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A test costing method for improved laboratory management
POSTER ABSTRACTS
should be assayed by a less costly less specific immunoinhibition assay (Hitachi 717) or by a more costly more specific immunoenzymatic assay (Tandem ICON QSR). Key elements of the algorithm are: 1. CK, AST and ALT are available on demand. 2. CK-MB (Hitachi 717) is available only when CK > reference range or ACK >50 and CK-MB not previously positive for MI (>35 U/L + >5%) within last 48 h. 3. CK-MB (Tandem ICON QSR) is available only when a t y p i c a l - C K or CK-BB interference of CK-MB (Hitachi 717) assay is suspected. That is when CK-MB (Hitachi 717/CK >24% or >18% plus CK/AST > 12 and AST/ALT <2 and CK-MB not previously positive for MI (>7 ng/ml + >1.5%) within last 48 h. This approach has been modeled and compared to other testing strategies on a patient database of about 3000 specimens submitted to the lab for investigation of MI. It was found to outperform all other alternative schemes in that it achieved highest possible sensitivity and specificity for a final diagnosis of MI at lowest cost.
INTRODUCTION OF AN INTEGRATED MULTIPLE-INSTRUMENT LC SYSTEM Tesanovic, M., Department of Laboratory Medicine, Foothills Provincial Hospital, Calgary, Alberta, T2N 2T9 As a result of health care budget cuts, resources in hospital laboratories are limited, alternatives for efficient operation are constantly investigated. Since High Performance Liquid Chromatography (HPLC) is an important service component in our Analytical Laboratory, in the process of optimization, we have introduced an Integrated Multipurpose Liquid Chromatography System (IMLCS). A long-term strategic plan of instrument selection and purchase, enabled us to integrate existing HPLC equipments, detectors, integrators and chemstations of different generations and makes, into an IMLCS, with three functioning injection sites. The system can also be operated as three independent HPLC units if needed, without any change in communication map. The 3D Chemstation (DOS Series) simultaneously operates two on-line instruments and can analyze imported data on two channels in the background. The integrated system is equipped with diode-array, fluorescence and electrochemical detectors, analog/digital converter, printers and a plotter. Capabilities include temperature controlled sample handling, automated voltagramms, automated column switch, on-line temperature controlled derivatization. Data processing is optimized at the central Chemstation. Presentation can vary from simple to extensive data evaluation. In conclusion, we have found the integrated LC system an excellent approach to address almost all analytical challenges requiring HPLC - one operator can control two on-line
CLINICAL BIOCHEMISTRY,VOLUME 27, JUNE 1994
HPLC's and process data in the background at the same time. Uniform data presentation can serve as a final step to direct on-line reporting. A TEST COSTING METHOD FOR IMPROVED LABORATORY MANAGEMENT Arnold, P., and Tan~e. S., Department of Biochemistry, The Montreal Children's Hospital, McGill University, 2300 Tupper, Montreal, Quebec H3H 1P3, Canada Accurate test costs are essential for budgetary planning, test pricing to assure cost recovery for referred-in tests, and cost-benefit/cost-effectiveness analyses. Because the Canadian Laboratory Workload Measurement System (WMS) method is often misleading in costing tests, we describe an alternative method, the AVERAGE TEST COST (ATC). The method is based on financial and test volume data available in any laboratory. All direct and indirect supply and labour costs are assigned to test groups which are defined by similar requirements for labour, instrumentation, and supplies. An ATC spreadsheet, using Lotus or Quattro Pro, is developed which provides an average laboratory test cost within each test group, yet allows the selection of one or more components (e.g., direct supply costs only) depending on the desired application. Comparing the ATC and WMS method, there is no consistent relationship. This is not surprising given that the WMS uses technologist time as the variable to calculate the test costs, thereby excluding the supply and indirect labour costs which may vary considerably from one test to another. Applications of the method in our laboratory have included (a) budgetary planning for a new therapeutic modality, extracorporeal membrane oxygenation (ECMO), (b) pricing of referred-in tests to assure recovery of actual costs, (c) a cost-benefit analysis of alternative management strategies in diabetic children, and (d) targetting of tests for utilization management mmatlves. The ATC method can be developed in any laboratory, is "user friendly," and provides an improved estimate of laboratory test costs. PROGRESSIVE TESTING AS AN APPROACH TO REDUCE LABORATORY UTILIZATION Mock, T., Irvine, T., LeGatt, D., and Yatscoff R., Department of L a b o r a t o r y Medicine and Pathology, University of Alberta Hospitals, 8440 -112 Street, Edmonton, Alberta, T6G 2B7, Canada With the increasing financial constraints confronting laboratories, approaches must be developed to reduce laboratory utilization without compromising diagnostic capabilities. One such approach is through progressive testing. This
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should be assayed by a less costly less specific immunoinhibition assay (Hitachi 717) or by a more costly more specific immunoenzymatic assay (Tandem ICON QSR). Key elements of the algorithm are: 1. CK, AST and ALT are available on demand. 2. CK-MB (Hitachi 717) is available only when CK > reference range or ACK >50 and CK-MB not previously positive for MI (>35 U/L + >5%) within last 48 h. 3. CK-MB (Tandem ICON QSR) is available only when a t y p i c a l - C K or CK-BB interference of CK-MB (Hitachi 717) assay is suspected. That is when CK-MB (Hitachi 717/CK >24% or >18% plus CK/AST > 12 and AST/ALT <2 and CK-MB not previously positive for MI (>7 ng/ml + >1.5%) within last 48 h. This approach has been modeled and compared to other testing strategies on a patient database of about 3000 specimens submitted to the lab for investigation of MI. It was found to outperform all other alternative schemes in that it achieved highest possible sensitivity and specificity for a final diagnosis of MI at lowest cost.
INTRODUCTION OF AN INTEGRATED MULTIPLE-INSTRUMENT LC SYSTEM Tesanovic, M., Department of Laboratory Medicine, Foothills Provincial Hospital, Calgary, Alberta, T2N 2T9 As a result of health care budget cuts, resources in hospital laboratories are limited, alternatives for efficient operation are constantly investigated. Since High Performance Liquid Chromatography (HPLC) is an important service component in our Analytical Laboratory, in the process of optimization, we have introduced an Integrated Multipurpose Liquid Chromatography System (IMLCS). A long-term strategic plan of instrument selection and purchase, enabled us to integrate existing HPLC equipments, detectors, integrators and chemstations of different generations and makes, into an IMLCS, with three functioning injection sites. The system can also be operated as three independent HPLC units if needed, without any change in communication map. The 3D Chemstation (DOS Series) simultaneously operates two on-line instruments and can analyze imported data on two channels in the background. The integrated system is equipped with diode-array, fluorescence and electrochemical detectors, analog/digital converter, printers and a plotter. Capabilities include temperature controlled sample handling, automated voltagramms, automated column switch, on-line temperature controlled derivatization. Data processing is optimized at the central Chemstation. Presentation can vary from simple to extensive data evaluation. In conclusion, we have found the integrated LC system an excellent approach to address almost all analytical challenges requiring HPLC - one operator can control two on-line
CLINICAL BIOCHEMISTRY,VOLUME 27, JUNE 1994
HPLC's and process data in the background at the same time. Uniform data presentation can serve as a final step to direct on-line reporting. A TEST COSTING METHOD FOR IMPROVED LABORATORY MANAGEMENT Arnold, P., and Tan~e. S., Department of Biochemistry, The Montreal Children's Hospital, McGill University, 2300 Tupper, Montreal, Quebec H3H 1P3, Canada Accurate test costs are essential for budgetary planning, test pricing to assure cost recovery for referred-in tests, and cost-benefit/cost-effectiveness analyses. Because the Canadian Laboratory Workload Measurement System (WMS) method is often misleading in costing tests, we describe an alternative method, the AVERAGE TEST COST (ATC). The method is based on financial and test volume data available in any laboratory. All direct and indirect supply and labour costs are assigned to test groups which are defined by similar requirements for labour, instrumentation, and supplies. An ATC spreadsheet, using Lotus or Quattro Pro, is developed which provides an average laboratory test cost within each test group, yet allows the selection of one or more components (e.g., direct supply costs only) depending on the desired application. Comparing the ATC and WMS method, there is no consistent relationship. This is not surprising given that the WMS uses technologist time as the variable to calculate the test costs, thereby excluding the supply and indirect labour costs which may vary considerably from one test to another. Applications of the method in our laboratory have included (a) budgetary planning for a new therapeutic modality, extracorporeal membrane oxygenation (ECMO), (b) pricing of referred-in tests to assure recovery of actual costs, (c) a cost-benefit analysis of alternative management strategies in diabetic children, and (d) targetting of tests for utilization management mmatlves. The ATC method can be developed in any laboratory, is "user friendly," and provides an improved estimate of laboratory test costs. PROGRESSIVE TESTING AS AN APPROACH TO REDUCE LABORATORY UTILIZATION Mock, T., Irvine, T., LeGatt, D., and Yatscoff R., Department of L a b o r a t o r y Medicine and Pathology, University of Alberta Hospitals, 8440 -112 Street, Edmonton, Alberta, T6G 2B7, Canada With the increasing financial constraints confronting laboratories, approaches must be developed to reduce laboratory utilization without compromising diagnostic capabilities. One such approach is through progressive testing. This
205