT, get expeditious training and troubleshooting in more timely manner and the providers get the results of the ordered POCTs much faster and more efficiently and overall the quality metrics get improved markedly, indicated by internal audit team. Conclusion Even though Implementation of the planned POCT standardization was initially challenging due to the vastness and complexity of our multisite ambulatory care network and later confounded by the COVID -19 pandemic effect but eventually, it helped improve patient care delivery significantly and very effectively. Expectedly, our planned transfer implementation provided standardization and ensured improved quality of POC testing across our health system.
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Affiliation(s)
- T Sherpa
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
| | - T Choesang
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
| | - S Ahmad
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
| | - F M Huq Ronny
- Laboratory Service, Gotham Health NYCHHC, New York, New York, UNITED STATES
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Feola M, Zamperone A, Moskop D, Chen H, Casu C, Lama D, Di Martino J, Djedaini M, Papa L, Martinez MR, Choesang T, Bravo-Cordero JJ, MacKay M, Zumbo P, Brinkman N, Abrams CS, Rivella S, Hattangadi S, Mason CE, Hoffman R, Ji P, Follenzi A, Ginzburg YZ. Pleckstrin-2 is essential for erythropoiesis in β-thalassemic mice, reducing apoptosis and enhancing enucleation. Commun Biol 2021; 4:517. [PMID: 33941818 PMCID: PMC8093212 DOI: 10.1038/s42003-021-02046-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/23/2021] [Indexed: 02/03/2023] Open
Abstract
Erythropoiesis involves complex interrelated molecular signals influencing cell survival, differentiation, and enucleation. Diseases associated with ineffective erythropoiesis, such as β-thalassemias, exhibit erythroid expansion and defective enucleation. Clear mechanistic determinants of what make erythropoiesis effective are lacking. We previously demonstrated that exogenous transferrin ameliorates ineffective erythropoiesis in β-thalassemic mice. In the current work, we utilize transferrin treatment to elucidate a molecular signature of ineffective erythropoiesis in β-thalassemia. We hypothesize that compensatory mechanisms are required in β-thalassemic erythropoiesis to prevent apoptosis and enhance enucleation. We identify pleckstrin-2-a STAT5-dependent lipid binding protein downstream of erythropoietin-as an important regulatory node. We demonstrate that partial loss of pleckstrin-2 leads to worsening ineffective erythropoiesis and pleckstrin-2 knockout leads to embryonic lethality in β-thalassemic mice. In addition, the membrane-associated active form of pleckstrin-2 occurs at an earlier stage during β-thalassemic erythropoiesis. Furthermore, membrane-associated activated pleckstrin-2 decreases cofilin mitochondrial localization in β-thalassemic erythroblasts and pleckstrin-2 knockdown in vitro induces cofilin-mediated apoptosis in β-thalassemic erythroblasts. Lastly, pleckstrin-2 enhances enucleation by interacting with and activating RacGTPases in β-thalassemic erythroblasts. This data elucidates the important compensatory role of pleckstrin-2 in β-thalassemia and provides support for the development of targeted therapeutics in diseases of ineffective erythropoiesis.
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Affiliation(s)
- Maria Feola
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- University of Piemonte Orientale, Amedeo Avogadro, Novara, Italy
| | - Andrea Zamperone
- Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Daniel Moskop
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Huiyong Chen
- Erythropoiesis Laboratory, New York Blood Center, New York, NY, USA
- Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Carla Casu
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dechen Lama
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie Di Martino
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mansour Djedaini
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luena Papa
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc Ruiz Martinez
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tenzin Choesang
- Erythropoiesis Laboratory, New York Blood Center, New York, NY, USA
| | | | | | - Paul Zumbo
- Weill Cornell Medical College, New York, NY, USA
| | | | - Charles S Abrams
- Perelman Center for Advanced Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peng Ji
- Northwestern University, Chicago, IL, USA
| | - Antonia Follenzi
- University of Piemonte Orientale, Amedeo Avogadro, Novara, Italy
| | - Yelena Z Ginzburg
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Chen H, Choesang T, Li H, Sun S, Pham P, Bao W, Feola M, Westerman M, Li G, Follenzi A, Blanc L, Rivella S, Fleming RE, Ginzburg YZ. Increased hepcidin in transferrin-treated thalassemic mice correlates with increased liver BMP2 expression and decreased hepatocyte ERK activation. Haematologica 2015; 101:297-308. [PMID: 26635037 DOI: 10.3324/haematol.2015.127902] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 12/01/2015] [Indexed: 12/13/2022] Open
Abstract
Iron overload results in significant morbidity and mortality in β-thalassemic patients. Insufficient hepcidin is implicated in parenchymal iron overload in β-thalassemia and approaches to increase hepcidin have therapeutic potential. We have previously shown that exogenous apo-transferrin markedly ameliorates ineffective erythropoiesis and increases hepcidin expression in Hbb(th1/th1) (thalassemic) mice. We utilize in vivo and in vitro systems to investigate effects of exogenous apo-transferrin on Smad and ERK1/2 signaling, pathways that participate in hepcidin regulation. Our results demonstrate that apo-transferrin increases hepcidin expression in vivo despite decreased circulating and parenchymal iron concentrations and unchanged liver Bmp6 mRNA expression in thalassemic mice. Hepatocytes from apo-transferrin-treated mice demonstrate decreased ERK1/2 pathway and increased serum BMP2 concentration and hepatocyte BMP2 expression. Furthermore, hepatocyte ERK1/2 phosphorylation is enhanced by neutralizing anti-BMP2/4 antibodies and suppressed in vitro in a dose-dependent manner by BMP2, resulting in converse effects on hepcidin expression, and hepatocytes treated with MEK/ERK1/2 inhibitor U0126 in combination with BMP2 exhibit an additive increase in hepcidin expression. Lastly, bone marrow erythroferrone expression is normalized in apo-transferrin treated thalassemic mice but increased in apo-transferrin injected wild-type mice. These findings suggest that increased hepcidin expression after exogenous apo-transferrin is in part independent of erythroferrone and support a model in which apo-transferrin treatment in thalassemic mice increases BMP2 expression in the liver and other organs, decreases hepatocellular ERK1/2 activation, and increases nuclear Smad to increase hepcidin expression in hepatocytes.
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Affiliation(s)
- Huiyong Chen
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Tenzin Choesang
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Huihui Li
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA Central South University, Changsha, PR China
| | - Shuming Sun
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Petra Pham
- Flow Cytometry Core Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Weili Bao
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Maria Feola
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA University of Piemonte Orientale, Amedeo Avogadro, Novara, Italy
| | | | - Guiyuan Li
- Central South University, Changsha, PR China
| | - Antonia Follenzi
- University of Piemonte Orientale, Amedeo Avogadro, Novara, Italy
| | - Lionel Blanc
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
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