From Beverly Rogers and colleagues: The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

Beverly B. Rogers, James L. Adams, Alexis B. Carter, Francine Uwindatwa, Cynthia B. Brawley, Charles G. Cochran;, Leah N. Bryan, Elizabeth P. Weinzierl, and Sampath Prahalad (2018) The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System. Archives of Pathology & Laboratory Medicine In-Press.

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The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

Beverly B. Rogers, MD; James L. Adams, MS; Alexis B. Carter, MD; Francine Uwindatwa, MBA; Cynthia B. Brawley, MHA; Charles G. Cochran;; Leah N. Bryan, MPH; Elizabeth P. Weinzierl, MD, PhD; Sampath Prahalad, MD, MS

From the Departments of Pathology (Drs Rogers, Carter, and Weinzierl; Mr Adams; and Mss Uwindatwa and Brawley), Pediatrics (Drs Rogers and Prahalad), and Care Transformation (Mr Cochran), Children's Healthcare of Atlanta, Atlanta, Georgia; and the Departments of Pathology (Drs Rogers, Carter, and Weinzierl) and Pediatrics (Drs Rogers and Prahalad; and Ms Bryan), Emory University School of Medicine, Atlanta, Georgia.

Corresponding author: Beverly B. Rogers, MD, Children's Healthcare of Atlanta, 1001 Johnson Ferry Rd NE, Atlanta, GA 30342 (email: beverly.rogers@choa.org).

The authors have no relevant financial interest in the products or companies described in this article.

Context.— Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm.

Objective.— To identify differences when outpatient tests are performed at a Children's Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing.

Design.— Outpatient testing was sent to 3 different laboratories, specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual.

Results.— The median time from phlebotomy to result was 0.7 hours for testing at the children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and resulting for testing performed at commercial labs was approximately $640,000 per year.

Conclusions.— Both tangible monetary costs, plus intangible costs in delay in resulting, occur when the system of laboratory testing is disrupted.